Can we substitute brush cytology for biopsy in the evaluation of cervical lesions under the guidance of colposcopy?

In cervical cancer screening, colposcopically directed biopsy is the gold standard method for identifying intraepithelial and occult invasive lesions of the uterine cervix. As biopsy needs special expertise and the procedure is not convenient for the patients, we sought to evaluate colposcopically directed brush cytology as a substitute for biopsy of cervical lesions. We studied a series of 150 women who were referred for colposcopic evaluation. Colposcopically directed brush cytology and biopsy were performed for all patients with abnormal colposcopic findings. A total of 40 samples were excluded due to unsatisfactory report of brush cytology. Of the remaining 110 samples, 34 abnormal pathologies were reported in biopsy evaluations, while only 9 abnormal cytologies were reported in brush cytology specimens. Brush cytology sensitivity and specificity were 26% and 97%, respectively. We conclude that colposcopically directed brush cytology is not a safe substitute for biopsy in the evaluation of cervical lesions.

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Visual techniques for cervical cancer screening in Colombia

Biomédica ◽

10.7705/biomedica.v39i1.4007 ◽

2019 ◽

Vol 39 (1) ◽

pp. 65-74

Author(s):

Óscar Gamboa ◽

Mauricio González ◽

Jairo Bonilla ◽

Joaquín Luna ◽

Raul Murillo ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

False Positive ◽

Gold Standard ◽

Visual Inspection ◽

Low Grade ◽

High Grade ◽

Detection Rates ◽

Lower Detection

Introduction: Direct visual inspection for cervical cancer screening remains controversial, whereas colposcopy-biopsy is considered the gold standard for diagnosis of preneoplastic cervical lesions.Objectives: To determine the rates of cervical intraepithelial neoplasia grade 2 or more and of false positives for colposcopy and direct visual inspection.Materials and methods: Women aged 25-59 underwent direct visual inspection with acetic acid (VIA), Lugol’s iodine (VIA-VILI), and colposcopy. Punch biopsies were obtained for all positive tests. Using histology as the gold standard, detection and false positive rates were compared for VIA, VIA-VILI, and colposcopy (two thresholds). Sensitivity and false positive ratios with the corresponding 95% confidence intervals were estimated.Results: We included 5,011 women in the analysis and we obtained 602 biopsies. Positivity rates for colposcopy high-grade and low-grade diagnosis were 1.6% and 10.8%. Positivity rates for VIA and VIA-VILI were 7.4% and 9.9%. VIA showed a significantly lower detection rate than colposcopy with low-grade diagnosis as the threshold (SR=0.72; 95% CI 0.57-0.91), and significantly lower false positive rate (FPR=0.70; 95% CI 0.65-0.76). No differences between VIA-VILI and colposcopy low-grade threshold were observed. VIA and VIA-VILI showed significantly higher detection and false positive rates than colposcopy high-grade threshold. Sensitivity rates for visual inspection decreased with age and false positive rates increased. For all age groups, false positive rates for VIA and VIA-VILI were significantly higher than colposcopy.Conclusions: Detection rates for VIA-VILI similar to colposcopy low-grade threshold represent a chance to reduce cervical cancer mortality through see-and-treat approaches among women with limited access to health care. Lower detection rates suggest reviewing high-grade colposcopy findings as the threshold for biopsy in certain settings.

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Spectrum of epithelial cell abnormalities of uterine cervix in a cervical cancer screening programme: Implications for resource limited settings

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/j.ejogrb.2006.07.022 ◽

2007 ◽

Vol 134 (2) ◽

pp. 238-242 ◽

Cited By ~ 3

Author(s):

Sanjay Gupta ◽

Pushpa Sodhani ◽

Kaushik Halder ◽

Krishan Lal Chachra ◽

Sarita Sardana ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Epithelial Cell ◽

Cervical Cancer Screening ◽

Uterine Cervix ◽

Screening Programme ◽

Resource Limited Settings ◽

Resource Limited ◽

Cancer Screening Programme ◽

Cervical Cancer Screening Programme

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Urine test for HPV genotypes as a predictor of precancerous cervical lesions and for cervical cancer screening

International Journal of Gynecology & Obstetrics ◽

10.1002/ijgo.12453 ◽

2018 ◽

Vol 141 (3) ◽

pp. 332-336 ◽

Cited By ~ 1

Author(s):

Ahmed M. Maged ◽

Hany Saad ◽

Emad Salah ◽

Hadeer Meshaal ◽

Mostafa AbdElbar ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Urine Test ◽

Cervical Lesions ◽

Hpv Genotypes ◽

Precancerous Cervical Lesions

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Screen, Notify, See, and Treat: Initial Results of Cervical Cancer Screening and Treatment in Rwanda

JCO Global Oncology ◽

10.1200/go.20.00147 ◽

2021 ◽

pp. 632-638

Author(s):

Marie-Aimee Muhimpundu ◽

Fidele Ngabo ◽

Felix Sayinzoga ◽

Jean Paul Balinda ◽

John Rusine ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Service Delivery ◽

