ABSTRACT
Background: Cervical cancer is the fourth most frequent cancer in women according to World Health Organization. In India the incidence is approximately 1 in 53 compared with 1 in 100 women in more developed regions of the world. Cervical cancer is eminently preventable by early detection using various screening tests like Pap smear, colposcopy, HPV testing. In this study we aim to evaluate the use of colposcopy in early detection of cervical cancer and also assess risk factors for the same. Primary objective was to study the correlation between colposcopic findings and histopathological analysis with a secondary objective to assess risk factors for development of cervical neoplasia.Methods: The study was carried over a period of 2 years (October 2016 to October 2018) with a sample size of 60 in the department of obstetrics and gynecology at tertiary care centre. Participants who fit the inclusion criteria were included in the study after taking a written and informed consent. The colposcopy findings were correlated with the histopathological findings of the cervical biopsy that was undertaken.Results: Colposcopy impression had sensitivity of 93.8% in predicting the histopathology, specificity was 77.3%, positive predictive value was 60%, negative predictive value was 9% and the diagnostic accuracy was 81.7%. On analyzing the risk factors, it was found that the odds of malignant histopathology were 0.55 times decreasing with each unit increase in age (at first intercourse) (p value<0.05).Conclusions: Colposcopy gives immediate and accurate results and its value as a diagnostic test is undisputable. The sensitivity of colposcopy is high and hence in high risk population or remote places where women do not turn for regular screening tests, colposcopy can be used primarily as the screening test.
ABSTRACT
INTRODUCTION: Visual inspection with 5% Acetic acid (VIA) as a low cost screening method has good sensitivity with the limitation of low specificity and low positive predictive values. The present study therefore evaluates the performance of secondary testing by human papillomavirus (HPV) test and Colposcopy in a single‑visit screening approach to increase program effectiveness in limited health‑care resources settings. MATERIALS AND METHODS: In a cross‑sectional cervical cancer screening trial, 3629 women (30‑65 years) were screened by primary screening test VIA. VIA test positive women were subsequently tested for the presence of oncogenic HPV types by hybrid capture II and with colposcopy. The reference investigation histopathology was performed for all primary screen positive women. RESULTS: Data for 3613 evaluable women showed 352 (9.7%) women positive on primary screening by VIA. VIA had a sensitivity of 93% (95% confidence interval (CI): 0.76‑0.99) and specificity of 91% (95% CI: 0.90‑0.92) respectively to detect the cervical intraepithelial neoplasia grade 2+ . HPV DNA and colposcopy as secondary tests to triage VIA positive women had a sensitivity of 61% (95% CI: 0.41‑0.78), 43% (95% CI: 0.24‑0.63) and specificity of 99% (95% CI: 0.99‑1.00), 99% (95% CI: 0.99‑0.99) respectively for detecting CIN2+ lesions. CONCLUSION: Two step screening model combining highly sensitive low cost test like VIA for primary screening followed by more specific HPV DNA test as triage test for primary screen positive can be a cost‑effective cervical screening strategy in resource constrained settings.