Efficacy of the Swede Score in Optimizing Triage of Visual Inspection with Acetic Acid Positive Women

BackgroundConventional screening methods for cervical cancer like visual inspection with acetic acid (VIA) have limited specificity. The Swede score, a structured colposcopic scoring system, may improve detection and triage of cervical intraepithelial neoplasia (CIN) in VIA-positive women. MethodsThis cross-sectional study was conducted at the Department of Obstetrics and Gynaecology, Sir Salimullah Medical College, Mitford Hospital, from August 2022 to July 2023. A total of 60 VIA-positive women matching the selection criteria were consecutively enrolled after receiving informed consent. Socio-demographic information and detailed medical history were recorded. All participants underwent colposcopic assessment using the Swede score, followed by colposcopy-guided biopsy. Data were analyzed by Stata (v.17). ResultsThe mean age was 41.7{+/-}8.1 years, with 41.7% aged 40-49 and 48.3% having below-secondary education. Chronic cervicitis was found in 50%, while 30% had CIN1 and 18.3% had CIN2+. The mean Swede score was 5.3{+/-}2.0. Notably, 96.6% of women with abnormal histopathology had Swede scores of 5-10, while 61.3% of those with normal histology scored 0-4. A Swede score cut-off of 6 demonstrated high sensitivity (82.8%) and specificity (96.8%) for CIN1+ (PPV 96.0%, NPV 85.7%). For CIN2+, a cut-off of 7 achieved perfect sensitivity (100%) and high specificity (85.7%), with an NPV of 100%. Multivariate analysis showed that each unit increase in Swede score increased the risk of CIN by 39-fold (AOR: 39.14, 95% CI: 2.33-658.33). ConclusionThe Swede score is a reliable tool for detecting CIN among VIA-positive women, supporting its use for targeted biopsies and "see-and-treat" strategies in low-resource settings.