Prevalence of high-grade squamous intraepithelial neoplasia (HiSIL) in symptomatic women referred to the colposcopy clinic with negative cytology

Objective We have evaluated patients who were referred to the colposcopy clinic with postcoital and/or intermenstrual bleeding and suspicious looking cervix with normal smear tests (negative cytology) mainly to establish the incidence of underlying high-grade squamous intraepithelial neoplasia in these groups and also to look at our intervention rate. Design Retrospective study. Setting Colposcopy clinic in a District General Hospital in the United Kingdom. Population A total of 134 patients out of 812 new referrals to our colposcopy clinic during the study period were due to clinical indications only. Results Main indication for referral with negative cytology was post coital bleeding (47.8%). The main causes of postcoital and intermenstrual bleeding were cervical ectropions and polyps. The incidence high-grade squamous intraepithelial neoplasia (HiSIL) was 2.2% out of all the patients, which was determined after 66 biopsies. Conclusion In the majority of cases the pathology is benign. However the underlying prevalence of high-grade cervical disease in symptomatic women with normal smears necessitates colposcopy in selected cases. Prior assessment in the gynaecology clinic, to rule out common pathology like polyps and ectropions would reduce patient anxiety and inappropriate referrals to the clinic.