Evaluation of the accuracy in detecting cervical lesions by nurses versus doctors using a stationary colposcope and Gynocular in a low-resource setting

Nessa, Ashrafun; Roy, Joya Shree; Chowdhury, Most Afroza; Khanam, Quayuma; Afroz, Romena; Wistrand, Charlotte; Thuresson, Marcus; Thorsell, Malin; Shemer, Itzhak; Shemer, Elisabeth Andrea Wikström

doi:10.1136/bmjopen-2014-005313

Cited by 28 publications

(51 citation statements)

References 26 publications

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“…Nessa et al (14) evaluated cervical lesions in women with abnormal VIA findings using Swede score by Gynocular and colposcope. The cut-off value of 5 and greater for Swede score by the colposcope had a sensitivity of 83.3% (95% CI, 65.3%-94.7%) and specificity of 24.2% (95% CI, 17.9%-31.5%) Nessa et al (15) evaluated the accuracy in detecting cervical lesions by nurses versus doctors using a stationary colposcope and gynocular. Colposcope by doctors had a sensitivity of 83.3%, and specificity of 22% in detecting CIN 2+ lesions at a cut-off ≥ 5 for Swede score.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Colposcopy Using Swede Score in Screening of Cervical Cancer

Penumalli¹,

G²,

Kasthuri³

2017

jemds

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BACKGROUND Cervical cancer is a global health problem. It ranks as the 4 th leading cause of female cancer in the World, (1) the 2 nd leading cause of female cancer in India and the 2 nd most common female cancer in the women aged 15 to 44 years in World (1) and India. About 527,624 new cases are diagnosed and 265,672 cervical cancer deaths occur annually in the World. Incidence and prevalence of cervical cancer remains high in developing countries due to lack of resources, lack of effective screening programmes and poorly organised health system aimed for detecting precancerous condition before they progress to invasive cancer.Colposcopy remains the reference standard for assessing the validity of all the screening procedures for cervical cancer. Colposcopy scoring systems provide an objective diagnosis to grade the severity of premalignant lesions and select patients who require treatment. A new scoring system, Swede score, has added lesion size as a parameter.Objective-This study aimed to evaluate the diagnostic efficacy of colposcopy using Swede score and to determine the degree of correlation between colposcopy impression and histopathology. women aged 20 to 65 who met the selection criteria were included in the study. All women underwent colposcopy; the findings were scored by Swede score, biopsy taken from the abnormal areas. Patients in whom colposcopy was normal, biopsy was taken from the cervix within the transformation zone. RESULTSAccording to the Swede scoring system, 133 (60.45%) were benign cases, 64 (29.1%) women were diagnosed as LGL, 23 (10.45%) were diagnosed as HGL. As far as histologic results were concerned, 144 (65.45%) were benign showing chronic cervicitis, whereas 52 (23.64%), 24 (10.9%) were diagnosed as CIN 1 (LGL), HGL (CIN 2, CIN 3) respectively. CONCLUSIONThe 'k' value for the strength of correlation between colposcopy impression for CIN using Swede score and histopathology was k=0.73, for CIN 2+ it was k=0.92. Colposcopy by Swede score had a satisfactory sensitivity of 89.47% and specificity of 86.81% in the detection of CIN. Whereas in the detection of high-grade CIN (CIN 2+), Swede score colposcopy had a sensitivity of 91.67% and specificity of 99.49%.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Colposcopy Using Swede Score in Screening of Cervical Cancer

Penumalli¹,

G²,

Kasthuri³

2017

jemds

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“…In these studies, the colposcopic procedure followed a positive PAP smear and/or HPV and/or VIA test. Prevalence of CIN2 + in studies assessing the device and colposcopic procedure as a rst-line test was 0.6% [29], and when used in either situation at two points in the screening pathway, a prevalence of 4.2% [31] was found.…”

Section: Table 1 Characteristics Of Included Studiesmentioning

confidence: 94%

“…Table 1 shows the characteristics of these studies, which include 2693 women. Four of the studies were conducted in LMIC (India [30], Bangladesh [31], Peru [32] and China [29]) and one was conducted in a high-income country (Sweden [33]). All studies used a single-gate design [12].…”

Section: Literature Search Overviewmentioning

confidence: 99%

“…All studies used a single-gate design [12]. One study estimated DTA with two methods of screening [29] and another, for two different groups of providers (nurses/doctors) [31]. Four studies evaluated the Gynocular™ [30,31,33,34] and one study evaluated the Pocket device.…”

Section: Literature Search Overviewmentioning

confidence: 99%

“…The Gynocular™ was evaluated as a rst-line test [29] and as an add-on test to HPV, PAP-smear or VIA [30,33]. In one study, the Gynocular™ device was used indiscriminately as a rst-line test among 404 women (43%), and as an add-on test after VIA positivity among 528 women (57%) [31]. Estimates of test accuracy were not available separately for the two subgroups, so the results could not be summarised with the other study results.…”

Section: Table 1 Characteristics Of Included Studiesmentioning

confidence: 99%

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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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A systematic review of handheld tools in lieu of colposcopy for cervical neoplasia and female genital schistosomiasis

Søfteland

Sebitloane

Taylor

et al. 2021

Intl J Gynecology & Obste

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Background Visualization of the lesions in the lower genital tract is the mainstay for diagnosis of the four lesions found in female genital schistosomiasis (FGS), but colposcopes are generally not available in low‐resource settings. Objective We sought to review handheld devices that could potentially be used for FGS diagnosis. Search strategy We searched Medline and Embase 2015–2019 for handheld devices used in cervical cancer screening and FGS diagnosis. Selection criteria We excluded studies that did not compare the device to standard‐of‐care colposcopes or histopathology. Main results and conclusion In 11 studies, four handheld colposcopes, two smartphones, and one compact digital camera were evaluated. Two handheld colposcopes were found to be potentially adequate for FGS diagnosis, namely Gynocular and Mobile ODT. The smartphones and digital camera did not have sufficient magnification to diagnose grainy sandy patches, one of the FGS lesion types. Customized software should be made to support the diagnosis of both FGS and cervical neoplasia. Real‐time postgraduate training and quality control should be considered in future studies of handheld colposcopes. For patients from schistosomiasis endemic areas, we recommend that handheld devices are used for FGS. Studies are needed to determine which of the two devices is most adequate for FGS diagnosis in schistosomiasis endemic areas.

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Evaluation of the accuracy in detecting cervical lesions by nurses versus doctors using a stationary colposcope and Gynocular in a low-resource setting

Cited by 28 publications

References 26 publications

Evaluation of Colposcopy Using Swede Score in Screening of Cervical Cancer

Evaluation of Colposcopy Using Swede Score in Screening of Cervical Cancer

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

A systematic review of handheld tools in lieu of colposcopy for cervical neoplasia and female genital schistosomiasis

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