Cervical Cancer Screening ◽

Health Workers ◽

Screening Program ◽

Public Awareness ◽

Cervical Lesions ◽

District Hospitals

PURPOSE To describe the first year results of Rwanda's Screen, Notify, See, and Treat cervical cancer screening program, including challenges encountered and revisions made to improve service delivery. METHODS Through public radio broadcasts, meetings of local leaders, church networks, and local women's groups, public awareness of cervical cancer screening opportunities was increased and community health workers were enlisted to recruit and inform eligible women of the locations and dates on which services would be available. Screening was performed using human papillomavirus (HPV) DNA testing technology, followed by visual inspection with acetic acid (VIA), and cryotherapy, biopsy, and surgical treatment for those who tested HPV-positive. These services were provided by five district hospitals and 15 health centers to HIV-negative women of age 35-45 and HIV-positive women of age 30-50. Service utilization data were collected from the program's initiation in September 2013 to October 2014. RESULTS Of 7,520 cervical samples tested, 874 (11.6%) screened HPV-positive, leading 780 (89%) patients to undergo VIA. Cervical lesions were found in 204 patients (26.2%) during VIA; of these, 151 were treated with cryoablation and 15 were referred for biopsies. Eight patients underwent complete hysterectomy to treat advanced cervical cancer. Challenges to service delivery included recruitment of eligible patients, patient loss to follow-up, maintaining HIV status confidentiality, and efficient use of consumable resources. CONCLUSION Providing cervical cancer screening services through public health facilities is a feasible and valuable component of comprehensive women's health care in resource-limited settings. Special caution is warranted in ensuring proper adherence to follow-up and maintaining patient confidentiality.

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Determinants of precancerous cervical lesion among women screened for cervical cancer in south Ethiopia: A case-control study

10.21203/rs.2.14781/v1 ◽

2019 ◽

Author(s):

Tesfalidet Tekelab Beyene ◽

Mohammed Akibu ◽

Henok Bekele ◽

Wengelawit Seyoum

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Sexual Behaviour ◽

Case Control Study ◽

Case Control ◽

Sexual Partners ◽

Cervical Lesions ◽

Precancerous Cervical Lesions ◽

Control Study

Abstract Background Nearly 90% of deaths from cervical cancer occurred in low resource setting. In Ethiopia the magnitude of cervical cancer was 17%. Precancerous cervical lesions may progress to cervical cancer. Early screening and treatment of precancerous cervical lesions is a cost effective way to avert the growth of cervical cancer. However, there is a limited research on risk factors of precancerous cervical lesions in Ethiopia. Therefore the aim of this study was to identify determinants of precancerous cervical lesions in south Ethiopia.Method A facility based case-control study was carried out in five health facilities in south Ethiopia between 8 May to 28 September 2018. Interviewer administered questionnaires were used to collect data from 98 cases and 197 controls. Multivariate logistic regression was employed to identify determinants of precancerous cervical lesions.Results Women aged 30-39 years (AOR = 2.51, 95% CI: 1.03 – 6.08), monthly income < 42 USD and 43-66 USD (AOR = 3.41, 95% CI: 1.34 – 6.08; AOR = 3.63, 95% CI: 1.31 – 9.88), initiation of first sexual intercourse at age less than or equal to 20 (AOR = 2.39, 95% CI: 1.14 – 5.47), having more than one life time sexual partners (AOR=4.70, 95% CI:2.02–10.95), having a partner/ husband with more than one lifetime sexual partners (AOR=2.98, 95% CI: 1.35–6.65) had higher odds of precancerous cervical lesions.Conclusion Strategies to prevent precancerous cervical lesions should focus on modification of life style and sexual behaviour. The findings of this study highlight implications for policy makers by suggesting that targeting older women for cervical cancer screening, addressing inequalities and education relating to risky sexual behaviour may reduce precancerous cervical lesions. Further longitudinal study is needed to assess awareness of women about cervical cancer screening.

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Cost analysis of different cervical cancer screening strategies in Mexico

Salud Pública de México ◽

10.21149/spm.v56i5.7374 ◽

2014 ◽

Vol 56 (5) ◽

pp. 492 ◽

Cited By ~ 10

Author(s):

Christyn M Beal ◽

Jorge Salmerón ◽

Yvonne N Flores ◽

Leticia Torres ◽

Víctor Granados-García ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Cost Effective ◽

Poor Quality ◽

Cervical Lesions ◽

Hpv 16 ◽

Papilloma Virus ◽

Primary Screening ◽

Screening Strategies

Objective. To compare the costs and number of unde- tected cases of four cervical cancer screening strategies (CCSS) in Mexico. Materials and methods. We estimated the costs and outcomes of the following CCSS: a) conventional Papanicolaou smear (Pap) alone; b) high-risk human papilloma virus testing (HR-HPV) as primary screening with Pap as reflex triage; c) HR-HPV as primary screening with HPV-16/18 typing, liquid-based cytology (LBC) and immunostaining for p16/Ki67 testing as reflex triage, and d) co-testing with HR-HPV and LBC with HPV-16/18 typing and immunostaining for p16/Ki67 as reflex triage. The outcome of interest was high-grade cervical lesions or cervical cancer. Results. HR-HPV testing, HPV typing, LBC testing and immunostaining is the best alternative because it is the least expensive option with an acceptable number of missed cases. Conclusions. The opportunity costs of a poor quality CCSS is many false negatives. Combining multiple tests may be a more cost-effective way to screen for cervical cancer in Mexico.

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