Mobile colposcopy by trained nurses in a cervical cancer screening programme at Battor, Ghana

Objectives: Cervical precancer screening programs are difficult to establish in low resource settings partly because of a lack of human resource. Our aiming was to overcome this challenge. We hypothesized that this could be done through task shifting to trained nurses. Design: Descriptive retrospective cross-sectional review. Setting: Training was at the Cervical Cancer Prevention and Training Center (CCPTC) and screening was carried out at the clinic and at outreaches / peripheral facilities.Participants: All women who reported to the clinic for screening or were recruited during outreaches Interventions: All 4 nurses were trained for at least 2weeks (module 1). A total of 904 women were screened by the trained nurses using the EVA system. Quality assurance was ensured. Main outcome measures: Primary screening and follow-up were carried out by the trained nurses with quality assured through image sharing and meetings with peers and experienced gynaecologists. Results: 828 women had primary screening and 76 had follow-up screening. 739 (89.3%) were screened at the clinic and 89 (10.7%) at outreaches/peripheral facilities. Of all screened, 130 (14.5%) had cervical lesions, and 25 (2.8%) were treated, 12 (48.0%) by Loop Electrosurgical Excision Procedure (LEEP) performed by a gynaecologist, 11 (44.0%) with thermal coagulation by trained nurses except one, and 2 (8.0%) with cryotherapy by trained nurses. Conclusion: We demonstrate the utility of a model where nurses trained in basic colposcopy can be used to successfully implement a cervical precancer screening and treatment program in low-resource settings

Correlation between colposcopic impression and histologic diagnosis of premalignant lesions of the cervix

Background: Cervical cancer is the commonest cancer in sub-Saharan African with majority of the women presenting with an advanced disease stage. This is largely due to the unavailability of an established cervical cancer screening programme in most countries. This also includes the use of colposcopy which is still not available to many gynaecologists practicing in Nigeria. Aim: To review reports of colposcopy carried out at the University of Abuja Teaching Hospital, Abuja, Nigeria and to determine the degree of concurrence between colposcopic impression and histologic diagnosis. Methods: A retrospective analysis of the colposcopic findings of 84 patients was done. Subsequent correlation with histopathology report was carried out in 53 patients who had colposcopically directed biopsies between March 2012 and February 2014. Results: The commonest impression made on colposcopy was high grade CIN in 40(47.6%) patients. The concurrence rate between colposcopic findings and histology diagnosis was 64.2% (34/53) {K =0.302, 95%CI= -0.010-0.436}. The concurrence rate was higher for high grade CIN 29/40(72.5%) than for low grade CIN 5/12 (41.7 %). There was an overestimation of colposcopic diagnosis in 13(24.5%) patients and an underestimation in 6(11.3%) patients. The sensitivity of colposcopy for detecting high grade lesions or more was 32/36(88.9%) while the specificity was 8/17(47.1%). False positive rate for high grade lesions was 9/17(52.9%) and false negative rates for low grade lesions was 4/36(11.1%). Positive predictive value (PPV) of high grade colposcopic diagnosis or more was 32/41(78.04%) while the negative predictive value (NPV) was 8/12(66.73%). Conclusion: The strength of agreement between colposcopic diagnosis and cervical pathology was fair and colposcopy performs better in the detection of high grade lesions

Intégration de la colposcopie comme méthode de dépistage des lésions précancéreuses et cancéreuses dans le paquet minimum d'activités dans une maternité niveau 3 sur une série de 569 cas. Exemple du CHU de Yopougon - Abidjan

