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Winton Kalluvelil SR, Narayanan VS. Acetic acid versus toluidine blue as screening tools for oral potentially malignant disorders. Indian J Cancer 2023; 60:427-431. [PMID: 36861696 DOI: 10.4103/ijc.ijc_42_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Background Diagnostic adjuncts such as toluidine blue have been investigated as screening tools that improve visual examination of potentially malignant disorders (PMD) and oral cancer. Acetic acid has been reported to be of value in the early detection of cervical cancers. This study assessed the utility of 5% acetic acid as a diagnostic adjunct in oral PMD and compared the accuracy of acetic acid with toluidine blue in the detection of dysplastic PMD and high-risk lesions. Materials and Methods This cross-sectional study was conducted at a dental hospital in a rural setting. Thirty-one patients with oral PMD formed the study group. Five percent acetic acid was applied to the lesions, followed by toluidine blue application and biopsy. Sensitivity, specificity, and positive and negative predictive values were computed considering true positives as stain uptake in dysplastic and high-risk PMD. Results The sensitivity, specificity, and positive and negative predictive values of acetic acid for identifying dysplastic or malignant lesions were 100%, 13.3%, 51.2%, and 100%, respectively, and that for toluidine blue were 75%, 100%, 100%, and 78.9%, respectively. The corresponding values for identifying high-risk PMD (lesions with moderate and severe dysplasia) using acetic acid were 100%, 9.1%, 25.9%, and 100%, respectively, and for toluidine blue were 85.7%, 81.8%, 60%, and 94.7%, respectively. Conclusion The utility of acetic acid in detecting dysplasia and high-risk PMD is severely limited due to its poor specificity. Compared with acetic acid, toluidine blue is a superior screening tool.
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Affiliation(s)
- San Rose Winton Kalluvelil
- Department of Oral Medicine and Radiology, Coorg Institute of Dental Sciences, Virajpet, Karnataka, India
| | - Veena S Narayanan
- Department of Oral Medicine and Radiology, Coorg Institute of Dental Sciences, Virajpet, Karnataka, India
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2
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Reddy S, Reddy SS, Laipubam FS, Nagaraju R, Tupakula PK, V S. Comparative study of effectiveness of colposcopic examination versus visual examination for determining the biopsy site of potentially premalignant oral epithelial lesions. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e380-e384. [PMID: 35257930 DOI: 10.1016/j.jormas.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
Diagnosis of oral malignant and potentially premalignant oral epithelial lesions (PPOELs) cannot be based solely on clinical findings. Tissue biopsy with histopathologic examination remains the gold standard in diagnosis. Selection of a representative biopsy site becomes essential to arrive at an early and precise diagnosis which substantially reduces the incidence of morbidity and mortality from oral cancer. The site for biopsy, however, is always a subjective choice that sometimes raises doubts about its representativeness. Among various techniques developed to complement clinical examination and facilitate early diagnosis, colposcopy can be a simple, reliable diagnostic method available for the selection of the most appropriate biopsy site based on the vascular patterns. Hence, this study has been planned to assess the role of colposcopic examination in the selection of the most representative specimen for histopathologic examination from the oral lesions.
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Affiliation(s)
- Srirekha Reddy
- Department of Oral Medicine, Diagnosis and Radiology, Faculty of Dental Sciences, Ramaiah University of Applied Sciences, MSRIT Post, New BEL Road, Bangalore, Karnataka, India.
| | - Sujatha S Reddy
- Department of Oral Medicine, Diagnosis and Radiology, Faculty of Dental Sciences, Ramaiah University of Applied Sciences, MSRIT Post, New BEL Road, Bangalore, Karnataka, India.
| | - Fabina Sharma Laipubam
- Department of Oral Medicine, Diagnosis and Radiology, Faculty of Dental Sciences, Ramaiah University of Applied Sciences, MSRIT Post, New BEL Road, Bangalore, Karnataka, India.
| | - Rakesh Nagaraju
- Department of Oral Medicine, Diagnosis and Radiology, Faculty of Dental Sciences, Ramaiah University of Applied Sciences, MSRIT Post, New BEL Road, Bangalore, Karnataka, India.
| | - Pavan Kumar Tupakula
- Department of Oral Medicine, Diagnosis and Radiology, Faculty of Dental Sciences, Ramaiah University of Applied Sciences, MSRIT Post, New BEL Road, Bangalore, Karnataka, India.
| | - Shwetha V
- Department of Oral Medicine, Diagnosis and Radiology, Faculty of Dental Sciences, Ramaiah University of Applied Sciences, MSRIT Post, New BEL Road, Bangalore, Karnataka, India.
