Testing Cervicography and Cervicoscopy as Screening Tests for Cervical Cancer

1993 ◽  
Vol 79 (1) ◽  
pp. 22-25 ◽  
Author(s):  
Silvia Cecchini ◽  
Rita Bonardi ◽  
Antonia Mazzotta ◽  
Grazia Grazzini ◽  
Anna Iossa ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Screening Test ◽  
Detection Rate ◽  
Pap Test ◽  
Cost Effective ◽  
Screening Tests ◽  
Screening Methods ◽  
Abnormal Cytology

Aims and Background Suboptimal sensitivity is currently reported for Pap test in screening for cervical cancer. Colposcopy is known to be more sensitive than cytology but its use as a screening test is not possible due to costs and complexity. Screening by cervicography has been suggested as a compromise being less costly and feasible. The present study evaluates the feasibility of screening by cervicography and cervicoscopy (naked eye examination of the cervix after acetic acid lavage) on a consecutive screening series. Methods Cervicography and cervicoscopy were performed by the smear taker in subjects consecutively attending a screening clinic. Women with abnormal cytology (atypia or more severe lesion) and/or abnormal cervicography or cervicoscopy (acetowhite lesion) underwent colposcopic assessment. The three screening methods were compared according to positivity rate, CIN 2-3 detection rate and positive predictive value. Results 2105 consecutive subjects were screened. Positivity rate was 3.8 %, 15.3 % or 25.4 % for cytology, cervicography or cervicoscopy, respectively, 486 of 555 women attended the assessment phase, 281 directed biopsies were performed and 8 CIN 2-3 lesions were detected. Cytology, cervicography and cervicoscopy, detected 5.5, or 7 of 8 CIN 2-3 lesions, respectively. The positive predictive value was 0% for cytologic atypia, 25 % for cytologic SIL, 1.75 % for cervicography and 2.05% for cervicoscopy. Detecting one CIN 2-3 lesion at cytology cost $ 5,543. The cost per each additional cytologically negative CIN 2-3 lesion detected at cervicography or cervicoscopy was $ 12,947 or $ 3,916, respectively. Conclusions The study confirms the limited sensitivity of cytology for CIN 2-3. The association of cervicography was not cost effective. Cervicoscopy was poorly specific but increased the detection rate of CIN 2-3 at relatively low costs. Cervicoscopy is worth further evaluation as a screening test.

scholarly journals Assessing the implementation of population based cervical cancer screening in Amadora, Portugal

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Leite ◽  
S Pereira ◽  
D Vaz ◽  
T Smet ◽  
C Portilheiro ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Positive Predictive Value ◽  
Cervical Cancer Screening ◽  
Predictive Value ◽  
Intraepithelial Neoplasia ◽  
Cost Effective ◽  
Target Population ◽  
Population Based ◽  
Screening Tests

Abstract Background Population-based cervical cancer screening (CCS) are deemed to be more cost-effective than opportunistic screening and to reduce inequalities. Implementation in Portugal has been heterogeneous, at the regional level. In Amadora healthcare cluster (Lisbon area), implementation started in April 2018 in a pilot unit and was scaled-up. We aimed to assess population-based CCS implementation in Amadora. Methods Population-based CCS targets women aged 30-65, and utilises liquid-based cytology with partial HPV genotyping (HPV16/18 and other high-risk HPV - hrHPV). Samples positive for other hrHPV undergo a cytology. HPV16/18+ and other hrHPV+ with ≥ASCUS (atypical squamous cells of undetermined significance) are referred to colposcopy. We assessed implementation according to key indicators extracted from our information system: geographic coverage, number of tests, positive results, positive predictive value of referral (number of cervical intraepithelial neoplasia-CIN/number colposcopies). Results As of 30 August 2019, CCS were in place in 4 of the 9 units, potentially covering 20904 women (48.4% of the target population). 1797 womem performed screening within the programme. Invitation for screening is currently implemented in 1 of the 4 units. Screening results were available for 1702 women, 11,1% were HPV+. From these, 26,5% were HPV 16/18+ and 86.2% positive for other hrHPV. Among the latter, 63.2% were negative for intraepithelial lesion and 36.8% were ≥ASCUS. Overall, of these 189 women, 51.3% (n = 97) were referred for colposcopy. Colposcopy results were available for 37 women, of which 13 had a CIN. PPV of referral was 35.1% (95%confidence interval: 20.7;52.6). Conclusions Despite being a population-based screening most tests are still opportunistic. There is still a limited number of colposcopies results but the current PPV of referral is low and requires further investigation. Implementation towards a full population-based screening in Amadora should continue. Key messages Implementation of a population-based cervical cancer screening in Amadora, Portugal is underway but most screening tests are still applied in an opportunistic manner. A limited number of results is avaliable to estimate positive predictive value of referral to colposcopy. Results available indicate a value of 35.1%, which requires further investigation.

