Evaluation of a compact, rechargeable, magnifying device to triage VIA and HPV positive women in a cervical cancer screening program in rural India

Basu, Partha; Banerjee, Dipanwita; Mittal, Srabani; Mandal, Ranajit; Ghosh, Ishita; Das, Pradip; Muwonge, Richard; Biswas, Jaydip

doi:10.1007/s10552-016-0805-7

Cited by 25 publications

(23 citation statements)

References 13 publications

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“…Colposcopy and biopsy are also not considered feasible or sustainable within existing health services for population-level screening in PNG. Researchers in other low-resource settings have also used HSIL as their preferred disease threshold for similar reasons [26] , [30] , [31] . In the Australian setting, around 80% of HSIL diagnoses at VCS are confirmed histologically as high-grade disease (cervical intraepithelial neoplasia grade 2 or worse), with the majority (around 54%) diagnosed as CIN3 or worse [32] .…”

Section: Discussionmentioning

confidence: 99%

Performance of clinical screening algorithms comprising point-of-care HPV-DNA testing using self-collected vaginal specimens, and visual inspection of the cervix with acetic acid, for the detection of underlying high-grade squamous intraepithelial lesions in Papua New Guinea

Toliman

Kaldor

Badman

et al. 2018

Papillomavirus Research

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The performance of different clinical screening algorithms comprising point-of-care HPV-DNA testing using self-collected vaginal (‘V’) specimens, and visual inspection of the cervix with acetic acid (VIA) was evaluated in Papua New Guinea.Women aged 30–59 years provided V specimens that were tested at point-of-care using the Xpert HPV Test (Cepheid, Sunnyvale, CA). A clinician-collected cervical (‘C’) specimen was then collected for point-of-care Xpert testing, and liquid-based cytology (LBC). Following this, VIA examination was conducted, blind to HPV test results, and ablative cervical cryotherapy provided if indicated. Detection of high-grade squamous intraepithelial lesion (HSIL) by LBC was the reference standard used to evaluate clinical screening algorithms.Of 1005 women, 36 had HSIL+. Xpert HPV Test performance using V specimens (sensitivity 91.7%, specificity 87.0%, PPV 34.0%, NPV 99.3%) was superior to VIA examination alone (51.5%, 81.4%, 17.5%, 95.6% respectively) in predicting underlying HSIL+. A screening algorithm comprising V specimen HPV testing followed by VIA examination had low sensitivity (45.5%) but comparable specificity, PPV and NPV to HPV testing alone (96.3%, 45.5%, 96.3% respectively).A ‘test-and-treat’ screening algorithm based on point-of-care HPV testing of V specimens had superior performance compared with either VIA examination alone, or a combined screening algorithm comprising HPV testing plus VIA.

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Section: Discussionmentioning

confidence: 99%

Performance of clinical screening algorithms comprising point-of-care HPV-DNA testing using self-collected vaginal specimens, and visual inspection of the cervix with acetic acid, for the detection of underlying high-grade squamous intraepithelial lesions in Papua New Guinea

Toliman

Kaldor

Badman

et al. 2018

Papillomavirus Research

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“…Portable colposcopy is a simplified version of traditional colposcopy, and it has the potential to improve the efficacy of visual screening methods 10. It is low-cost and easy to handle, which could help improve the feasibility.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of portable colposcopy and human papillomavirus testing for screening of cervical cancer in rural China

Newman

et al. 2019

Int J Gynecol Cancer

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ObjectiveTo evaluate the use of a portable, rechargeable colposcope combined with human papillomavirus (HPV) testing, as compared with HPV testing alone, for screening of cervical cancer and pre-cancerous lesions.MethodsThis was a cross-sectional study among 488 women in Baoshan County, Yunnan. The women underwent HPV testing followed by Gynocular portable colposcopy with visual inspection with acetic acid. Obvious lesions were biopsied. If portable colposcopy testing was negative but HPV testing was positive, the women underwent follow-up testing with thin-prep cytology and traditional colposcopy. Cervical biopsies were performed for any abnormalities. Histopathology was followed up with diagnosis and treatment.ResultsAmong 488 women screened with portable colposcopy, 24 women underwent biopsy based on positive colposcopy screening. Of these 24 women, three were HPV positive and 21 were HPV negative. Five women had cervical intra-epithelial neoplasia (CIN) I and one had advanced cervical cancer. Forty-six women tested positive for HPV. Three of these women had screened positive on preliminary colposcopy, with one positive for CIN III/squamous cell carcinoma and one woman with CIN I. Forty-three women underwent follow-up testing with thin-prep cytology. Two women had atypical squamous cells of undetermined significance and five had low-grade squamous intra-epithelial lesions and were biopsied; three women had CIN I, one had CIN II and one had CIN III. HPV testing and portable colposcopy was more sensitive but slightly less specific than portable colposcopy or HPV testing alone.ConclusionWhile HPV testing has high sensitivity and specificity for the detection of pre-cancerous and cancerous lesions and portable colposcopy has lower specificity, both methods of detection have low positive predictive value and high negative predictive value. In tandem, HPV testing and portable colposcopy had higher sensitivity for detection among women who underwent biopsies. In clinical practice, portable colposcopy was an effective, easy and affordable tool to transport to villages where cytology is not currently feasible.

