Acetowhite Lesions Research Articles

Congenital Transformation Zone Mimicking Cervical Premalignant Lesion.

Congenital transformation zone (CTZ) of the uterine cervix is a non-neoplastic, rare condition resembling high-grade lesions on colposcopic examination which leads to diagnostic dilemmas.Case DescriptionA multiparous woman was screened for cervical cancer. Visual inspection using acetic acid was positive for which further evaluation with colposcopy was done. An aceto-white lesion resembling high-grade precancerous condition was seen. Punch biopsy was taken from multiple areas and the histopathology report demonstrated chronic cervicitis with increased maturation of the superficial layers of squamous epithelium. The lesion persisted on the follow-up colposcopy even after a course of antibiotics. CTZ could be difficult to differentiate from cervical premalignant lesions. The main aim of this article is to help other colposcopists to understand this physiological variant. The CTZ is a physiological entity and differential diagnosis for cervical premalignant lesions on colposcopy.

Low-Cost Technology for the Prevention of Cervical Cancer in Cameroon

PURPOSE Our aim was to assess the accuracy of visual inspection with acetic acid (VIA) as a screening method for cervical lesions. METHODS VIA and cytologic smears were carried out on the cervices of nonpregnant women age 30 to 60 years with no previous history of cervical cancer. Cervices with acetowhite lesions or positive Pap smears, as well as 1 in 10 negative cervices (control), were biopsied. RESULTS Of patients, 10,020 women were enrolled and 9,626 (96.1%) were screened. With screening, 9,534 patients (99.0%) had adequate cytology smears, 1,148 (11.9%) underwent colposcopy, and 3,486 biopsies were obtained, of which 1,056 were controls. Sensitivity of VIA was 70.4% versus 47.7%, specificity was 77.6% versus 94.2%, positive predictive value was 44.0% versus 67.2%, and negative predictive value was 91.3% versus 87.8% for Papanicolau test, respectively. CONCLUSION VIA has acceptable test qualities and is now well implemented as a large-scale screening method in Cameroon.

Visual Inspection Using Acetic Acid (VIA) and Pap’s Smear as Methods of Cervical Cancer Screening: An Experience of Dhaka Medical College Hospital, Dhaka, Bangladesh

Background: National screening programme for cervical cancer has been running in Bangladesh since 2004 through visual inspection using acetic acid (VIA). However, Pap’s smear is also used for the same, where it is available.Objectives: To see the effectiveness of VIA and Pap’s Smear as cervical cancer screening methods.Methods: This prospective study was done on 600 women who attended the outpatient gynaecology clinic and cervical cancer screening programme underwent both VIA and Pap’s smear cytology. Histopathology was taken as gold standard to compare the performance of VIA and cytology (Pap’s smear). Hence, positive cases were further subjected to colposcopy directed biopsy. Then the sensitivity and specificity of VIA and Pap’s smear were compared. The study was done in Dhaka Medical College Hospital, Dhaka, between July and December 2012.Results: On VIA, 46 had aceto-white lesions and on Pap’s smear, 28 had atypical squamous cells of undetermined significance (ASCUS) or worse lesions out of 600 women screened. 22 were positive on both VIA and cytology; 24 were positive on VIA only; and 6 were positive on cytology only. Histological diagnosis of CIN/carcinoma cervix was found in 36 positive cases, who underwent biopsy (n=52). Among them, 20 were picked up from Pap’s smear positive cases, whereas, 34 were VIA positive cases. VIA was found more sensitive (94.44%) than Pap’s smear (55.55%), which was statistically significant (p<0.001). However, the specificity of VIA was slightly lower (97.87%) than that of cytology (98.58%). Positive predictive value (PPV) of VIA was 73.91% for VIA and 71.42% for Pap’s smear, while Negative Predictive Value (NPV) were 9.63% and 97.2% respectively.Conclusion: VIA has got much more sensitivity and slightly lower specificity than that of Pap’s smear in cervical cancer screening.International Journal of Human and Health Sciences Vol. 04 No. 03 July’20 Page : 189-193

How long is too long? Application of acetic acid during colposcopy: a prospective study