scholarly journals Use of a Sentinel Lymph Node Biopsy Algorithm in a South African Population of Patients With Cervical Cancer and High Prevalence of Human Immunodeficiency Virus Infection

2018 ◽  
Vol 28 (7) ◽  
pp. 1432-1437 ◽  
Author(s):  
Leon Cornelius Snyman ◽  
Emma P. Bryant ◽  
Elize I. Wethmar ◽  
Tom de Greve ◽  
Florette Reyneke ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Human Immunodeficiency Virus ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Detection Rate ◽  
Immunodeficiency Virus ◽  
High Prevalence ◽  
Sensitivity Specificity

ObjectivesCervical cancer is common in resource-poor settings with high prevalence of tuberculosis, pelvic inflammatory disease, and human immunodeficiency virus (HIV) infection. There are no data regarding the sentinel lymph node (SLN) algorithm in these high-risk cancer populations. Our objectives were to establish the sensitivity, specificity, positive predictive value, and negative predictive value of the SLN algorithm in cervical cancer and to compare the detection rate of indocyanine green (ICG) versus blue dye versus technetium Tc 99m nanocolloid (99mTc).MethodsThis prospective study was conducted at the University of Pretoria. 99mTc-nanocolloid tracer, ICG dye, and methylene blue (MB) were used to detect SLNs. Pathological ultrastaging was performed on hematoxylin-eosin– negative nodes.ResultsResults of 72 women were analyzed. The mean age was 47.2 years, 5.5% had a history of tuberculosis, 18.1% had pelvic inflammatory disease, and 65.3% were HIV positive. The SLN detection rate was 65.3%. Detection rate of MB was 56.9%; 99mTc, 69.4%; ICG, 87.5%; and the combination of MB and 99mTc, 91.7%. Pelvic nodal metastases occurred in 26.4%. The sensitivity, specificity, negative predictive value, and positive predictive value of SLN biopsy were 85.7%, 100%, 100%, and 98.33%, respectively. The false-negative rate was 14.3%, and it was 0% if the algorithm was applied.ConclusionsThe SLN algorithm is a feasible option for use in cervical cancer women with a high prevalence of HIV infection. The detection rate is generally lower, but in select subgroups of women, it was comparable to that reported elsewhere. This is the first report of the use of SLN biopsy in a substantial group of HIV-infected women.

Identification of ideal strategy of cervical cancer screening in Japan based on Fukui cervical cancer screening study.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e17025-e17025
Author(s):  
Tetsuji Kurokawa ◽  
Akiko Shinagawa ◽  
Yoko Chino ◽  
Motohiro Kobayashi ◽  
Yoshio Yoshida
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Positive Predictive Value ◽  
Cervical Cancer Screening ◽  
Predictive Value ◽  
Screening Method ◽  
Hpv Testing ◽  
Abnormal Cytology ◽  
Predictive Values ◽  
Hpv Status

