Accuracy of concurrent visual and cytology screening in detecting cervical cancer precursors in rural India

The high burden of cervical cancer and inadequate/suboptimal cytology screening in developing countries led to the evaluation of visual screening tests, like visual inspection with acetic acid (VIA) and Lugol's iodine (VILI). We describe the performance of VIA, VILI and cytology, carried out in...

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Veröffentlicht in:International journal of cancer 2012-09, Vol.131 (6), p.E954-E962
Hauptverfasser: Deodhar, Kedar, Sankaranarayanan, Rengaswamy, Jayant, Kasturi, Jeronimo, Jose, Thorat, Ranjit, Hingmire, Sanjay, Muwonge, Richard, Chiwate, Aruna, Deshpande, Rutha, Ajit, Dulhan, Kelkar, Rohini, Rekhi, Bharat, Ruben, Irene, Malvi, Sylla G., Chinoy, Roshni, Jambhekar, Nirmala, Nene, Bhagwan M.
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container_end_page E962
container_issue 6
container_start_page E954
container_title International journal of cancer
container_volume 131
creator Deodhar, Kedar
Sankaranarayanan, Rengaswamy
Jayant, Kasturi
Jeronimo, Jose
Thorat, Ranjit
Hingmire, Sanjay
Muwonge, Richard
Chiwate, Aruna
Deshpande, Rutha
Ajit, Dulhan
Kelkar, Rohini
Rekhi, Bharat
Ruben, Irene
Malvi, Sylla G.
Chinoy, Roshni
Jambhekar, Nirmala
Nene, Bhagwan M.
description The high burden of cervical cancer and inadequate/suboptimal cytology screening in developing countries led to the evaluation of visual screening tests, like visual inspection with acetic acid (VIA) and Lugol's iodine (VILI). We describe the performance of VIA, VILI and cytology, carried out in a multinational project called “Screening Technologies to Advance Rapid Testing” in 5,519 women aged 30–49 years, in detecting cervical intraepithelial neoplasia (CIN). VIA, VILI and cytology were positive in 16.9%, 15.6% and 6.1% women, respectively. We found 57 cases of CIN2, 55 of CIN3 and 12 of cervical cancer; 90% of CIN3 and 43% CIN2 cases were positive for p16 overexpression and high‐risk HPV infection, indicating a high validity of histological diagnosis. The sensitivity of VIA, VILI and cytology to detect high‐grade CIN were 64.5%, 64.5% and 67.7%, respectively; specificities were 84.2%, 85.5% and 95.4%. A high proportion of p16 positive CIN 3 (93.8%) and 2 (76.9%) were positive on cytology compared with visual tests (68.8% and 53.8%, respectively) indicating a higher sensitivity of cytology to detect p16 positive high‐grade CIN. However, the immediate availability of the results from the visual tests permits diagnosis and/or treatment to be performed in the same sitting, which can potentially reduce loss to follow‐up when women must be recalled following positive cytology. Organizing visual screening services in low‐resource countries may facilitate the gradual building of an infrastructure committed to screening allowing the eventual introduction of more sensitive, highly objective, reproducible and affordable human papillomavirus screening tests in future.
doi_str_mv 10.1002/ijc.27633
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A high proportion of p16 positive CIN 3 (93.8%) and 2 (76.9%) were positive on cytology compared with visual tests (68.8% and 53.8%, respectively) indicating a higher sensitivity of cytology to detect p16 positive high‐grade CIN. However, the immediate availability of the results from the visual tests permits diagnosis and/or treatment to be performed in the same sitting, which can potentially reduce loss to follow‐up when women must be recalled following positive cytology. 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J. Cancer</addtitle><date>2012-09-15</date><risdate>2012</risdate><volume>131</volume><issue>6</issue><spage>E954</spage><epage>E962</epage><pages>E954-E962</pages><issn>0020-7136</issn><eissn>1097-0215</eissn><abstract>The high burden of cervical cancer and inadequate/suboptimal cytology screening in developing countries led to the evaluation of visual screening tests, like visual inspection with acetic acid (VIA) and Lugol's iodine (VILI). We describe the performance of VIA, VILI and cytology, carried out in a multinational project called “Screening Technologies to Advance Rapid Testing” in 5,519 women aged 30–49 years, in detecting cervical intraepithelial neoplasia (CIN). VIA, VILI and cytology were positive in 16.9%, 15.6% and 6.1% women, respectively. We found 57 cases of CIN2, 55 of CIN3 and 12 of cervical cancer; 90% of CIN3 and 43% CIN2 cases were positive for p16 overexpression and high‐risk HPV infection, indicating a high validity of histological diagnosis. 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Organizing visual screening services in low‐resource countries may facilitate the gradual building of an infrastructure committed to screening allowing the eventual introduction of more sensitive, highly objective, reproducible and affordable human papillomavirus screening tests in future.</abstract><cop>Hoboken</cop><pub>Wiley Subscription Services, Inc., A Wiley Company</pub><pmid>22581670</pmid><doi>10.1002/ijc.27633</doi><tpages>9</tpages></addata></record>
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subjects Accuracy
Acetic Acid
Adult
Cancer
Cellular biology
Cervical cancer
cervical intraepithelial neoplasia
Cervical Intraepithelial Neoplasia - diagnosis
Cross-Sectional Studies
Cyclin-Dependent Kinase Inhibitor p16
Cytodiagnosis
cytology
Female
Human papillomavirus
Humans
India
Medical research
Medical screening
Middle Aged
Neoplasm Proteins - analysis
Precancerous Conditions - diagnosis
Reference Standards
Sensitivity and Specificity
Uterine Cervical Neoplasms - diagnosis
visual inspection with acetic acid
visual inspection with Lugol's iodine
title Accuracy of concurrent visual and cytology screening in detecting cervical cancer precursors in rural India
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