Evaluation of colposcopy vs cytology as secondary test to triage women found positive on visual inspection test

Sa, Pimple; Amin, Geetanjali; Goswami, Sumanta; Shastri, SS

doi:10.4103/0019-509x.64726

Cited by 23 publications

(12 citation statements)

References 21 publications

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“…Our study also showed that a VIA nurse colposcopist Swede score of 8 or above had parallel high specificities of CIN2+ as the Swede score of the doctors. These results are comparable to CIN2+ specificities in Swede score trials by doctors from both high-resource11 12 and low-resource settings 1314…”

Section: Discussionsupporting

confidence: 60%

“…Colpscopy may also be used for primary screening in low-resource settings, especially when using the Swede score systematic colposcopy system, where the total score gives an indication of the severity of the visual impression of the cervix 11–15. However, the limited access of doctors and the limitations of stationary colposcopes (heavy, requires an electrical grid and technical support) are reasons why screening colposcopy has not reached widespread use in rural areas with poor infrastructure 11…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of the accuracy in detecting cervical lesions by nurses versus doctors using a stationary colposcope and Gynocular in a low-resource setting

et al. 2014

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ObjectivesEvaluation of the performance of VIA (visual inspection with acetic acid) trained nurses to learn colposcopy and the Swede score method to detect cervical lesions by using stationary colposcope or a portable, hand-held colposcope; the Gynocular, as compared to doctors.DesignA crossover randomised clinical trial.SettingThe Colposcopy Clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh.Participants932 women attending the clinic as either screening naïve for VIA screening (404) or women referred as VIA positive (528) from other VIA screening centres in the Dhaka region.InterventionVIA trained nurses were trained on-site in colposcopy and in the Swede score systematic colposcopy method. The Swede score grade cervical acetowhiteness, margins plus surface. vessel pattern, lesion size and iodine staining. The women were randomised to start the examination by either a stationary colposcope or the Gynocular. Swede scores were first obtained by a nurse and the same patient was equally evaluated by a doctor.Primary and secondary outcome measuresAgreement between nurses and doctors in Swede scores was evaluated using the weighted κ statistic for the Gynocular and standard colposcope. The ability to predict CIN 2+ (CIN 2, CIN 3 and invasive cervical cancer) using Swede scores was evaluated using receiver-operating characteristic curves.ResultsThe Swede scores obtained by nurses and doctors using the Gynocular and stationary colposcope showed high agreement with a κ statistic of 0.858 and 0.859, respectively, and no difference in detecting cervical lesions in biopsy. Biopsy detected CIN 2+ in 39 (4.2%) women.ConclusionsOur study showed that VIA nurses can perform colposcopy. There was no significant differences compared to doctors in detecting cervical lesions by stationary colposcope or the Gynocular using the Swede score system. Swede scores obtained by nurses using the Gynocular could offer an accurate cervical diagnostic approach in low resource settings.Trial registration numberISRCTN53264564.

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Section: Discussionsupporting

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Evaluation of the accuracy in detecting cervical lesions by nurses versus doctors using a stationary colposcope and Gynocular in a low-resource setting

et al. 2014

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“…Histopathology findings were reported as benign in 81.6%, CIN I in 5.8% of cases, CIN II in 2.9% of cases, CIN III in 2.6% of cases, and invasive carcinoma in 2.9% of cases. The estimates of sensitivity for low- and high-threshold colposcopy were 58% and 74.5%, respectively, and those of specificity were 57.5% and 92.9%, respectively [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Analysis of Sensitivity, Specificity, and Positive and Negative Predictive Values of Smear and Colposcopy in Diagnosis of Premalignant and Malignant Cervical Lesions

