Colposcopy and treatment of cervical intraepithelial neoplasia: a beginnersí manual

Other Non-Series Publications

Edited by Sellors JW, Sankaranarayanan R

2003/4

ISBN-13 (Database)

978-92-832-0412-1

Colposcopy and treatment of cervical intraepithelial neoplasia: a beginnersí manual

Other Non-Series Publications

Edited by Sellors JW, Sankaranarayanan R

2003/4

ISBN-13 (Database)

978-92-832-0412-1

Home / Training / Manuals / Colposcopy and treatment of cervical intraepithelial neoplasia: a beginnersí manual / Appendix / Appendix 5: The modified Reid colposcopic index (RCI)*
Colposcopy and treatment of cervical intraepithelial neoplasia: a beginnersí manual, Edited by J.W. Sellors and R. Sankaranarayanan

Appendix 5: The modified Reid colposcopic index (RCI)*

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Colposcopic signs Zero point One point Two points
Colour Low-intensity acetowhitening (not completely opaque); indistinct acetowhitening; transparent or translucent acetowhitening Acetowhitening beyond the margin of the transformation zonePure snow-white colour with intense surface shine Intermediate shade - grey/white colour and shiny surface (most lesions should be scored in this category) Dull, opaque, oyster white; grey
Lesion margin and surface configuration Microcondylomatous or micropapillary contour1
Flat lesions with indistinct marginsFeathered or finely scalloped margins
Angular, jagged lesions3
Satellite lesions beyond the margin of the transformation zone
Regular-shaped, symmetrical lesions with smooth, straight outlines Rolled, peeling edges2 Internal demarcations between areas of differing colposcopic appearance-a central area of high-grade change and peripheral area of low-grade change
Vessels Fine/uniform-calibre vessels4- closely and uniformly placed Poorly formed patterns of fine punctation and/or mosaic
Vessels beyond the margin of the transformation zone
Fine vessels within microcondylomatous or micropapillary lesions6
Absent vessels Well defined coarse punctation or mosaic, sharply demarcated5 - and randomly and widely placed
Iodine staining Positive iodine uptake giving mahogany-brown color
Negative uptake of insignificant lesion, i.e., yellow staining by a lesion scoring three points or less on the first three criteria
Areas beyond the margin of the transformation zone, conspicuous on colposcopy, evident as iodine-negative areas (such areas are frequently due to parakeratosis)7
Partial iodine uptake - variegated, speckled appearance Negative iodine uptake of significant lesion, i.e., yellow staining by a lesion already scoring four points or more on the first three criteria


* Colposcopic grading performed with 5% aqueous acetic acid and Lugol's iodine solution. (See Appendix 3 for recipes for 5% acetic acid and for Lugol's iodine solution).
1 Microexophytic surface contour indicative of colposcopically overt cancer is not included in this scheme.
2 Epithelial edges tend to detach from underlying stroma and curl back on themselves. Note: Prominent low-grade lesions often are overinterpreted, while subtle avascular patches of HSIL can easily be overlooked.
3 Score zero even if part of the peripheral margin does have a straight course.
4 At times, mosaic patterns containing central vessels are characteristic of low-grade histological abnormalities. These low-grade-lesion capillary patterns can be quite pronounced. Until the physician can differentiate fine vascular patterns from coarse, overdiagnosis is the rule.
5 Branching atypical vessels indicative of colposcopically overt cancer are not included in this scheme.
6 Generally, the more microcondylomatous the lesion, the lower the score. However, cancer also can present as a condyloma, although this is a rare occurrence.
7 Parakeratosis: a superficial zone of cornified cells with retained nuclei.



Colposcopic prediction of histologic diagnosis using the Reid Colposcopic Index (RCI)

RCI (overall score) Histology
0 - 2 Likely to be CIN 1
3 - 4 Overlapping lesion: likely to be CIN 1 or CIN 2
5 - 8 Likely to be CIN 2-3
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