e17025 Background:The estimated age-standardized incidence rate for cervical cancer is higher in Japan than in North America and the UK. It is important to improve cancer screening. The introduction of HPV testing with cytology for triage of those that test positive for cervical cancer screening has been challenging. The Fukui Cervical Cancer Screening (FCCS) study was designed to determine the best cervical cancer screening method in the Japanese population. We performed a subanalysis using baseline data of FCCS study to determine the performance of cytology, the human papillomavirus (HPV) testing and cotesting with cytology and HPV testing, and to evaluate whether the stratification of HPV16, HPV18, and 12 other hrHPV types appropriately balances risks and harms in the Japanese cancer screening population. Methods:The study enrolled 7,584 women aged 25 years or older undergoing routine screening. All women underwent liquid-based cytology (LBC) and cobas HPV testing. Women with abnormal cytology regardless of the HPV status, women with positive hrHPV results regardless of cytology results, and women randomly selected from among those with normal cytology and negative hrHPV results were referred for colposcopy. Results:The prevalence of hrHPV, HPV16, and HPV18 was 6.8%, 1.2%, and 0.5%, respectively. The estimated sensitivities for cervical intraepithelial neoplasia (CIN) 2 or worse for cytology, HPV testing, and cotesting with cytology and HPV testing were 71%, 92%, and 100%, respectively. The estimated positive predictive values for cytology, HPV testing, and cotesting with cytology and HPV testing were 33%, 21% and 21%, respectively. Using a strategy whereby those with abnormal cytology or positive HPV16 genotype undergo colposcopy and biopsy results in a sensitivity of 85% and a positive predictive value of 33%. This strategy results in improved sensitivity while at the same time maintains the positive predictive value compared to screening with cytology alone. Conclusions:Baseline data from the FCCS study suggests that strategy of using colposcopy for women with abnormal cytology and/or HPV16 positivity appropriately balances risks and harms for Japanese women. Clinical trial information: UMIN000025977.

scholarly journals Self-Collected Samples in Cervical Cancer Screening: Results of HPV and Pap Self-Collected Samples Compared to Physician-Obtained Specimens

2019 ◽  
Vol 63 (5) ◽  
pp. 379-384
Author(s):  
Bernhard Reinhold Mangold
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Pap Test ◽  
Pap Tests ◽  
Test Sensitivity ◽  
Self Testing ◽  
Hpv Test ◽  
Very High

Objective: In order to increase overall participation in cervical cancer screening, several investigators propose a concept of introducing self-tests. The study presented here compared test results of the Pap test and 4 different HPV test systems of self-collected and physician-collected vaginal specimens. Study Design: 208 patients of a colposcopy clinic had physician-taken and self-taken vaginal samples. All cell samples enabled a liquid-based Pap test and testing for carcinogenic HPV genotypes. In addition, all patients had a colposcopy with or without cervical biopsy and/or conisation. Results: 99 patients had the histological diagnosis of CIN2+. The HPV test sensitivity of self-collected samples differed significantly in this patient group depending on the test system performed. The sensitivity of the self-collected Pap test was significantly lower than HPV testing, but the positive predictive value of the Pap self-test was very high. Conclusion: The results of this study indicate that under the circumstances of self-testing HPV test systems differ in test sensitivity and specificity. Self-collected Pap tests can provide a test result with a very high positive predictive value and introduce therapeutic strategies. In order to improve screening strategies, it could be an opportunity to combine HPV and Pap tests in self-taken vaginal samples, especially in countries with a low income level. In countries with a good medical infrastructure, self-testing has to be introduced with caution.

Quality Control for Colposcopy in the Florence Screening Program for Cervical Cancer

1992 ◽  
Vol 78 (5) ◽  
pp. 291-294 ◽  
Author(s):  
Silvia Cecchini ◽  
Anna Iossa ◽  
Grazia Grazzini ◽  
Rita Bonardi ◽  
Stefano Ciatto
Keyword(s):  
Cervical Cancer ◽  
Quality Control ◽  
Positive Predictive Value ◽  
Cancer Registry ◽  
Private Practice ◽  
Predictive Value ◽  
Detection Rate ◽  
Screening Program ◽  
Cin Iii ◽  
Routine Quality Control

The authors report on the quality control for colposcopy adopted in the Florence District screening program. The sensitivity of colposcopy was determined on all cases of CIN III recorded in the local cancer registry in a four-year period. However although this showed that a centralized colposcopic clinic employing a limited number of expert operators is superior to the performance of colposcopy in private practice, such a parameter was impractical for further routine quality control since differences among operators were too small and statistically insignificant. Other parameters for quality control were chosen, namely a) the rate of colposcopically directed biopsies performed, b) the detection rate of CIN II or more severe lesions, and c) the positive predictive value of a directed biopsy for CIN II or more severe lesions. Analysis of these indicators after stratification by cytologic report allows the identification of those operators who need additional training and provides useful information for colposcopists to optimize their diagnostic and operative criteria.

