First Results of Treatment of Cervical Intraepithelial Neoplasia in the Republic of Tajikistan

Abstract

Objective: To assess the clinical results of cervical intraepithelial neoplasia (CIN) treatment following the outcomes of the first pilot implementation of visual screening in the Republic of Tajikistan. Methods: The study was conducted from 2016 to 2020. The piloting included the population of two large districts of Kushoniyon and B. Gafurov, with a total number of 608,700 people, which is 6.74% of the country's total population. The target group of this screening included healthy women aged 30-49 years, numbering 72574 people. As a result of communication campaigns with the target group of both districts, 69391 women participated in visual screening; the overall screening coverage was 94.2%. Of the 2958 women referred for diagnosis, in 164 cases (0.24%) CIN was identified and morphologically confirmed. Results: Tajikistan, along with piloting imaging screening, has adopted a "detection-diagnosis-treatment" strategy, which involves treatment after histological confirmation of CIN. Additionally, electrosurgical loop excision/conization was adopted as the primary method, regardless of the degree of CIN involvement. Patients with CIN in 136 (82.9%) cases underwent electrosurgical loop excision, in 21 cases – conization (12.8%), and in 7 (4.3%) cases, at the insistence of the women themselves – hysterectomy. In the long-term follow-up period from 6 months to 2 years, in 159 (96.9%) cases, a favorable course of CIN was noted after the above procedures, and in 5 (3.1%) cases, relapse occurred. Patients with relapses received re-surgical treatment using electrosurgical excision/conization with a satisfactory outcome. Conclusion: The "detection-diagnosis-treatment" strategy adopted by Tajikistan has shown its high efficiency in detecting precancerous pathology and the success of CIN treatment by electrosurgical excision/conization, which contributes to the healing of the population from precancerous pathology. Keywords: Cervical intraepithelial neoplasia, visual screening, VIA/VILI visual method, colposcopic examination, electrosurgical loop excision/conizatio.