Abstract
Background: Screening for cancer of the cervix at Kenyatta National Hospital (KNH), follows the recommended three-step strategy; Papanicolaou (Pap) smear, colposcopy/biopsy and loop electrosurgical excision procedure (LEEP)/biopsy. This approach poses the following challenges: multiple clinic visits, costly, time consuming, long turnaround time to treatment, non-compliance and loss-to-follow-up. Objective: To determine the agreement between histologies following colposcopy and LEEP amongst women in KNH as a forerunner for opportunity to shift from the three-step approach to the two-step “see and treat” (same-day colposcopy and LEEP) approach. Methods: This was a retrospective descriptive cohort of Women who underwent LEEP procedure between January 2008 and 31st December 2010 following the three-step approach at KNH, Kenya. Results: A total of 124 patients out of the 132 patients who underwent LEEP were included in the analysis. The 8 patients excluded had missing files. HIV infected, uninfected or unknown women are similar socio-demographically. The mean (SD) age for the HIV infected, uninfected and unknown is 37 (6), 33 (10) and 35 (9) years respectively. Colposcopic and LEEP biopsy histology within patients demonstrated a high weighted kappa statistics agreement of 84%. LEEP increased diagnosis of invasive cancer. Patients had a median (IQR) 5 (4 - 6) clinic visits from Pap smear to LEEP treatment. It took median (IQR) 55 (27 - 116) days between Pap smear to colposcopy result and 167 (101 - 276) days between Pap smear results to LEEP treatment. If a LEEP procedure were to be performed in this cohort of women on the same day of the colposcopy biopsy a median (IQR) 77 (55 - 137) days could have been saved. Conclusion: There is a high agreement between colposcopy and LEEP biopsies in our setting offering a window of opportunity to perform “See and Treat” same-day colposcopy and LEEP treatment procedure, skipping the colposcopy biopsy stage.
Highlights
Detection and treatment of cervical intraepithelial neoplasia (CIN) whose aetiopathogenesis is oncogenic sub-types of Human Papilloma Virus (HPV); is key in abating invasive cancer of the cervix [1,2]
There is a high agreement between colposcopy and loop electrosurgical excision procedure (LEEP) biopsies in our setting offering a window of opportunity to perform “See and Treat” same-day colposcopy and LEEP treatment procedure, skipping the colposcopy biopsy stage
Muruka et al / Open Journal of Obstetrics and Gynecology 3 (2013) 313-318 of the cervix at Kenyatta National Hospital (KNH), follows the three-step strategy recommended by the American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines, which entails Papanicolaou (Pap) smear, colposcopy/biopsy and Loop electrosurgical excision procedure (LEEP)/biospy [6]
Summary
Detection and treatment of cervical intraepithelial neoplasia (CIN) whose aetiopathogenesis is oncogenic sub-types of Human Papilloma Virus (HPV); is key in abating invasive cancer of the cervix [1,2]. Muruka et al / Open Journal of Obstetrics and Gynecology 3 (2013) 313-318 of the cervix at Kenyatta National Hospital (KNH), follows the three-step strategy recommended by the American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines, which entails Papanicolaou (Pap) smear, colposcopy/biopsy and Loop electrosurgical excision procedure (LEEP)/biospy [6] Challenges presented by this approach in resource constraint settings to the patient include: multiple clinic visits, costly, time consuming, protracted duration from diagnosis to definitive treatment with poorer prognosis, psycho-social sequelae while awaiting biopsy results, non-compliance to treatment and loss-to-follow-up [6]. Screening for cancer of the cervix at Kenyatta National Hospital (KNH), follows the recommended three-step strategy; Papanicolaou (Pap) smear, colposcopy/biopsy and loop electrosurgical excision procedure (LEEP)/biopsy This approach poses the following challenges: multiple clinic visits, costly, time consuming, long turnaround time to treatment, non-compliance and loss-to-follow-up. Conclusion: There is a high agreement between colposcopy and LEEP biopsies in our setting offering a window of opportunity to perform “See and Treat” same-day colposcopy and LEEP treatment procedure, skipping the colposcopy biopsy stage
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