Application of acetic acid to the cervix followed by colposcopic assessment with or without colposcopically directed biopsy is the standard test used to detect dysplastic lesions of the cervix. However, there is no evidence-based common standard defining how exactly to perform this test. To prospectively define the optimal timing for the colposcopic assessment of acetowhite lesions. Consecutive women referred to our colposcopy unit were recruited. Using a standardized colposcopy protocol, we recorded the most severe colposcopic lesion 1, 3, and 5 minutes after application of acetic acid (primary study end point). The time to first appearance of the most severe colposcopic lesion, highest staining intensity, and fading of the most severe colposcopic lesion were video documented (secondary study end points, assessed independently by 3 raters). Results were compared using parametric and nonparametric tests. A total of 300 women were included. After 1 minute, 290 of 300 patients (96.7%) were diagnosed with the most severe colposcopic lesion. This proportion did not improve after 3 minutes (290/300 [96.7%]) or after 5 minutes (233/264 [88.3%]). The proportion of minor and major changes continuously declined over time from 142 in 300 (47.3%; 1 minute) to 107 in 264 (40.5%; 5 minutes) and from 110 in 300 (36.7%) to 91 in 264 (34.5%), respectively. The median time until the first appearance of the most severe colposcopic lesion was 13.5 (interquartile range, 3-27.25) seconds and was significantly lower in high-grade squamous intraepithelial lesion (7 [interquartile range, 1-20] seconds) compared to low-grade squamous intraepithelial lesion (19 [interquartile range, 9-39.5] seconds; P < .001). We observed fading of acetowhite lesions in 78% of cases, occurring at a median of 191 (interquartile range, 120-295) seconds after application of acetic acid. Fading started earlier in high-grade squamous intraepithelial lesion compared to low-grade squamous intraepithelial lesion (179.5 [interquartile range, 110- 253.25] versus 212.5 [interquartile range, 146.5-300]; P= .044). Overall, the net difference between colposcopic assessments at 3 minutes versus at 1 minute was 1 more high-grade squamous intraepithelial lesion and 1 less low-grade squamous intraepithelial lesion. It is reasonable to conclude that the best time to identify lesions is 1 minute after the application of acetic acid. Continued evaluation for up to 3 minutes may be considered reasonable for an optimal high-grade squamous intraepithelial lesion yield. However, fading of acetowhite lesions is common, especially in high-grade squamous intraepithelial lesions, and supports a recommendation of not prolonging colposcopy beyond 3 minutes.

Comparison between anal cytology, high-resolution anoscopy and HPV DNA genotyping by polymerase chain reaction in the post-treatment follow-up of condylomata acuminata.

to evaluate the presence of subclinical HPV-induced anal lesions with anal cytology, High-Resolution Anoscopy (HRA) and HPV genotyping by polymerase chain reaction (PCR) in the follow-up of treated condylomata acuminata (CA). seventy-nine male patients were included. One month after anal CA eradication, the patients underwent brush samples collection for anal cytology and PCR, and HRA with biopsy of acetowhite lesions. These methods were compared within all patients and between groups, according to Human Immunodeficiency Virus (HIV) infection status: HIV-negative; HIV-positive with TCD4 count above and below 350 cells/mm3. the most frequent HPV types were 6 and 16. HPV DNA was isolated in 92%. HIV infection was associated with a higher number of oncogenic HPV types (p=0.038). All patients with negative PCR had negative HRA and cytology. There were no differences in cytological, HRA or histopathological findings between groups. the association of the findings of cytopathology, HRA and genotyping of HPV refined the diagnosis of HPV-induced lesions. The degree of immunodeficiency was not associated with increase in remnant HPV-induced anal lesions.

1824 Description of the Endocervicoscopy Technique for the Identification of Acetowhite Lesions Before Cervical Cone

Video Objective To describe the endocervicoscopy technique for the identification of acetowhite lesions before cervical cone. Setting All women with a diagnosis of persistent low-grade squamous intraepithelial lesions and non-visible or partially visible union colposcopy and patients with HSIL and non-visible or partially visible union colposcopy. Patients with previous excisional treatments were excluded. Interventions Endocercoscopy technique for identification of acetowhite lesions placed in the endocervical canal Conclusion We show our experience in the implementation of a previously described practice. We show a good correlation between the location seen in the endocerviscoscopy and the surgical piece, that is the main objective to achieve tailored treatments.