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3
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Nuranna L, Lubis DN, Arozal W, Purbadi S, Barinda AJ, Purwoto G, Rustamadji P, Putra AD, Utami TW, Kekalih A. Pilot Study on the Effect of a Single Topical Application of Trichloroacetic Acid 85% on Normal Cervical Tissue. Front Pharmacol 2022; 13:880333. [PMID: 35668953 PMCID: PMC9164303 DOI: 10.3389/fphar.2022.880333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/14/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Early detection and treatment of cervical intraepithelial neoplasia (CIN) through a “see and treat” approach is a pillar of cervical cancer prevention programs in developing countries such as Indonesia. One of the major challenges faced is the limited N2O or CO2 gas supply for cryotherapy. Thus, an alternative therapeutic method such as trichloroacetic acid (TCA) topical application is needed as an alternative solution. The effectiveness of this therapy will depend on its destructive effect on eliminating the whole lesion in CIN.Objective: To estimate the extent of damage in the normal cervical tissue after a single topical application of 85% TCA solution.Design and Methods: This research was an intervention study carried out by applying ±5 ml of 85% TCA solution into the cervix of 40 patients scheduled for total hysterectomy for indications other than cervical pathology 24 h before surgery. The extent of tissue destruction was determined microscopically using histopathological specimens. The study protocol is registered at www.clinicaltrial.gov (ID NCT04911075).Results: In the final analysis, 39 subjects were included. The necrotic area was detected at the superficial layer, accompanied by the full epithelial erosion thickness. In addition, there were also fibrotic areas resembling burned tissue in the stroma. The mean depth of destruction was 1.16 ± 0.01 mm in the anterior lip and 1.01 ± 0.06 mm in the posterior lip. There was no significant depth difference between the anterior and posterior lips (p ≥0.05). Moreover, the 85% TCA topical application was tolerable, as represented by the fact that the vast majority (82.1%) of participants experienced pain with a visual analog scale score of <4.Conclusion: Single dose of TCA 85% in topical solution was able to destroy the normal cervical tissue with a deeper mean depth than the mean depth of CIN III in squamous epithelium.
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Affiliation(s)
- Laila Nuranna
- Obstetrics Gynecology Department, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo National General Hospital, Oncology Gynecology Division, Jakarta, Indonesia
| | - Dolly N. Lubis
- Obstetrics Gynecology Department, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo National General Hospital, Oncology Gynecology Division, Jakarta, Indonesia
| | - Wawaimuli Arozal
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
- *Correspondence: Wawaimuli Arozal,
| | - Sigit Purbadi
- Obstetrics Gynecology Department, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo National General Hospital, Oncology Gynecology Division, Jakarta, Indonesia
| | - Agian Jeffilano Barinda
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Gatot Purwoto
- Obstetrics Gynecology Department, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo National General Hospital, Oncology Gynecology Division, Jakarta, Indonesia
| | - Primariadewi Rustamadji
- Department of Pathology and Anatomy, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Andi D. Putra
- Obstetrics Gynecology Department, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo National General Hospital, Oncology Gynecology Division, Jakarta, Indonesia
| | - Tofan W. Utami
- Obstetrics Gynecology Department, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo National General Hospital, Oncology Gynecology Division, Jakarta, Indonesia
| | - Aria Kekalih
- Community Medicine Department, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
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4
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Han J, Xu B, Wang H, Huang G, Zhang X, Xu Y. Purification of acidic lignocellulose hydrolysate using anion-exchange resin: Multicomponent adsorption, kinetic and thermodynamic study. BIORESOURCE TECHNOLOGY 2022; 351:126979. [PMID: 35276375 DOI: 10.1016/j.biortech.2022.126979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/06/2022] [Accepted: 03/07/2022] [Indexed: 06/14/2023]
Abstract
Acid hydrolysis of lignocellulosic biomass to produce high value-added products presents a breathtaking industrial application foreground. However, the hydrolysate under harsh conditions contains extremely complex degradations, resulting in many restrictions or lethal toxicity on the following utilization and bioconversion. In this study, the anion-exchange resin 335 was exploited to separate and purify main degradations from the acidic corncob-hydrolysate. A comprehensive investigation was explored on equilibrium isotherms, adsorption kinetics, and thermodynamic parameters of the representative substances in the hydrolysate. The results indicated that the removal of acetic acid, furfural, and lignin reached 90.13%, 92.58%, and 94.85% respectively, while the loss rate of xylose was well controlled within 20%. Based on these studies, various models and parameters were evaluated to uncover the mechanisms. In conclusion, this work offered a theoretical basis for the application in the separation and purification of acidic lignocellulose-hydrolysate and further bioconversion.