scholarly journals NESTROFT AS SCREENING TEST FOR BETA THALASSEMIA TRAIT

2020 ◽  
pp. 1-3
Author(s):  
Keshav Bansal ◽  
Dhaval Bhatt ◽  
G.K. Sharma
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Screening Test ◽  
Cost Effective ◽  
Thalassemia Major ◽  
Hplc Method ◽  
Beta Thalassemia ◽  
Thalassemia Trait ◽  
Sensitivity Specificity

Objective: To evaluate the utility of NESTROFT as a screening test for Beta Thalassemia Trait. Material and Methods: A Prospective study of total 137 clinically normal siblings of thalassemia major patients registered at thalassemia clinic in department of pediatrics, Govt. medical college, Kota were selected randomly for the study. All cases were investigated for CBC, Mentzer’s index, NESTROFT and HbA2 estimation by HPLC method. Result: Total 137 cases were screened for thalassemia carrier by HbA2 estimation using HPLC technique. Total 67 (48.90%) cases having HbA2 level ≥3.5 % considered as carrier whereas rest 70 (51.10%) cases were normal. In this study 95 cases showed MCV<80. Out of them 59 cases were carrier and 36 cases were normal. The Sensitivity, specificity, positive predictive value and negative predictive value of MCV<80 are 90.12%, 49.71%, 63.78% and 84.68% respectively. The Sensitivity, specificity, positive predictive value and negative predictive value of Mentzer index are 85.25%, 97.16%, 96.45% and 89.19 % respectively. In present study, NESTROFT were done in all cases, the sensitivity of NESTROF test is 94.21%, specificity is 89.72%, Predictive value of positive test is 89.17% and Predictive value of negative test is 93.75%. So NESTROFT is better test for screening for Beta Thalassemia trait. Conclusion: NESTROF test is reliable, cost effective and better screening test for Thalassemia carrier detection. Positive cases can be confirmed by HPLC. NESTROFT can be used as mass screening programme for hemoglobinopathies.

scholarly journals Transcranial Doppler for patent foramen ovale screening: is there a good correlation with transesophageal echocardiography?

2008 ◽  
Vol 66 (4) ◽  
pp. 785-789 ◽  
Author(s):  
Marcos Christiano Lange ◽  
Viviane Flumignan Zétola ◽  
Admar Moraes de Souza ◽  
Élcio Juliato Piovesan ◽  
Juliano André Muzzio ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Transcranial Doppler ◽  
Predictive Value ◽  
Screening Test ◽  
Patent Foramen Ovale ◽  
Foramen Ovale ◽  
Negative Results ◽  
Contrast Enhanced ◽  
Group 2 ◽  
Group 1

Right-to-left shunt (RLS) can be identified by contrast-enhanced transcranial Doppler (cTCD) in patent foramen ovale (PFO) patients. AIM: To evaluate cTCD for PFO screening comparing it to cTEE. METHOD: 45 previous cTCD performed for PFO diagnosis and correlated its findings with cTEE. Patients were submitted to a cTCD standardized technique and were divided in two groups according to RLS: Group 1, patients with a positive RLS and Group 2 when RLS was negative. RESULTS: 29 (65%) patients were included in group 1 and 16 (35%) in group 2. PFO confirmation by cTEE was performed in 28 (62%) patients. cTCD had a 92.85% sensitivity, 82.35% specificity, 89.65% positive predictive value and 87.5% negative predictive value when compared to cTEE for PFO diagnosis. CONCLUSION: Standardized technique cTCD allows for RLS visualization in PFO patients with a good correlation with cTEE and can be used as a screening test before cTEE.

scholarly journals Accuracy of Visual Tests for Primary Cervical Cancer Screening in Rural Nepal