Feasibility of visual inspection with acetic acid (VIA) screening for cervical cancer in Tanzania with emphasis on special populations.

5527 Background: Following the report that VIA screening reduced cervical cancer mortality by 31% in India (ASCO LBA2 2013; Shastri SS, et al JNCI 2014), the W.H.O. endorsed VIA guidelines for Africa, where the global disease burden is highest. In Tanzania, cervical cancer is a major source of morbidity and mortality, with nearly 10,000 new cases and 7,000 deaths annually. Due to lack of resources, therapies are limited and patient outcomes are further confounded by the relatively high prevalence of concurrent HIV infection. We report on the feasibility of VIA screening in Tanzania with emphasis on unique populations. Methods: Our two 5-day VIA screen-and-treat workshops in Buzuruga and Sangabuye Health Centres in Mwanza, Tanzania were approved by the University of California, Irvine IRB and local health authorities. Participants were recruited from surrounding communities and offered free cervical VIA screening, cryotherapy when indicated, and HIV rapid testing. Acetowhite lesions and/or abnormal vascular markings were VIA+. Chi-square and Fisher exact tests were performed with statistical significance assigned at 0.05. Results: During July 2018, 825 of 917 registered participants underwent VIA screening and 25.1% (n=207) were VIA+. 147 VIA+ non-pregnant women received same day cryotherapy and 15 (1.8%) with lesions suspicious for cancer were referred to Bugando Medical Center. In the subanalysis of 64 HIV+ patients (23 diagnosed at the workshops, 41 with prior diagnosis on ART), HIV infection was not associated with VIA positivity (p=0.497). Additionally, a non-significant trend of higher VIA+ screens among newly diagnosed untreated HIV patients (27.7%) vs patients with known HIV on ART (17.5%) was observed (p=0.556). Conclusions: VIA screening for cervical cancer, while feasible in Tanzania, will require follow-up and repetitive screening. Although cervical cancer is an AIDS-defining illness, lack of correlation between HIV infection and VIA-positivity may reflect the availability of W.H.O.-subsidized ART in sub-Saharan Africa to attenuate HPV-mediated neoplastic transformation, as previously reported by others. Further study of this phenomenon is warranted.

Comparison of cervical cancer screening by visual inspection with acetic acid versus cervical-cytology in pregnancy

Abstract Aims: The aim of this study was to compare visual inspection with acetic acid (VIA) with cervical cytology for cervical cancer screening in pregnant women. Settings and Design: A prospective cohort study was conducted after institutional ethical committee approval in a tertiary care hospital in Northern India. Pregnant women of gestational age &lt;28 weeks were randomly recruited from the antenatal clinic. Subjects and Methods: All eligible women had a Pap smear followed by VIA; colposcopy was performed if either test was positive. Swede score was used for grading of the acetowhite lesion; biopsy was planned if Swede score was ≥8. Statistical Analysis Used: The sensitivity, specificity, and predictive values for both screening methods were compared with colposcopy as the reference standard. Results: There were 370 low-risk pregnant women in the age group of 20–36 years in the study with a mean parity was 2.1, and the median period of gestation of 14.6 weeks. Abnormal Pap cytology was seen in 5.9% (n = 22) of patients; the abnormalities were ASCUS in 13 (59%), LSIL in 4 (18.2%), and AGC-NOS in 5 (22.7%) patients. VIA positivity was found in 8.4% (n = 31). The positive predictive value was 31.8% for cervical cytology and 48.4% for VIA (P = 0.001). No invasive lesion was detected. Positive predictive value of VIA was significantly higher than Pap cytology for detection of abnormal lesions. Conclusions: VIA is a cost-effective method with better predictive value than Pap smear for cervical cancer screening in pregnant women.

