Background: Poor compliance to screening, diagnosis and treatment due to multiple visits involved is perceived as the single most major barrier for their successful implementation of cervical cancer screening programs. In resource constrained settings in the absence of reliable health infrastructure for cytology and HPV testing programs single visit approaches with Colposcopy could be suitable alternative for sustainable cervical cancer screening programs .
Aim:To evaluate the efficacy of diagnostic triage by colposcopy compared to conventional cytology and HPV DNA testing in cervical cancer screening programs.
Methods:Women in the age group of 30-65 years attending the cervical cancer screening clinic in Mumbai between January to December 2013, were administered primary screening by Visual Inspection with 5% Acetic Acid(VIA). 257 VIA positive women were offered diagnostic triage with Colposcopy, Conventional cytology and HPV DNA testing. Test characteristics and their 95% confidence intervals for Colpscopy were compared with that of conventional cytology and HPV DNA test against the reference standard of histopathology.
Results:The sensitivity of diagnostic colposcopy, cytology and HPV DNA by Hybrid Capture II was 0.69(95% CI: 0.41 - 0.89), 0.44 (95% CI: 0.20 - 0.70) and 0.69 (95% CI: 0.41 - 0.89) respectively and that of specificity was 0.76 (95% CI: 0.70 - 0.81), 0.97 (95% CI: 0.94 - 0.99) and 0.83 (95% CI: 0.78 - 0.88) respectively. Cytology had the highest false negative rate (FNR) of 0.56 (95% CI: 0.30 - 0.80) whereas colposcopy and HPV DNA had similar FNR [0.31 (95% CI: 0.11 - 0.59)].
Conclusions:Diagnostic triage for VIA positive women by colposcopy was comparable to HPV DNA testing and was more sensitive than conventional cytology. In settings with limitations in establishing diagnostic cytology and molecular testing facilities and also difficulty in accessing health-care facilities triage by colposcopy should be considered as a possible alternative.