Contexte : Les techniques de dépistage des lésions précancéreuses les plus efficaces et rentables dans les pays africains comprennent les inspections visuelles à l'aide de tests d'acide acétique et lugol tels que recommandés par l'OMS car peu coûteuses, indolores, simples à réaliser, reproductibles, socialement et culturellement acceptables, sans effets secondaires avec des résultats immédiats.Objectifs : Déterminer le taux de participation des femmes et ses déterminants, la prévalence des lésions précancéreuses et leur prise en charge. Patientes et méthodes : De janvier 2011 à décembre 2013, 569 femmes volontaires âgées de 18 à 65 ans, ayant eu une activité sexuelle ou non, porteuse ou non d'une grossesse de moins de 15 semaines d'aménorrhée, après un passage en consultation ou aux urgences pendant lesquelles, un dépistage par la méthode visuelle a été proposé ont été incluses. La colposcopie a eu lieu au service de Gynécologie-Obstétrique du Centre Hospitalier Universitaire de Yopougon Abidjan. Les prélèvements biopsiques étaient acheminés au laboratoire d'anatomie pathologie du Centre Hospitalier Universitaire de Treichville Abidjan. Les données ont été recueillies et analysées en utilisant le logiciel Epi info version 3.4.5.Résultats : Le taux de participation des femmes était en général de 6,03%. L'âge moyen de la population était de 40,3 ans IC1-α [36,2-44,4]. La moitié de la population (52,4%) n'avait pas de revenus fixes, et 36,9% d'entre elles étaient non-instruites. 74,2% des femmes habitaient la commune et étaient situées dans un rayon de 10 km. 20,2% des patientes étaient ménopausées. Les lésions acidophiles et iodo-négatives étaient respectivement de 8 et 10%. La prévalence des lésions précancéreuses et cancéreuses à la colposcopie était de 9,3% des cas. Les néoplasies intra épithéliales (CIN) CIN 1 représentaient près de la moitié des cas prélevés (44,8%) quand les CIN 2 et + totalisaient 20,7%. Soixante-huit virgule neuf pour cent (68,9%) des transformations atypiques (TAG) avaient des néoplasies intra-épithéliales de tout grade confirmées histologiquement. L'hystérectomie simple et l'électro-conisation ont été effectué respectivement chez 5,7 et 11,3% des femmes toutes CIN 2 et +. La cryothérapie avait été faite chez les femmes jeunes avec une CIN 1 soit 24,5%. Conclusion : Intégrée dans le paquet minimum des activités des centres hospitaliers, la colposcopie pourrait contribuer à la réduction de l'incidence et la mortalité liée au cancer du col de l'utérus dans nos pays

Impact of Introduction of a Colposcopy Service in a Rural South African Sub-District on Uptake of Colposcopy

Objective.To describe the establishment of a colposcopy service at a district hospital in a rural sub-district of the Western Cape; South Africa; and assess its impact on colposcopy uptake. Design. A retrospective double-group cohort study using a laboratory database of cervical cytology results; clinical records and colposcopy clinic registers.Setting. The Overstrand sub-district; where 80 000 people are served by seven clinics and a district hospital in Hermanus; 120 km from its referral hospitals in Cape Town and Worcester. A colposcopy service was established at Hermanus Hospital in 2008.Subjects. All women in the sub-district who required colposcopy on the basis of cervical smears done in 2007 and 2009.Outcome measures. Numbers of women booked for colposcopy at distant referral hospitals in 2007 and at the district hospital in 2009; the proportions who attended colposcopy; the time from cervical smear to colposcopy; and comparison between the two years.Results. Uptake of colposcopy booked at distant referral hospitals was 67 in 2007. Uptake improved by 18 to 79 for the district hospital colposcopy service in 2009 (p=0.06). When patients from an area with no public transport to the district hospital were excluded from analysis; the improvement was more marked at 22 (p=0.02). The delay from cervical smear to colposcopy improved significantly from 170 to 141 days (p=0.02).Conclusion. Establishment of a colposcopy service in a rural sub-district increased uptake of colposcopy and decreased the delay from cervical smear to colposcopy. The service removed 202 booked patients in one year from the colposcopy load of the referral hospitals

Evaluation des lesions precancereuses et cancereuses du col uterin par les methodes visuelles (IVA; colposcopie) aux Cliniques Universitaires de Kinshasa

Introduction. Le cancer du col uterin demeure un probleme de sante publique dans les pays endeveloppement; a cause de son diagnostic tardif et de son mauvais pronostic. Sa prevention secondaire se fait par le depistage des lesions precancereuses et cancereuses du col. Objectif. Evaluer la faisabilite et les performances diagnostiques de l'IVA par rapport a la colposcopie prise comme test de reference. Methodologie. Cette etude transversale a ete realisee aux Cliniques Universitaires de Kinshasa; de juillet 2009 a avril 2010; aupres de 350 femmes agees de 25 a 75 ans recues en consultation de gynecologie. Apres un consentement eclaire; les sujets ont subi un examen clinique comprenant l'anamnese; l'examen physique general; et l'examen gynecologique. Le test a l'IVA a ete realise a l'examen au speculum; suivi de la colposcopie. Resultats. Sur 350 femmes; 70 (20) ont ete positives a l'IVA. A la colposcopie des lesions intramalpighiennes de bas grade ont ete constatees chez 57 patientes (16;3) ; des lesions intramalpighiennes de haut grade chez 7 (2); et des lesions de cancer chez 9 patientes (2;6) . La sensibilite; la specificite; les valeurs predictives positive et negative de l'IVA par rapport a la colposcopie; ont ete respectivement de 89; 98; 93et 97. Conclusion. Compte tenu de sa sensibilite et sa specificite excellentes; l'IVA apparait comme une technique fiable et adapte pour le depistage du cancer du col uterin en situation de precarite