Prenatal Cervical Cancer Screening Using Visual Inspection with Acetic Acid in a Low Resource Setting

Cervical cancer is one of the most common malignancies among women in low resource setting. The objective of this study was to assess the acceptability of prenatal cervical cancer screening using visual inspection with acetic acid (VIA) in a low resource setting. This was a cross-sectional study conducted at Moi Teaching and Referral Hospital. Over a period of 12 months, we enrolled 331 women who were attending antenatal care clinic with a gestation of age of less than 22 weeks. We screened them for cervical cancer by applying 5% acetic acid to the cervix (VIA Method). Visualization of aceto-white lesions was interpreted as a positive VIA test. A cervicography was obtained for independent review by two clinicians. A repeat VIA test or colposcopy and biopsy were recommended at 6 weeks postpartum for those with a positive VIA test. Mean gestational age was 16 weeks. Seventy five percent of participants (n = 247) had used contraceptives, 31.1% (n = 103) had previously been screened for cervical cancer and 9.1% (n = 14) were HIV positive. The study clinician detected 11.3% VIA positive while first and second independent reviewers reported 22.5% and 7.7% VIA-positive results, respectively. About 85.7% of the participants did not experience any immediate adverse reaction as a result of the procedure. However, 3.8%, 38.4% and 0.7% experienced pain, burning sensation and bleeding respectively. Overall, 98.4% (n = 306) indicated that they would recommend the test, and 99% (n = 307) indicated that they would return for a repeat test 6 weeks postpartum. HIV status had no influence on VIA-positive rates (p = 0.909). The rate of VIA positive was 13.8% among the pregnant women. It is acceptable to use VIA to screen pregnant women for cervical cancer.

Increasing Breast and Cervical Cancer Screening Uptake in Women of Child-Bearing Age in Niger State, Nigeria

Background: Prevalence of breast and cervical cancer are on the increase in the developing countries despite the knowledge of how these diseases can be prevented through screening. Reproductive rights, Advocacy, Safe space and Empowerment Foundation (RAISE) initiated breast and cervical cancer screening program in Niger State as part of its reproductive health services. The program is hereby evaluated with the aim of improving its performance toward reducing burden of these diseases in Niger State. Aim: To evaluate the breast and cervical cancer screening program, to report the experience from the program, and to recommend necessary changes and scaling up of best practices. Methods: Audit of the breast and cervical cancer screening program was conducted. The basic components of cervical cancer screening programs; screening uptake, screening services, treatment of screen positives, follow-up and referrals were audited against previously set standards for the program. The difference in screening uptake for breast and cervical cancer was evaluated for better understanding of factors determining screening uptake in Niger state. Results: Between 18 July 2016 and 30 April 2018, 2035 women between the age of 15-75 years were screened for breast cancer and 1258 women between the age of 20-55 years were screened for cervical cancer, representing about 38% higher uptake of breast cancer screening compared with cervical cancer. The parity range of these women is 0-20. The mean age and parity for women screened during the audit period were; 35 years and 8 for breast cancer, while 29 years and 7 for cervical cancer. Fifty-two (2.56%) of the 2035 women screened for breast cancer had a palpable lump in either 1 or both breasts, while 4 (0.3%) of the 1258 women screened for cervical cancer had a positive result (aceto-white lesions) treated with cryotherapy. The women have low socioeconomic status with predominantly farmers, petty traders and housewives earning less than $2 per day. Most of the women are illiterate with little or no form of education. Other possible barriers for low uptake of breast and cervical cancer screening is lack of transportation, religious and cultural beliefs, shyness and lack of sensitization. Conclusion: Screening uptake is still very poor despite massive awareness campaign. The current awareness creation strategy has not been able to create needed demand for the available screening services. A total overhaul of awareness creation strategies is therefore advocated.

Visual inspection of cervix with acetic acid as a feasible screening test for cervical neoplasia among women attending at OPD in Rajshahi Medical College Hospital

Background: Visual inspection of cervix after application of 3-5% acetic acid (VIA) is a potential alternative to Pap smear cytology for screening of cervical cancer in resource poor settings.Objectives: This study was to evaluate the performance of visual inspection based screening approach in the detection of precancerous and early cancerous lesions of the cervix.Materials &amp; Methods: VIA was carried out in 540 eligible women attending Gynae OPD. Detection of well-defined, opaque, acetowhite lesion close to squamocolumnar junction or in transitional zone of the cervix constituted positive VIA. All screened women evaluated by colposcopy and biopsy were taken from colposcopically suspected areas. The final diagnosis was based on histology.Results: Out of 540 patients, 328 were VIA negative and 212 were VIA positive. Colposcopy showed normal results in 340 cases, low grade CIN in 138 cases, high grade CIN in 44 cases and cancer in 18 cases. There were biopsy proven chronic cervicitis and metaplastic changes in 423 cases, CIN I in 66 cases, CIN II in 25 cases, CIN III / carcinoma-in-situ in 5 cases. The sensitivity of VIA was 74.36%, specificity 70.45%, positive predictive value 41.04%, &amp; negative predictive value 90.85%.Conclusion: VIA can differentiate a normal cervix from a precancerous cervix with reasonable accuracy. As it is low cost and simple method, it can be set in any hospital or any health care centre of rural or urban areas of poor resource settings.KYAMC Journal Vol. 9, No.-2, July 2018, Page 56-60