Barut¹,

Kale

Kuyumcuoğlu

et al. 2015

Med Sci Monit

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BackgroundThis study aimed to examine the positive and negative predictive value in the diagnosis of premalignant and malignant lesions of cervical colposcopy, the sensitivity and specificity of smear, and to evaluate the correlation with histopathology of abnormal cytology and colposcopy.Material/MethodsThe criteria for inclusion of patients with unhealthy cervix in the study were: Erosion, Chronic cervicitis, and Healed lacerations, Hypertrophied cervix, bleeding on touch, suspicious growth/ulcer/polyp on the cervix, and abnormal discharges from the cervix. Women with frank carcinoma cervix, pregnant females, patients with bleeding per vaginum at the time of examination, and those who had used vaginal medications, vaginal contraceptives or douches in the last 48 h of examination were excluded from the study.Demographic analysis was performed for 450 patients who were admitted to the clinic. Sensitivity, specificity, positive predictive value and negative predictive values of patients to identify cervical pathologies of smear and colposcopy were histopathologically calculated. The statistical software package SPSS 15.0 (SPSS Inc., Chicago, IL, USA) and Spearman‘s and Chi-Square tests were used for statistical analysis.ResultsSensitivity, specificity, PPD and NDP of smear were 0.57%, 0.76%, 0.26%, 0.92% respectively. Sensitivity, specificity, PPD and NDP of colposcopy were 0.92%, 0.67%, 0.52%, 0.96% respectively. A statistically significant correlation was found between abnormal cytology and histopathology, and abnormal colposcopy finding and histopathology.ConclusionsWomen with clinical diagnosis of unhealthy cervix should be evaluated by cytology to detect any premalignant or malignant lesions. It was concluded that Pap smear, colposcopy and histopathology should be collectively evaluated to evaluate cervical findings in low socio-economic regions.

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“…[ 19 ] An earlier Mumbai study reported sensitivity of 67.9%, 62.3%, and 57.4% of cytology at the threshold of ASCUS+, LGSIL+, and HGSIL, respectively, with CIN 2+ histopathology as the gold standard on all VIA-positive women. [ 20 ]…”

Section: Discussionmentioning

confidence: 99%

“…[ 19 ] In the Mumbai study, the specificity of pap as triage test was 99.4%, 98.0%, and 96.8% to detect HGSIL+, LGSIL+, and ASCUS+ with histopathology CIN 2+ as the gold standard on VIA-positive women. [ 20 ]…”

Section: Discussionmentioning

confidence: 99%

Evaluation of cytology as secondary triage in visual inspection after application of 4% acetic acid-based cervical cancer screening program

Mishra

Pimple

Gupta

2019

South Asian J Cancer

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Context (Background): Visual-based screening techniques are low cost and have good sensitivity. Hence, they appear promising for primary screening in low-resource settings. However, to reduce referrals for diagnostic colposcopy, there is need to triage these screen-positive women with test with good specificity. Aims: The study aims to evaluate the performance of cytology as triage for visual inspection after application of 4% acetic acid (VIA) screen-positive women. Settings and Design: Community-based cervical cancer screening using VIA was implemented among socioeconomically disadvantaged women in Mumbai, India. Methods: Cytology was performed on screen-positive women. All primarily screen-positive women underwent colposcopy. Directed biopsies were obtained among women with positive findings on colposcopy. The gold standard used for final disease status was histopathology or negative colposcopy. Statistical Analysis Used: Test characteristics of cytology as triage test. Results: Among the 138,383 population, 16,424 eligible women were screened with VIA. 785 (4.78%) women were VIA positive and 580 women participated in triage with cytology. The sensitivity and specificity of cytology at threshold of atypical squamous cells of undetermined significance in detecting ≥cervical intraepithelial neoplasia (CIN) 2 were 75.0 and 94.7, respectively. The positive and negative predictive values of cytology as triage test were 23.1 and 99.4, respectively, and the false positivity and false negativity rates were 5.34 and 25.0, respectively. Conclusion: Cytology triage with VIA can reduce referrals for colposcopy to 4.97% of original referrals but may miss around 25%, of high-grade CIN. The substantial reduction in referrals has special implication for low-resource settings, wherein compliance to referral and availability of diagnostic facilities are poor.

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Evaluation of colposcopy vs cytology as secondary test to triage women found positive on visual inspection test

Abstract: Colposcopy is a good sensitive test for the detection of CIN and can be considered as a secondary testing tool to triage women found positive on VIA.

Cited by 23 publications

References 21 publications

Evaluation of the accuracy in detecting cervical lesions by nurses versus doctors using a stationary colposcope and Gynocular in a low-resource setting

Evaluation of the accuracy in detecting cervical lesions by nurses versus doctors using a stationary colposcope and Gynocular in a low-resource setting

Analysis of Sensitivity, Specificity, and Positive and Negative Predictive Values of Smear and Colposcopy in Diagnosis of Premalignant and Malignant Cervical Lesions

Evaluation of cytology as secondary triage in visual inspection after application of 4% acetic acid-based cervical cancer screening program

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