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| Year : 1993 | Volume
: 39
| Issue : 1 | Page : 29-30 |
Enhancement of colposcopic image by sulphosalicylic acid.
PH Khilnani, SV Parulekar
Dept of Obstetrics and Gynaecology, KEM Hospital and Seth GS Medical College, Parel, Bombay, Maharashtra.
Correspondence Address:
P H Khilnani
Dept of Obstetrics and Gynaecology, KEM Hospital and Seth GS Medical College, Parel, Bombay, Maharashtra.
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 0008295142 
Acetic acid is used conventionally for enhancement of the colposcopic image. We used sulphosalicylic acid instead of acetic acid in 50 normal cases. The normal appearance was enhanced in all cases. The image was also enhanced in 70% cases of cervical intraepithelial neoplasia and 90% cases of cervical condyloma accuminata. The image was not inferior to that with acetic acid in any of the cases.
Keywords: Acetic Acid, Acetic Acids, diagnostic use,Cervical Intraepithelial Neoplasia, diagnosis,Cervix Neoplasms, diagnosis,Cervix Uteri, pathology,Colposcopy, methods,Female, Human, Salicylic Acids, diagnostic use,
How to cite this article:
Khilnani P H, Parulekar S V. Enhancement of colposcopic image by sulphosalicylic acid. J Postgrad Med 1993;39:29-30 |
Acetic acid (2 to 3%) is conventionally applied to the uterine cervix during colposcopy. It precipitates protein and helps in removal of cervical mucus. It also penetrates between the cervical epithelial cells in cases of cervical intraelpithelial neoplasia and makes it appear white during colposeopy[1]. But it does not help in correct diagnosis in all the cases as is evident from the fact that there is sometimes disparity in the diagnosis of exfoliative cytology, colposcopy and cervical biopsy. We decided to replace acetic acid with sulphosalicylic acid in the procedure to study its effect on the colposcopic image.
Between October 1990 and December 1992, we evaluated 50 normal cases and 10 cases each of histopathologically proven cervical intraepithelial neoplasia and cervical condyloma accuminata colposcopically. We studied first the effect of application of 3% acetic acid and then of 2% sulphosalicylic acid, after the effect of the acetic acid had worn off, and repeated the procedure with only sulphosalicylic acid after a week. The colposcopic images of the three examinations were compared. The points noted were colour and clarity of the epithelium, both squamous and columnar; and the details of the transformation zone, normal or abnormal. Colposcopy was done in all the cases using direct light from the light source, as well as light passed through red and green filters. Schiller's iodine was applied to the cervix at the end of the procedure and then cervical biopsy was obtained from appropriate areas, to confirm the diagnosis made from exfoliative cytology and colposcopy. The colposcopy was repeated after a week to assess persistence of the effect or any adverse effects.
The colposcopic image after application of acetic acid was enhanced by 2% sulphosalicylic acid applied after the effect of the former had worn off in 50 (100%) of normal cases, 7 (70%) cases of cervical intraepithelial neoplasia and 9 (90%) cases of cervical condyloma accuminata. The results were similar when sulphosalicylic acid aided colposcopy was done after one week. In no case was the image inferior to that produced by the application of acetic acid alone. The acetowhite epithelium became whiter after the application of sulphosalicylic acid in cases of abnormal transformation zone. Punctation, mosaic and abnormal vasculature were better seen in the cases, which had an enhancement of the image with sulphosalicylic acid. The image was enhanced by sulphosalicylic acid soon after the use of acetic acid and after a week in 9 (90%) cases of condyloma accuminata, while in 1 (10%) case there was no change.
The diagnosis was confirmed in all cases of cervical intraepithelial neoplasia and condyloma accuminata with the use of histopathology.
None of the patients had any local discomfort or any adverse effects due to the use of sulphosalicylic acid. The cervical changes were reversible, and were found to be absent at the time of the colposcopy done after a week.
Simple magnification of the cervix for inspection is inadequate for early detection of cervical abnormalities like intraepithelial neoplasia and condyloma accuminata. Various agents have been used so far to enhance the colposcopic image of the cervix, such as acetic acid, 70% alcohol, salicylic alcohol, and metacresol sulphonic acid[2],[3]. We have used sulphosalicylic acid for this purpose for the first time in the world literature. It is a biochemical reagent used for testing for proteins in urine by a precipitiation reaction[4]. It is biologically safe and noncarcinogenic[4]. The colposcopic visualization of the cervix is made difficult by the presence of cervical mucus. Sulphosalicylic acid in a concentration of 2% precipitated the mucus well and helped in its removal. It also enhanced the image of the cervix, both independently and after the initial application of 3% acetic acid, probably by diffusion between epithelial cells and precipitating intercellular proteins. The changes produced were totally reversible, as was discovered at follow up examinations done after 2 weeks. Such enhancement was independent of prior application of acetic acid. It helps identification of the normal epithelia with 100% accuracy, thus differentiating between the normal and abnormal. This is useful in borderline cases. Its accuracy in diagnosis was better than that of acetic acid alone. Thus it is a better agent for colposcopy. It is possible that the condylomatous lesions bind sulphosalicylic acid and hence are enhanced better.
The results of the present study indicate that sulphosalicylic acid can be used alone, making application of acetic acid unnecessary. However, we currently use 2% sulphosalicylic acid after application of 3% acetic acid routinely during all colposcopies. This is to collect more data before abandoning the use of acetic acid. Since sulphosalicylic acid induced changes are reversible and its use is not associated with local discomfort, in the long run this agent may be used alone with high efficacy and safety.
We thank the Dean of Seth GS Medical College and King Edward Memorial Hospital for allowing us to publish hospital data.
| :: References | |  |
| 1. |
Hinselman H, Crisp WE, Craine BL. Colposcopy in diagnosis of cervical lesions. Am J Obstet Gynaecol 1925; 162:1491-1495.  |
| 2. | Wespi HJ. Enhancement of the colposcopic image of uterine cervix by salicylic alcohol and metacresol sulphonic acid. In: Burke L Ed. Colposcopy: Text and Atlas, 1st ed. New York: Appleton and Lange; 1991, pp 69-70. |
| 3. | Paruiekar SV, Khilnani PH. Enhancement of colposcopic image with salicylic alcohol and 70% alcohol. J Obstet Gynaecol India 1992; 42:83-85. |
| 4. | Lynch MJ. Medical Laboratory Technology, 1st ed. Philadelphia, London: WB Saunders; 1964, pp 50-51.
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