Cervical Cancer Screening and Treatment Services in South West Shoa Zone of Oromia Region

Cervical Cancer Screening and Treatment Services in South West Shoa Zone of Oromia Region Hezkiel Petros, MD1, Andarge Abie Ayele1, BSc, MPH 1St. Luke Catholic Hospital , Waliso, Oromia Regional State, Ethiopia Abstract Introduction: Global cervical cancer incidence increased by 0.6% annually for the last 30 years and reached 454,000 cases per year in 2010. Cervical cancer death rates have been decreasing but the disease still killed 200,000 women in 2010, of which 46,000 were aged 15-49 years in developing countries. There are an estimated 7,000 new cases of cervical cancer in Ethiopia per year; nearly 5,000 people are estimated to die of the disease per year. Objective: To describe outcome of cervical cancer screening services in Walliso St. Luke Catholic Hospital, to assess patient characteristics and associated factorsand to suggest recommendations based on findings Method: Women who come for screening from September 2015-August 2016 at St. Luke Catholic Hospital in South West Shoa zone of Oromia region were included in the study. Patient sociodemographic characteristics, information on therapy and outcome were extracted from screening forms, log registration and patient files retrospectively with document review. Diagnosis of precancerous lesion is made by applying 3-5% acetic acid; positive precancerous lesions were treated with either cryotherapy or LEEP. Result: The hospital screened a total of 1,004 clients with VIA, 73 clients had aceto-white lesion, 68 clients were eligible for cryotherapy treatment and 93% were treated with see and treat approach. Conclusion and recommendation: The screening service is relatively good and with good treatment coverage rate, but the positivity rate is higher for some months so need to improve the quality of the screening and treatment services. (Ethiopian Journal of Reproductive Health 2018;10:15-21)

Screening for precancerous anal lesions with P16/Ki67 immunostaining in HIV-infected MSM.

BackgroundScreening of anal cancer in HIV-infected MSM with anal cytology results in high rates of false positive results and elevated burden of high-resolution anoscopies. High-risk HPV up-regulates p16 and Ki67 expression in epithelial cells. We assessed the usefulness of P16/Ki-67 immunostaining cytology for the diagnosis of precancerous anal lesions.MethodologyCross-sectional multicenter study. Concomitant anal liquid cytology with p16/Ki-67 immunostaining and HRA with biopsy of acetowhite lugol-negative lesions was performed in HIV-infected MSM. We compared the diagnostic performance of an abnormal anal cytology and p16/Ki-67 immunostaining relative to HRA-guided biopsy by logistic regression and comparison of ROC areas.ResultsWe included 328 HIV-infected MSM. HSIL was histologically diagnosed in 72 subjects (25.1%), and 2 (0.6%) were diagnosed with anal cancer. An abnormal cytology showed a sensitivity of 95.6% and a specificity of 58.8% for the diagnosis of biopsy-proven HSIL. P16/Ki67 positivity was associated with the presence of biopsy-proven HSIL (P trend = 0.004) but with low sensitivity (41.2%) and specificity (71%). The combination of standard cytology with P16/Ki67 immunostaining did not increment the predictive value of standard cytology alone (AUC 0.685 vs. 0.673, respectively, P = 0.688).ConclusionIn HIV-infected MSM P16/Ki67 immunostaining does not improve the diagnostic accuracy of anal cytology, which shows a high sensitivity yet poor specificity. Other approaches aimed at improving the diagnostic accuracy of current techniques for the diagnostic of precancerous HSIL are warranted.

