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Atlas of colposcopy – principles and practice


Calculating the Swede score  

After the findings of colposcopy are documented according to the IFCPC nomenclature, the Swede score should be calculated. The score takes into consideration five characteristics. A score of 0, 1, or 2 is assigned to each of these characteristics. Images of different categories of findings of all five characteristics are shown below to improve the image recognition skills of trainees.

  • Density of acetic acid uptake



  • 0: Zero or transparent


    1: Shady, milky (not transparent, not opaque)


    2: Distinct, opaque white


    0: Zero or transparent


    1: Shady, milky (not transparent, not opaque)


    2: Distinct, opaque white


    0: Zero or transparent


    1: Shady, milky (not transparent, not opaque)


    2: Distinct, opaque white



  • Margin and surface of the lesion



  • 0: Diffuse or no margin


    1: Sharp but irregular, jagged, “geographical”; satellites


    2: Sharp and even; difference in surface level, including “cuffing”


    0: Diffuse or no margin


    1: Sharp but irregular, jagged, “geographical”; satellites


    2: Sharp and even; difference in surface level, including “cuffing”


    0: Diffuse or no margin


    1: Sharp but irregular, jagged, “geographical”; satellites


    2: Sharp and even; difference in surface level, including “cuffing”



  • Characteristic of blood vessels



  • 0: Fine, regular


    1: Absent


    2: Coarse or atypical


    0: Fine, regular


    1: Absent


    2: Coarse or atypical


    0: Fine, regular


    1: Absent


    2: Coarse or atypical



  • Size of the lesion



  • 0: < 5 mm


    1: 5–15 mm or spanning 2 quadrants


    2: > 15 mm or spanning 3–4 quadrants, or endocervically undefined


    0: < 5 mm


    1: 5–15 mm or spanning 2 quadrants


    2: > 15 mm or spanning 3–4 quadrants, or endocervically undefined


    0: < 5 mm


    1: 5–15 mm or spanning 2 quadrants


    2: > 15 mm or spanning 3–4 quadrants, or endocervically undefined



  • Result of application of Lugol’s iodine



  • 0: Brown


    1: Faint or patchy yellow


    2: Distinct yellow


    0: Brown


    1: Faint or patchy yellow


    2: Distinct yellow


    0: Brown


    1: Faint or patchy yellow


    2: Distinct yellow



    For each characteristic, the score can be 0, 1, or 2. The scores for all five characteristics are added up to derive the final score. A provisional diagnosis can be made based on the total score.

    Final score     Colposcopic prediction of probable histology
    0–4:Normal/CIN1
    5–6:CIN2/CIN3
    7–10:CIN3/suspected cancer

    However, the diagnosis and management should not be based solely on the Swede score. The colposcopist should consider the woman’s age, the screening test results, and the specific colposcopic features while making a diagnosis.

      
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