Abstract oral session 2014 World Cancer Congress

Comparative evaluation of Colposcopy  verses Conventional Cytology and HPV DNA testing as  a diagnostic triage for  Single visit Screen and Treat strategy  in VIA based cervical cancer screening programs in low resource settings in India.  (#310)

Sharmila Pimple 1 , Gauravi Mishra 1 , Surendra Shastri 1
  1. Tata Memorial Centre, Mumbai, India

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.