Cytologic and colposcopic evaluation of all symptomatic women at tertiary care centre

Background: Cervical cancer in India ranks as the 2nd most frequent cancer among women and the 2nd most frequent cancer among women between 15 and 44 years of age. Invasive carcinoma of cervix is preventable as it is associated with pre-invasive stage which occurs 10-15 years prior to it, thus permitting early detection by screening and leading to effective treatment and thereby reducing mortality rate with greater impact on lives saved. Objectives were to correlate the findings of Pap smear with colposcopy in evaluation of all symptomatic women; and to assess the utility of colposcopy in detecting the premalignant and malignant lesions of cervix.Methods: This was a prospective observational study of 200 symptomatic women attending the Gynecology OPD of Umaid Hospital Dr. S. N. Medical College Jodhpur, Rajasthan, India from February 2015 to October 2016. Evaluation of all symptomatic women done with Pap smear, colposcopy and biopsy in selected cases and findings were noted.Results: Commonest complaint was white discharge per vaginum in 58.5% followed by pelvic pain in 24% women. 8% women had abnormal pap smear findings with 4% of women had ASCUS, 0.5% had ASC-H, 3% had LSIL and 0.5% had HSIL,73% had inflammatory and 19% with normal smear. 38.5% had abnormal colposcopy with maximum 28% women had acetowhite lesions. Sensitivity of pap smear was 44.44% while sensitivity of colposcopy was 88.88%.Conclusions: Pap smear had poor sensitivity as compared to colposcopy. Hence simultaneous use of colposcopy has shown to increase in the rate of carcinoma cervix detection in symptomatic women.

Characteristics and Distribution of Penile Lesions in Croatian Men with Laboratory-Confirmed Low-Risk and High-Risk Human Papillomavirus (HPV) Infection.

Studies that compare penoscopic evaluation with the results of molecular human papillomavirus (HPV) testing are scarce. This study assessed and compared both type and distribution of various penile lesions using penoscopy (peniscopy) technique in Croatian men with different, laboratory-confirmed HPV status. From a large cohort of men attending an outpatient STD clinic for HPV testing, a total of 120 patients were randomly selected and grouped into those positive for low-risk HPV, high-risk HPV, both low-risk and highrisk HPV, and those with negative results. Samples for HPV-DNA detection were taken by penile brushing and tested with the hc2 HPV DNA Test using Hybrid Capture 2 technology. Lesions were observed by photocolposcope after the application of aqueous 5% acetic acid, and classified as flat (macular), papular, papillary, classical condyloma, PIN-suspicious and non-specific lesions. The results have shown that flat and non-specific acetowhite lesions were the most common overall. All groups differed significantly with respect to papular and papillary lesions. A combination of heterogeneous lesions (i.e., a mixed penoscopic pattern) was commonly observed in all HPV-positive groups, but was significantly lower in the HPV-negative group. A majority of lesions were located in the coronal sulcus, and the four groups differed with respect to the location only considering the lesions of the penile shaft. Distribution of lesions in different sites did not appear to be significantly different with respect to the group, although differences within the high-risk HPV group and the group with both low-risk and high-risk HPV were detected. Penoscopy is relevant, but not a conclusive diagnostic tool for differentiating HPV from non-HPV findings in men - thus combining it with an HPV DNA test represents a more reliable approach.

Screening of Cervical Cancer by VIA among women in Rajshahi Medical College Hospital