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Affiliation(s)
- Jian Han
- Jiangsu Co-Innovation Center of Efficient Processing and Utilization of Forest Resources, College of Chemical Engineering, Nanjing Forestry University, Nanjing 210037, People's Republic of China; Jiangsu Province Key Laboratory of Green Biomass-based Fuels and Chemicals, Nanjing 210037, People's Republic of China
| | - Bin Xu
- ECO Zhuoxin Energy-saving Technology (Shanghai) Company Limited, Shanghai 200000, People's Republic of China
| | - Huan Wang
- ECO Zhuoxin Energy-saving Technology (Shanghai) Company Limited, Shanghai 200000, People's Republic of China
| | - Guohong Huang
- Nanjing Hydraulic Research Institute, Materials & Structural Engineering Department, Nanjing 210029, People's Republic of China
| | - Xiaolei Zhang
- Department of Chemical and Process Engineering, University of Strathclyde, Glasgow G1 1XJ, UK
| | - Yong Xu
- Jiangsu Co-Innovation Center of Efficient Processing and Utilization of Forest Resources, College of Chemical Engineering, Nanjing Forestry University, Nanjing 210037, People's Republic of China; Jiangsu Province Key Laboratory of Green Biomass-based Fuels and Chemicals, Nanjing 210037, People's Republic of China.
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5
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Elhage KG, St Claire K, Daveluy S. Acetic acid and the skin: a review of vinegar in dermatology. Int J Dermatol 2021; 61:804-811. [PMID: 34350993 DOI: 10.1111/ijd.15804] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/25/2021] [Accepted: 07/02/2021] [Indexed: 12/01/2022]
Abstract
Vinegar is commonly used as a home remedy for many skin problems. It is important for dermatologists to understand the evidence supporting its use in skin disease, as well as potential adverse effects, so they can properly counsel patients on the safe use of this widely available treatment. Vinegar possesses antimicrobial and antioxidant properties that provide utility in wound care as well as bacterial and fungal infections. There is also evidence to support its use in pruritus, head lice removal, and treatment of striae gravidarum. While generally safe, inappropriate use can result in damage to the skin. In this review, we discuss the evidence supporting vinegar as a treatment for skin disease, as well as adverse events reported from misuse, to provide dermatologists the knowledge to counsel patients on the safe and appropriate use of vinegar.