Colposcopy and Gytodiagnosis in the Prevention of Cervical Malignancies

Background:The aim of this study was to establish the value of cytology; colposcopy; and pathohistology in the prevention of cervical malignancies. Methodology: A prospective study involving 750 patients hospitalized in the Obstetric-Gynecologic department during the period between January 2008 to January 2009 for different reasons in whom cervical dysplasia were noted on speculum examination or who showed typical clinical symptoms; direct biopsy was also obtained from 117 patients. Results: 272 of the 750 patients (36.27) showed clinical symptoms of cervical pathology. Atypical epithelial changes noted during colposcopy were more frequent in patients 31-40 years of age (60 patients; 32.09) and 41- 50 years of age (59 patients; 31.55). Histopathological changes were noticed in 19 cases (16.24) of cervical dysplasia at different stages; six cases (5.13) of carcinoma in situ; and three cases (2;56) of invasive carcinoma. Conclusions: The correct clinical evaluation of cervical epithelial alterations enables a prompt diagnosis and the timely implementation of appropriate therapeutic measures

'Look and Lletz/' ­ a Chris Hani Baragwanath Hospital experience

Objectives. An audit was undertaken of a 'colposcopy and treatment' clinic between April 2003 and December 2006; to determine: (i) the frequency of overtreatment with Papanicolaou smear on its own; colposcopy on its own or a combination of the two methods; (ii) differences in overtreatment between patients who are HIV positive and those who are HIV negative; and (iii) the short term complications of Lletz (large loop excision of the transformation zone) at this clinic. Design. A retrospective analysis of data from the colposcopy clinic database of patients; who were referred according to national guidelines. Setting. Patients who are referred to Chris Hani Baragwanath hospital. Results. Normal histology was found in 1.3 of patients; and cervical intraepithelial neoplasia (CIN) 1 or human papillomavirus (HPV) in 8.4. The overall complication rate was 3. Conclusion. The high loss to follow-up and the low early complication rate together with an acceptable overtreatment rate make this a justifiable approach in our situation. HIVnegative women were more likely to be overtreated than HIVpositive patients (p=0.03)

Inspection visuelle comme procede de depistage du cancer du col uterin. A propos d'une serie de 312 patientes colligees au CHU de Yopougon

Le cancer du col de l'uterus est: l'une des principales causes de mortalite chez les femmes; dans les pays en developpement depourvus de moyens necessaires pour generaliser le depistage cytologique. Aussi; comme la decouverte d'une tumeur du col; a son debut; assure aux femmes de meilleures chances de survie que n'importe quel traitement administre plus tard; differentes etudes sont en cours; tendant a evaluer l'impact du depistage de La maladie au stade ou elle est cliniquement decelable. L'inspection visuelle du col uterin est ainsi en cours de validation dans de nombreux pays en developpement ou elle a ete proposee comme une alternative a la cytologie classique. Nous avons effectue une etude prospective dont l'objectif est d'evaluer les probabilites conditionnelles de l'inspection visuelle du col uterin dans le depistage du cancer du col. Elle a concerne une serie de 312 patientes recrutees en consultation externe au CHU de Yopougon. Nos resultats sont les suivants: *La frequence de detection des lesions precancereuses et cancereuses est de 14;75pour cent. ; *L'age inferieur a 19 ans aux premiers rapports sexuels et le bas niveau d'instruction sont les facteurs de risques individualises dans l'apparition des lesions precancereuses et cancereuses ; La combinaison du test a l'acide acetique et au Lugol est la meilleure de tous les tests etudies en terme de sensibilite (100pour cent) ; -L'absence de colposcopie a grevee la performance du test a l'acide acetique

Diagnostic colposcopique des ecoulements genitaux

Une colposcopie systematique a ete realisee chacune des 200 femmes ayant consulte pour ecoulement genital. Quatre varietes d'ecoulement genital ont constitue les motifs de consultation : lochies; leucorrhees; metrorragies; hydrorrhees. Il s'est agi de femmes jeunes; dont l'age moyen a ete de 40;5 ans. Les diagnostics retrouves a la suite des colposcopies ont ete : infection; pathologie benigne; neoplasie intra-epitheliale; cancer. Dans 68 cas le col uterin etait sain