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“…We described the Swede score optimising sensitivity and speci city in each study. For the pooled sensitivity and speci city, we used the Swede score threshold of ve, which is recommended as the cut-off optimising both sensitivity and speci city [17]. We pooled estimates of test accuracy when used as an add-on test using a bivariate random-effect model [18].…”

Section: Discussionmentioning

confidence: 99%

“…Seven publications were based on study populations already included in our analysis [17,[25][26][27][28][29]. We have presented a complete list of excluded full-text assessments and the reasons for their exclusion in additional le 4.…”

Section: Literature Search Overviewmentioning

confidence: 99%

Screening test Accuracy of Portable Devices that can be used to Perform Colposcopy for Detecting CIN2+ in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Taghavi

Rohner

Basu

et al. 2020

Preprint

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Objective: Portable devices that can be used to perform colposcopy may improve cervical cancer screening in low- and middle- income countries (LMIC) where access to colposcopy is limited. The objective of this study was to systematically review the diagnostic test accuracy (DTA) of these devices for the detection of cervical intraepithelial neoplasia grade 2 or higher (CIN2+). Methods: In accordance with our protocol (Prospero CRD42018104286), we searched Embase, Medline and the Cochrane Controlled Register of Trials up to 9/2019. We included DTA studies, which investigated portable devices with moderate-to-high optical magnification (≥6x) for colposcopy, as described in the manual for Colposcopy and Treatment by the International Agency for Research on Cancer, with a histopathological reference standard. We used the QUADAS-2 tool to assess study quality. We examined results for sensitivity and specificity in paired forest plots, stratified by stages in the clinical pathway. We pooled estimates of test accuracy for the index test, used as an add-on to other tests, using a bivariate random-effect model.Results: We screened 1737 references and assessed 239 full-text articles for eligibility. Five single-gate DTA studies, including 2693 women, met the inclusion criteria. Studies evaluated two devices (GynocularTM and Pocket) at different stages of the screening pathway. In three studies, which used the index test in an add-on capacity in 1273 women, we found a pooled sensitivity of 0.79 (95% CI: 0.55-0.92) and specificity of 0.83 (95% CI: 0.59-0.94). The main sources of bias were partial verification, incorporation and classification bias.Conclusion: Few studies have evaluated portable devices able to perform colposcopy, so their accuracy for the detection of CIN2+ remains uncertain. Future studies should include patient-relevant and long-term outcomes, including missed cases, overtreatment, residual and recurrent disease. To meet the challenge of eliminating cervical cancer in LMIC, methods for visual assessment of the cervix need urgent redress.Registration: Prospero, International prospective register of systematic reviews (CRD42018104286). Date of registration 27, July, 2018.

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Evaluation of a compact, rechargeable, magnifying device to triage VIA and HPV positive women in a cervical cancer screening program in rural India

Abstract: Gynocular can be used as an effective triaging device for VIA/HPV positive women.

Cited by 25 publications

References 13 publications

Performance of clinical screening algorithms comprising point-of-care HPV-DNA testing using self-collected vaginal specimens, and visual inspection of the cervix with acetic acid, for the detection of underlying high-grade squamous intraepithelial lesions in Papua New Guinea

Performance of clinical screening algorithms comprising point-of-care HPV-DNA testing using self-collected vaginal specimens, and visual inspection of the cervix with acetic acid, for the detection of underlying high-grade squamous intraepithelial lesions in Papua New Guinea

Evaluation of portable colposcopy and human papillomavirus testing for screening of cervical cancer in rural China

Screening test Accuracy of Portable Devices that can be used to Perform Colposcopy for Detecting CIN2+ in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

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