Cervical Screening by Pap Test and Visual Inspection Enabling Same-Day Biopsy in Low-Resource, High-Risk Communities.

OBJECTIVE: To develop an effective, low-cost, single-visit cervical screening strategy incorporating a modified Pap test and visual inspection with acetic acid and Lugol's iodine for low-income settings. METHODS: We conducted a prospective cohort trial. Two low-income Muslim Uyghur communities in China's far western Kashi Prefecture served as pilot and validation study sites, respectively, and 4,049 women (aged 30-59 years) were screened. The conventional Pap test was modified using a cotton swab to collect cervical cells without scraping the cervix using an Ayre spatula, allowing visual inspection with acetic acid (and visual inspection with Lugol's iodine if visual inspection with acetic acid was negative) to be performed in a single visit. Results from both tests were available within 1-2 hours. Women positive for either or both underwent same-day biopsy that was shipped by a courier service to a central pathology laboratory. RESULTS: Single-visit screening incorporating both a modified Pap test and visual inspection achieved a sensitivity of 96.0% (95% CI 91.6-100), which was superior to Pap testing (76%, 95% CI 66.3-85.7; P<.001) or visual inspection with acetic acid-visual inspection with Lugol's iodine (48%, 95% CI 36.7-59.3; P<.001) alone in detecting cervical intraepithelial neoplasia (CIN) 2 or worse lesions. Rapid interpretation of both diagnostic procedures facilitated efficient same-day biopsy that achieved a negative predictive value of 98.2% in detecting CIN 2 or worse lesions. The increased sensitivity and minimized loss of follow-up allowed this approach to identify an extremely high prevalence of CIN 1 (2,741/100,000, 95% CI 2,238-3,245/100,000), CIN 2 or 3 (1,457/100,000, 95% CI 1,088-1,826/100,000), and cervical cancer (395/100,000, 95% CI 202-589/100,000) among these underscreened, at-risk women. CONCLUSION: Single-visit cervical screening with both a modified Pap test and visual inspection has greater sensitivity to detect high-grade CINs, reduces loss of follow-up, and could be an efficient low-cost strategy for low-resource settings.

The diagnostic, prediction of postoperative recurrence and prognostic value of HE4 in epithelial ovarian cancer.

PURPOSE: To explore the clinical value of the level of human epididymis protein 4 (HE4) in serum in the diagnosis, prediction of postoperative recurrence and prognosis of epithelial ovarian cancer (EOC). METHODS: A total of 103 EOC patients and 121 individuals with benign ovarian lesions were selected. All of them were admitted to our hospital between January 2013 and January 2014 as group A (EOC, n=103) and group B (benign ovarian lesions, n=121), respectively. Additionally, 106 serum samples collected from healthy people who underwent physical examination were selected as group C. The serum levels of HE4 were assessed one day before and one day after the operation to reveal differences among the three groups. In addition, we analyzed the clinical value of HE4 in the diagnosis, prediction of recurrence and progression-free survival (PFS) of EOC patients. RESULTS: In group A, the level of HE4 was significantly higher than in groups B and C (p<0.05), while comparison between the group B and C revealed no statistically significant difference (p>0.05). The sensitivity, specificity, positive predictive value and negative predictive value of HE4 in the diagnosis of EOC were 82.52, 84.46, 83.47 and 92.34%, respectively. In the prediction of recurrence of EOC, the sensitivity and specificity of HE4 alone were 87.57 and 92.45%, respectively, while the sensitivity and specificity of HE4 combined with CA-125 were 93.45 and 94.24%, respectively. In addition, the level of HE4 showed a significant negative effect on PFS (p<0.05). CONCLUSIONS: Detection of HE4 is conducive to the diagnosis and prediction of recurrence of EOC, and HE4 in high concentration suggests poor prognosis.