Validity and Reproducibility of Cytologic Diagnosis in a Sample of Cervical Cancer Screening Centers in Mexico

Lazcano‐Ponce, Eduardo; Ruı́z, Patricia Alonso de; López‐Carrillo, Lizbeth; Nájera-Aguilar, Patricia; Avila-Ceniceros, Roberto; Escandón-Romero, Celia; Cisneros, Ma Teresa; Hernández-Ávila, Mauricio

doi:10.1159/000332512

Cited by 42 publications

(35 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…When these slides were reviewed by a very experienced pathologist, the agreement between the reviewer and individual laboratories ranged from Kappa=0.12 to Kappa=0.48. 29 In summary, ndings from our study and other reviews of cytology accuracy indicate that continued efforts on cytology quality assurance in sampling and reading are essential to maintain concurrently high sensitivity and high speci city. By pooling data from Mumbai and Trivandrum, the best performing conventional cytology has an average sensitivity around 75% at LSIL threshold (speci city 95%).…”

Section: Discussionmentioning

confidence: 57%

Accuracy of conventional cytology: results from a multicentre screening study in India

et al. 2004

View full text Add to dashboard Cite

Objective:We conducted a multi-centre cross-sectional study in India to evaluate the accuracy of conventional cytology to detect high-grade squamous intraepithelial lesions (HSIL). Setting:Cross-sectional studies in Jaipur, Kolkata, Mumbai and Trivandrum, India, during 1999-2003. Methods: A common protocol and questionnaire were used to test 22,663 women aged 25-65 years with conventional cytology in ve cross-sectional studies. Three thresholds were used to de ne test positivity: atypical squamous cells of uncertain signi cance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), or HSIL. All screened women were investigated with colposcopy, and biopsies were taken when necessary. The reference standard for nal disease status was histology or negative colposcopy. Data from the studies were pooled to evaluate the test characteristics for the detection of histologically con rmed HSIL. Results:The test positivity rates of cytology were 8.8% at ASCUS, 6.2% at LSIL and 1.8% at HSIL thresholds, and 355 women had histologically con rmed HSIL while 74 had invasive cancer. The pooled sensitivity, speci city, positive and negative predictive values at ASCUS threshold were 64.5%, 92.3%, 11.8% and 99.4% respectively. The corresponding values at LSIL threshold were 58.0%, 94.9%, 15.2% and 99.3%, while at the HSIL threshold they were 45.4%, 99.2%, 46.3% and 99.1%. The sensitivity varied between 37.8-81.3% at ASCUS , 28.9-76.9% at LSIL and 24.4-72.3% at HSIL thresholds. A signi cantly low sensitivity was observed in women aged 25-39 years (p<0.001). The wide variation in sensitivity across study sites persisted even after age standardisation. Conclusion:The sensitivity of cytology varied widely between the study sites. Findings from our study and other reviews indicate that sustained efforts in improving sampling, preparation and reading of cytological specimens and improvements in clinical judgement are essential to achieve concurrently high sensitivity and speci city. Cervical cytology screening programmes in developed countries of Western and Northern Europe, North America and Australia have been followed by a substantial reduction in disease burden. However, no signicant reduction in incidence and mortality from cervical cancer has been observed in developing countries where cytology screening programmes exist.2,3 The reasons for the lack of success include poor quality cytology and suboptimal coverage of target women with testing and treatment. Insuf cient sampling of cervical cells, imperfect preparation and staining of smears or failure to correctly identify cellular abnormalities in the smear lead to errors and a high frequency of false-negative reporting. The best estimates of the accuracy of conventional cytology screening based on the currently available data from cross-sectional studies, mostly conducted in developed countries, suggest that the range of sensitivity to detect cervical neoplasia is wide. There have been very few studies in developing countries addressing the test characteristics of cytology.W...

show abstract

Section: Discussionmentioning

confidence: 57%

Accuracy of conventional cytology: results from a multicentre screening study in India

et al. 2004

View full text Add to dashboard Cite

show abstract

“…21,22 Also, it performs particularly poorly in low-resource settings, similar to the ones where these downstaging studies have been performed. 23,24 In the study by Sujathan et al, 16 only 2.2% of the women were subjected to colposcopy and biopsy; in the studies by Wesley et al 19 and Nene et al, 18 around 1% of women underwent biopsy and none had colposcopy. In the study by Rao et al, 17 no woman had a confirmatory diagnostic investigation and the distribution of cytologically diagnosed dysplasia by different grades is not provided.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of downstaging in the detection of cervical neoplasia in Kolkata, India