Introduction: Visual inspection of cervix after application of 3-5% acetic acid (VIA) is a potential alternative to Pap smear cytology for screening of cervical cancer in resource poor settings. VIA has gained popularity and proven itself in many clinical trials as an adequate screening test. VIA is an attractive alternative to Pap smears for its ease of use, low-cost and fewer physician visits. Currently VIA is done in tertiary level hospitals by trained health care providers to generalize its efficacy.Objective: The main objective of this study was to evaluate the efficacy of visual inspection based screening approach in the detection of precancerous &amp; early cancerous lesions of the cervix.Materials and Methods: This study was done as a part of an ongoing screening program in Rajshahi Medical College Hospital from July 2008 to December 2009. VIA was carried out in 540 eligible women attending Gynae OPD for gynecological problems. The women underwent a complete clinical evaluation. Detection of well-defined, opaque, acetowhite lesion close to squamocolumnar junction (SCJ) or in transitional zone (TZ), well-defined circumferential, acetowhite lesions or dense acetowhitening of ulceroproliferative growth on the cervix constituted a positive VIA. All screened women evaluated by colposcopy and biopsy were taken from colposcopically suspected areas or in cases of VIA negative from different quadrants of the cervix. The final diagnosis was based on histology, which allowed direct estimation of sensitivity, specificity, and predictive values of VIA. Those with CIN I or cancerous lesions diagnosed by histology were considered as true positive.Results: Out of 540 patients screened, 328(61%) were VIA negative and 212(39%) were VIA positive. Out of positive cases 87 (41%)%) seemed to have pathology. Colposcopy yielded normal results in 340 (63%) cases, low grade CIN in 138 (26%) cases, high grade CIN in 44 (8%) cases and cancer in 18 (3%) cases making total 200 cases. Of the 200 (37%) patients with positive colposcopy, 98 (49%) turned out to be negative on histology. There were biopsy proven chronic cervicitis and metaplastic changes in 423 (78%) cases, CIN I in 66 (12%) cases, CIN II in 25 (5%) cases, CIN III/ carcinoma-in-situ in 5 (1%) cases. Eighteen (3%) cases of cervical carcinoma were diagnosed on colposcopy but ultimately 21(21%) cases of invasive cancer were detected on histology. The sensitivity of VIA for biopsy proven CIN I was 74.36%, specificity 75.8%, positive predictive value 41.04%, &amp; negative predictive value 90.85%.Conclusion: VIA can differentiate a normal cervix from a precancerous cervix with reasonable accuracy. Till now a good number of studies had been carried out in different countries of the world and now it is well established that the sensitivity of VIA equaled or exceeded the reported rates for conventional cervical cytology. As it is low cost and simple method, it can be set in any hospital or any health care centre of rural or urban areas of poor resource settings.Bangladesh J Obstet Gynaecol, 2013; Vol. 28(1) : 31-37

High-resolution microendoscopy: a point-of-care diagnostic for cervical dysplasia in low-resource settings.

Cervical cancer is the third leading cause of cancer-related death among women in low-to-middle income countries. Pap testing and pathological services are difficult to implement under these settings. Alternative techniques for the diagnosis of cervical precancer in these settings are needed to reduce the burden of the disease. The objective of this study was to evaluate the diagnostic accuracy of a low-cost, high-resolution microendoscope imaging system in identifying precancerous lesions of the cervix in vivo. A retrospective study of 59 patients undergoing colposcopy for an abnormal Pap test was performed at Hospital de Câncer de Barretos in Brazil. All patients underwent colposcopy as per standard of care, and acetowhite lesions were recorded. High-resolution microendoscopy (HRME) images were obtained from one colposcopically normal region and from all lesions observed on colposcopy. Biopsies of abnormal areas were obtained and reviewed by three independent, blinded pathologists and compared with HRME findings. The mean nuclear area and the median nuclear eccentricity were calculated from HRME images acquired from each site. A diagnostic algorithm to distinguish histopathologically diagnosed cervical intraepithelial neoplasias of grade 2 or more severe lesions (high grade) from less severe lesions (low grade) was developed using these parameters. A test of trend was used to analyze the relationship between HRME positivity and severity of histopathogical diagnosis. Fisher's exact test was used to analyze differences in HRME positivity between high-grade and low-grade lesions. Evaluable images were obtained from 108 of 143 discrete sites. Of these, 71 sites were colposcopically normal or low grade according to histopathology and 37 were diagnosed as high grade on the basis of histopathology. Using the mean nuclear area and the median nuclear eccentricity, HRME images from 59 colposcopically abnormal sites were classified as high grade or low grade with 92% sensitivity and 77% specificity compared with histopathological findings. Increasing HRME positivity showed a significant trend with increasing severity of diagnosis (Ptrend<0.001). We found a strong association (P<0.001) between HRME positivity and a histopathological diagnosis of cervical intraepithelial neoplasia of grade 2 or higher. HRME demonstrated an accurate in-situ diagnosis of high-grade dysplasia. In low-resource settings in which colposcopy and histopathology services are severely limited or unavailable, HRME may provide a low-cost, accurate method for diagnosis of cervical precancer without the need for biopsy, allowing for a single 'screen-and-treat' approach.