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Affiliation(s)
| | - Kayla St Claire
- Wayne State University School of Medicine, Detroit, MI, USA.,Department of Dermatology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Steven Daveluy
- Wayne State University School of Medicine, Detroit, MI, USA.,Department of Dermatology, Wayne State University School of Medicine, Detroit, MI, USA
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6
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Levy J, de Preux M, Kenfack B, Sormani J, Catarino R, Tincho EF, Frund C, Fouogue JT, Vassilakos P, Petignat P. Implementing the 3T-approach for cervical cancer screening in Cameroon: Preliminary results on program performance. Cancer Med 2020; 9:7293-7300. [PMID: 32757469 PMCID: PMC7541141 DOI: 10.1002/cam4.3355] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 07/05/2020] [Accepted: 07/09/2020] [Indexed: 01/25/2023] Open
Abstract
Option recommended by World Health Organization (WHO) includes human papillomavirus (HPV) primary screening followed by visual inspection with acetic acid (VIA) triage. We implemented a program based on a 3T‐approach (Test‐Triage and Treat). Our objective was to verify the effectiveness of the program by defining a set of performance indices. A sensitization campaign was performed in Dschang (Cameroon) and women aged 30‐49 years were invited to participate for screening based on the 3T‐approach. Participants performed HPV self‐sampling (Self‐HPV), analyzed with the point‐of‐care Xpert HPV assay followed by VIA/VILI triage and treatment if required. Key performance indicators (KPIs) for screening, diagnosis, treatment and follow‐up were defined, and achievable targets were described for which the approach is likely to be running optimally. A total of 840 women with a mean age of 39.4±5.9 years participated. The KPIs included (i) the screening rate (8.4% at 7 months, target =20% at 12 months), (ii) HPV positivity rate (19.8%, expected range 18‐25%), (iii) compliance to referral to VIA/VILI and complete test (100%, target >90%), (iv) compliance to referral to thermal ablation (100%, target >90%), (v) VIA/VILI positivity rate (50.6%, expected range 45‐55%), (vi) a single visit from diagnostic to treatment (79.8%, target >80%), (vii) compliance to follow‐up at 1 month (96.4%, target >80%) and (viii) at 6 months (70.6%, target >80%). Program performance based on the single‐visit 3T‐approach corresponded to defined targets and preliminary results support adequateness of KPIs for periodic monitoring.
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Affiliation(s)
- Juliette Levy
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Marie de Preux
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Bruno Kenfack
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang District Hospital, Dschang, Cameroon
| | - Jessica Sormani
- Gynecology Division, Department of Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland.,Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
| | - Rosa Catarino
- Gynecology Division, Department of Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Eveline F Tincho
- Faculty of Medicine and Biomedical Sciences, Centre Hospitalier Universitaire (CHUY), Yaoundé, Cameroon
| | - Chloé Frund
- Gynecology Division, Department of Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Jovanny T Fouogue
- Department of Obstetrics and Gynecology, Bafoussam Regional hospital, Bafoussam, Cameroon
| | - Pierre Vassilakos
- Gynecology Division, Department of Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland.,Geneva Foundation for Medical Education and Research, Genève, Switzerland
| | - Patrick Petignat
- Gynecology Division, Department of Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland
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7
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Kudva V, Prasad K, Guruvare S. Andriod Device-Based Cervical Cancer Screening for Resource-Poor Settings. J Digit Imaging 2019; 31:646-654. [PMID: 29777323 DOI: 10.1007/s10278-018-0083-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
Visual inspection with acetic acid (VIA) is an effective, affordable and simple test for cervical cancer screening in resource-poor settings. But considerable expertise is needed to differentiate cancerous lesions from normal lesions, which is lacking in developing countries. Many studies have attempted automation of cervical cancer detection from cervix images acquired during the VIA process. These studies used images acquired through colposcopy or cervicography. However, colposcopy is expensive and hence is not feasible as a screening tool in resource-poor settings. Cervicography uses a digital camera to acquire cervix images which are subsequently sent to experts for evaluation. Hence, cervicography does not provide a real-time decision of whether the cervix is normal or not, during the VIA examination. In case the cervix is found to be abnormal, the patient may be referred to a hospital for further evaluation using Pap smear and/or biopsy. An android device with an inbuilt app to acquire images and provide instant results would be an obvious choice in resource-poor settings. In this paper, we propose an algorithm for analysis of cervix images acquired using an android device, which can be used for the development of decision support system to provide instant decision during cervical cancer screening. This algorithm offers an accuracy of 97.94%, a sensitivity of 99.05% and specificity of 97.16%.