Basu

Sankaranarayanan

Mandal

et al. 2002

Intl Journal of Cancer

View full text Add to dashboard Cite

Unaided visual inspection or "downstaging" has been suggested as a potential alternative method for cervical cancer screening in developing countries. Our study was designed to evaluate the accuracy of downstaging to detect cervical neoplasia in a low-resource setting. A total of 6,399 women aged 30 -64 years were screened with downstaging by trained nonmedical health workers. Two thresholds were used to define positive downstaging: "low threshold" when any visible abnormality on the cervix was considered positive and "high threshold" when selected abnormalities such as bleeding on touch, bleeding erosion, hypertrophied oedematous cervix, congested stippled cervix and growth or ulcer constituted the positive test. All women underwent a colposcopy examination. Biopsies were directed when colposcopy revealed abnormal lesions. True disease status was defined as histologically proven moderate dysplasia and worse lesions. Since all the participants received a diagnostic (reference) investigation (biopsy and/or colposcopy), sensitivity, specificity and predictive values were estimated directly. Low-and high-threshold downstaging were positive in 1,585 (24.8%) and 460 (7.2%) women, respectively. Cytology screening for cervical cancer has been successful in reducing the incidence of and mortality from cervical cancer in many developed countries. 1-3 On the other hand, cervical cancer incidence and mortality rates have either remained unchanged or slowly declined in many low-resource developing countries. 4 -7 The primary reason for this is that most of these countries and regions lack effective cervical cancer screening programmes. Some of them have implemented cytology-based screening programmes nationally or regionally that have had very little impact on the incidence and mortality from cervical cancer. 7-9 The prerequisites for the success of cytology-based screening programmes are high coverage of the target population, preparation of goodquality cytology smears, well-equipped laboratory service with internal and external quality-control measures, adequate numbers of well-trained technical personnel, stringent quality assurance, efficient referral system and treatment and follow-up of those with precursor lesions, most of which are not feasible in underdeveloped countries. Therefore, the need for a relatively inexpensive and low-technology alternative to detect cervical neoplasia in low-resource settings has long been felt.Naked-eye visualization of the cervix (without application of acetic acid) by trained health workers has been considered as an option for low-resource countries to detect cervical cancer early and to improve the survival from the disease. 10,11 This approach, known as downstaging or unaided visual inspection (UVI), has been defined as "the detection of the disease in an earlier stage when still curable, by nurses and other nonmedical health workers using a speculum for visual inspection of the cervix". 11Here we report the findings from a cross-sectional study that evaluated the performance of d...

show abstract

“…The technique is relatively expensive and requires trained pathologists and technicians. As a result, the diagnostic performance (sensitivity and specificity) and the reproducibility of cytology evaluated under real conditions proved to be poor in a number of resourceconstrained countries (Cervical cancer project, 1999;Arbyn et al, 2008;Lazcano et al, 1997). All of these limitations may explain the failure to organize cytologybased organized cervical screening in a context of limited resources (Sankaranarayanan et al, 2001;Miller et al, 2003).…”

Section: Introductionmentioning

confidence: 99%

Detection of cervical human papillomavirus in women attending for cervical cancer screening by visual inspection in Cte d Ivoire

Abdoulaye¹,

Yeo²,

Blavo-Kouame³

et al. 2017

J. Cancer Res. Exp. Oncol.

View full text Add to dashboard Cite

Validity and Reproducibility of Cytologic Diagnosis in a Sample of Cervical Cancer Screening Centers in Mexico

Cited by 42 publications

References 7 publications

Accuracy of conventional cytology: results from a multicentre screening study in India

Accuracy of conventional cytology: results from a multicentre screening study in India

Evaluation of downstaging in the detection of cervical neoplasia in Kolkata, India

Detection of cervical human papillomavirus in women attending for cervical cancer screening by visual inspection in Cte d Ivoire

Contact Info

Product

Resources

About