Colposcopic characteristics and Lugol׳s staining differentiate anal high-grade and low-grade squamous intraepithelial lesions during high resolution anoscopy

BackgroundAnal squamous intraepithelial lesions (SIL) and cancers are increased in immunocompromised populations. Based upon anatomic and histologic similarities, the cervix is used as the model for anal screening. During cervical colposcopy, acetic acid (AA) and Lugol׳s staining (LS) result in characteristic changes that help distinguish low-grade (L)SIL from high-grade (H)SIL. Lesion characteristics were evaluated for their ability to distinguish anal (a)LSIL from anal (a)HSIL during high-resolution anoscopy after application of AA and LS. MethodsAA-stained lesions were described using standard cervical colposcopic criteria. LS was then applied and lesions were characterized as Lugol׳s-negative (L−), Lugol׳s-partial (L+/−), or Lugol׳s positive (L+) and then biopsied. Biopsies were characterized as benign, squamous atypia, LSIL or HSIL. Results835 anal lesions were analyzed. Sensitivity and positive predictive value (PPV) for aHSIL were highest for characteristics associated with cervical (c)HSIL. L− was independently associated with aHSIL (OR=4.7, 95% CI=3.4–6.7). In multiple logistic regression analysis, significant predictors of aHSIL were flat contour (OR=2.24, 95% CI=1.3–3.8), mosaic pattern (OR=2.0, 95% CI=1.4–2.9), vascular punctation (OR=1.5, 95% CI=1.1–2.1) and L− (OR=2.3, 95% CI=1.5–3.4). L− staining improved the PPV of aHSIL almost twofold in lesions that otherwise had a colposcopic impression of LSIL. ConclusionsEvaluating acetowhite lesions for contour, surface, vascularity, and LS may maximize the likelihood of identifying aHSIL.

Colposcopic acetowhitening of vulvar lesion: a validity study.

To evaluate the acetowhite changes of the vulva as a predictor for high grade vulvar intraepithelial neoplasia. We performed retrospective analysis from 344 patients referred to our gynecology oncology clinic for genital dysplasia. All patients underwent vulvar colposcopy. Vulvar biopsies were performed for acetowhite changes and visible vulvar lesions such as ulceration, hyperpigmentation, and thickening of the vulvar tissue. High grade vulvar dysplasia was defined as vulvar intraepithelial neoplasia 2 or worse. Results of the vulvar pathology were collected and sensitivity, specificity, negative and positive predictive values. Of the 344 women who underwent vulvoscopy 241 patients had acetowhite lesions, of whom 89 had true high grade dysplasia. Using colposcopic acetowhite changes as a marker for high grade vulvar dysplasia, the test's sensitivity was 97 %, specificity was 40 %, negative predictive value was 98 %, and the positive predictive value was 37 %. Acetowhitening of the vulva has high sensitivity but low specificity as a predictor of high grade vulvar intraepithelial neoplasia. The absence of acetowhite lesion can reassure that high grade vulvar lesion is absent.

Cervical screening using visual inspection with acetic acid (VIA) and treatment with cryotherapy in Fiji.

The purpose of this study was to demonstrate the feasibility of VIA screening with cryotherapy and to record normative values for indicators anticipated in similar low resource settings. Women aged 30-49 years were targeted, resulting in 1961 women screened and treated at two primary health care (PHC) centres near Suva, Fiji. Recruitment was through provision of information, education and communication (IEC). Referrals to a gynaecology outpatient department (OPD) at a referral hospital occurred throughout the screening pathway. Participation was 32% (95%CI 31-33%), higher in iTaukei (Melanesians) women (34%, 95%CI 33-36) compared to Fijians of Indian descent (26%, 95%CI 24-28). Regression analysis, adjusted for confounders, indicated significantly lower participation in those of Indian descent, and age groups 35-39 and 45-49 years. Of those examined by VIA, 190 were positive with aceto-white lesions (9.9%), within the expected range of 8-15%, with minor geographic and ethnic variation. Positive VIA results were more common in the peri-urban area, and in those aged 35-39 years. Of women aged 30-49 years, 59 received cryotherapy (none of whom had significant complications), 91 were referred to OPD, two cervical carcinomas were identified and eight cervical intra-epithelial neoplasms (CIN) II-III were diagnosed. These results provide normative findings from a community-based VIA screening program for other similar low resource settings.