What Is the Justification for the Practice of Examination Under Anesthesia Plus Biopsy for Suspected Cervical Cancer?

Abstract

Background: Management of suspected cervical cancer involve diagnosis by way of histologic evaluation of biopsy specimen and subsequent staging to determine spread to guide the choice of treatment modality. It is not uncommon to find examination under anesthesia plus biopsy as a single procedure in an operating theater list in Nigeria. The rationale for combining diagnostic procedure with staging procedure is hereby queried. Aim: To understand the rationale for the practice of combining examination under anesthesia with biopsy of suspected cervical cancer in Nigeria and project possible impact of such practice on quality of care to the patient. Methods: The study adopted combination of structured questionnaire and key informant interview. Structured questionnaires were administered to doctors below the level of consultants in departments of obstetrics and gynecology of 2 tertiary health institutions where examination under aneasthesia plus biopsy is being practiced. The questions were in four domains to assess the following; 1. Demographics 2. Any difference between knowledge and the practice of evaluation of suspected cervical cancer 3. Why combine examination under anesthesia with biopsy 4. Willingness to perform outpatient biopsy while key informant interview was conducted on randomly selected 10 consultants with interest in gynae-oncology. Results: Fifteen doctors from 2 departments of obstetrics and gynecology in 2 tertiary health institutions completed the questionnaire. Majority of the respondent were male 12/15 (80%), with average year of practice experience of 4.7 years (SD 3.5). While 100% of the respondents are duly aware of the role of cervical biopsy in confirming diagnosis of cervical cancer, none, 0% have done or witnessed cervical biopsy as an outpatient procedure. Majority 87% were not comfortable to perform outpatient biopsy of the cervix mainly because of fear of bleeding. While all the consultants were willing to perform outpatient cervical biopsy none routinely does it because of logistics. Conclusion: There is no evidence to support routine combination of examination under anesthesia and biopsy of suspicious cervical lesion. Unfounded fear of uncontrollable bleeding and lack of outpatient biopsy services are the major factors promoting the practice. Consequently, there is need for sensitization of gynecologic departments on safety of outpatient biopsy services.