Evaluation of portable colposcopy and human papillomavirus testing for screening of cervical cancer in rural China

Abstract

ObjectiveTo evaluate the use of a portable, rechargeable colposcope combined with human papillomavirus (HPV) testing, as compared with HPV testing alone, for screening of cervical cancer and pre-cancerous lesions.MethodsThis was a cross-sectional study among 488 women in Baoshan County, Yunnan. The women underwent HPV testing followed by Gynocular portable colposcopy with visual inspection with acetic acid. Obvious lesions were biopsied. If portable colposcopy testing was negative but HPV testing was positive, the women underwent follow-up testing with thin-prep cytology and traditional colposcopy. Cervical biopsies were performed for any abnormalities. Histopathology was followed up with diagnosis and treatment.ResultsAmong 488 women screened with portable colposcopy, 24 women underwent biopsy based on positive colposcopy screening. Of these 24 women, three were HPV positive and 21 were HPV negative. Five women had cervical intra-epithelial neoplasia (CIN) I and one had advanced cervical cancer. Forty-six women tested positive for HPV. Three of these women had screened positive on preliminary colposcopy, with one positive for CIN III/squamous cell carcinoma and one woman with CIN I. Forty-three women underwent follow-up testing with thin-prep cytology. Two women had atypical squamous cells of undetermined significance and five had low-grade squamous intra-epithelial lesions and were biopsied; three women had CIN I, one had CIN II and one had CIN III. HPV testing and portable colposcopy was more sensitive but slightly less specific than portable colposcopy or HPV testing alone.ConclusionWhile HPV testing has high sensitivity and specificity for the detection of pre-cancerous and cancerous lesions and portable colposcopy has lower specificity, both methods of detection have low positive predictive value and high negative predictive value. In tandem, HPV testing and portable colposcopy had higher sensitivity for detection among women who underwent biopsies. In clinical practice, portable colposcopy was an effective, easy and affordable tool to transport to villages where cytology is not currently feasible.

Screening test Accuracy of Portable Devices that can be used to Perform Colposcopy for Detecting CIN2+ in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

“…In these studies, the colposcopic procedure followed a positive PAP smear and/or HPV and/or VIA test. Prevalence of CIN2 + in studies assessing the device and colposcopic procedure as a rst-line test was 0.6% [29], and when used in either situation at two points in the screening pathway, a prevalence of 4.2% [31] was found.…”

“…Seven publications were based on study populations already included in our analysis [17,[25][26][27][28][29]. We have presented a complete list of excluded full-text assessments and the reasons for their exclusion in additional le 4.…”

“…Table 1 shows the characteristics of these studies, which include 2693 women. Four of the studies were conducted in LMIC (India [30], Bangladesh [31], Peru [32] and China [29]) and one was conducted in a high-income country (Sweden [33]). All studies used a single-gate design [12].…”

“…All studies used a single-gate design [12]. One study estimated DTA with two methods of screening [29] and another, for two different groups of providers (nurses/doctors) [31]. Four studies evaluated the Gynocular™ [30,31,33,34] and one study evaluated the Pocket device.…”

“…The Pocket device was evaluated as an add-on test to HPV or PAPsmear [24]. The Gynocular™ was evaluated as a rst-line test [29] and as an add-on test to HPV, PAP-smear or VIA [30,33]. In one study, the Gynocular™ device was used indiscriminately as a rst-line test among 404 women (43%), and as an add-on test after VIA positivity among 528 women (57%) [31].…”