2018 ◽  
Vol 56 (214) ◽  
pp. 917-923
Author(s):  
Niresh Thapa ◽  
Muna Maharjan ◽  
Girishma Shrestha ◽  
Narayani Maharjan ◽  
Deborah Lindell ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Negative Predictive Value ◽  
Cervical Cancer Screening ◽  
Predictive Value ◽  
Odds Ratio ◽  
Screening Program ◽  
Diagnostic Odds Ratio ◽  
Screening Tests ◽  
Resource Setting

Introduction: In Nepal, cervical cancer is the most common female cancer. Unfortunately, there is no uniform effective screening system available all around the country. The objective of this study is to evaluate the cytology, Visual Inspection with Acetic Acid and with Lugol’s Iodine alone or in combination to detect a pre-cancerous lesion in rural Nepal.Methods: It is an analytical cross-sectional study. Convenience sampling technique was used to select participants who were apparently healthy, married, non- pregnant women of aged 20-65 years for cervical cancer screening program. Screening tests were performed on all eligible women (n=2143) after socio-demographic and reproductive health data collection. A biopsy was applied as a gold standard test. Cross-tabulations were used to describe the test sensitivity, specificity, positive predictive value, and negative predictive value at a 95% confidence interval. Diagnostic odds ratio was also calculated. Results: A majority, 2143 (94%), of women accepted and participated in this study. The sensitivity vs specificity of cytology, VIA, and VILI was 57.1% vs 98.3%, 71.4% vs 88.8% and 78.6% vs 85.1%, and of the co-testing of ‘Both positive VIA and VILI’ and ‘Either positive VIA or VILI’ was 64.3% vs 85.7% and 90.1% vs 83.7% respectively. Negative predictive value of all tests exceeded 99.7%. Cytology had the highest Diagnostic odds ratio (64.9), followed by the co-test ‘Either positive VIA or VILI’ (27.7).Conclusions: Cervical cancer screening by co-testing ‘Either positive VIA or VILI’ is more useful than cytology; VIA and or VILI are easy, safe, feasible and well-accepted tests in a low resource setting, Nepal.

scholarly journals Bayesian updating and sequential testing: overcoming inferential limitations of screening tests

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Jacques Balayla
Keyword(s):  
Positive Predictive Value ◽  
Predictive Value ◽  
Bayesian Updating ◽  
Bayes Theorem ◽  
Disease Prevalence ◽  
Positive Test ◽  
Screening Tests ◽  
Sequential Testing ◽  
Widespread Application ◽  
Test Probability

Abstract Background Bayes’ theorem confers inherent limitations on the accuracy of screening tests as a function of disease prevalence. Herein, we establish a mathematical model to determine whether sequential testing with a single test overcomes the aforementioned Bayesian limitations and thus improves the reliability of screening tests. Methods We use Bayes’ theorem to derive the positive predictive value equation, and apply the Bayesian updating method to obtain the equation for the positive predictive value (PPV) following repeated testing. We likewise derive the equation which determines the number of iterations of a positive test needed to obtain a desired positive predictive value, represented graphically by the tablecloth function. Results For a given PPV ($$\rho$$ ρ ) approaching k, the number of positive test iterations needed given a prevalence of disease ($$\phi$$ ϕ ) is: $$n_i =\lim _{\rho \rightarrow k}\left\lceil \frac{ln\left[ \frac{\rho (\phi -1)}{\phi (\rho -1)}\right] }{ln\left[ \frac{a}{1-b}\right] }\right\rceil \qquad \qquad (1)$$ n i = lim ρ → k l n ρ ( ϕ - 1 ) ϕ ( ρ - 1 ) l n a 1 - b ( 1 ) where $$n_i$$ n i = number of testing iterations necessary to achieve $$\rho$$ ρ , the desired positive predictive value, ln = the natural logarithm, a = sensitivity, b = specificity, $$\phi$$ ϕ = disease prevalence/pre-test probability and k = constant. Conclusions Based on the aforementioned derivation, we provide reference tables for the number of test iterations needed to obtain a $$\rho (\phi )$$ ρ ( ϕ ) of 50, 75, 95 and 99% as a function of various levels of sensitivity, specificity and disease prevalence/pre-test probability. Clinical validation of these concepts needs to be obtained prior to its widespread application.

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