Efficacy of the swede score in optimizing triage of visual inspection with acetic acid positive women: cross-sectional evidence from Bangladesh.

BACKGROUND

Conventional screening methods for cervical cancer, such as 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.

METHODS

This cross-sectional study was conducted in the Department of Obstetrics and Gynecology at a tertiary-level hospital in Bangladesh from October 2023 to July 2024. A total of 60 VIA-positive women meeting the selection criteria were consecutively enrolled after providing 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 using Stata (version 17).

RESULTS

The 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).

CONCLUSION

The 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.