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Affiliation(s)
- Vidya Kudva
- School of Information Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.,NMAMIT, Nitte, 574110, India
| | - Keerthana Prasad
- School of Information Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
| | - Shyamala Guruvare
- Department of Obstetrics and Gynecology, Kasturba Medical College, Manipal, Karnataka, 576104, India
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8
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Yang B, Li Y, Gong N, Cao X, Wang S, Sun C. Study of molecular association in acetic acid-water binary solution by Raman spectroscopy. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2019; 213:463-466. [PMID: 30772663 DOI: 10.1016/j.saa.2018.08.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/13/2018] [Accepted: 08/15/2018] [Indexed: 06/09/2023]
Abstract
Raman spectra of acetic acid-water binary solutions with different concentrations have been measured in order to study molecular association of acetic acid. We find that the symmetric and asymmetric OH stretching vibration of water (3242 and 3443 cm-1) have marked changes of Raman shift when the volume fraction of acetic acid (VAA) is 0.3 and 0.8, respectively, which demonstrates that the hydrogen bonding of the water is affected, causing association molecule (acetic acid-water structure) to undergo two phase transitions. Furthermore, the peak of the HCH bending vibration is blue-shifted at VAA = 0.8, which shows that the acetic acid-acetic acid structure undergoes a phase transition and the acetic acid side-on dimer is formed. These results also indicate that the CH vibration mode in CH⋯O is HCH bending vibration. Finally, the phase transition process of association molecules (hydrated monomer, linear dimer, acetic acid side-on dimer and water-separated dimer) has been obtained in acetic acid-water binary solutions through theoretical analysis.
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Affiliation(s)
- Bo Yang
- Coherent Light and Atomic and Molecular Spectroscopy Laboratory, College of Physics, Jilin University, Changchun 130012, China
| | - Yeqiu Li
- Coherent Light and Atomic and Molecular Spectroscopy Laboratory, College of Physics, Jilin University, Changchun 130012, China; Key Laboratory of Physics and Technology for Advanced Batteries, College of Physics, Jilin University, Changchun 130012, China.
| | - Nan Gong
- Coherent Light and Atomic and Molecular Spectroscopy Laboratory, College of Physics, Jilin University, Changchun 130012, China
| | - Xianwen Cao
- Coherent Light and Atomic and Molecular Spectroscopy Laboratory, College of Physics, Jilin University, Changchun 130012, China
| | - Shenghan Wang
- Coherent Light and Atomic and Molecular Spectroscopy Laboratory, College of Physics, Jilin University, Changchun 130012, China; Key Laboratory of Physics and Technology for Advanced Batteries, College of Physics, Jilin University, Changchun 130012, China.
| | - Chenglin Sun
- Coherent Light and Atomic and Molecular Spectroscopy Laboratory, College of Physics, Jilin University, Changchun 130012, China; Key Laboratory of Physics and Technology for Advanced Batteries, College of Physics, Jilin University, Changchun 130012, China.
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9
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A mobile-phone based high-resolution microendoscope to image cervical precancer. PLoS One 2019; 14:e0211045. [PMID: 30726252 PMCID: PMC6364962 DOI: 10.1371/journal.pone.0211045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 01/07/2019] [Indexed: 01/12/2023] Open
Abstract
Nearly 90% of cervical cancer cases and deaths occur in low- and middle-income countries that lack comprehensive national HPV immunization and cervical cancer screening programs. In these settings, it is difficult to implement screening programs due to a lack of infrastructure and shortage of trained personnel. Screening programs based on visual inspection with acetic acid (VIA) have been successfully implemented in some low-resource settings. However, VIA has poor specificity and up to 90% of patients receiving treatment based on a positive VIA exam are over-treated. A number of studies have suggested that high-resolution cervical imaging to visualize nuclear morphology in vivo can improve specificity by better distinguishing precancerous and benign lesions. To enable high-resolution imaging in low-resource settings, we developed a portable, low-cost, high-resolution microendoscope that uses a mobile phone to detect and display images of cervical epithelium in vivo with subcellular resolution. The device was fabricated for less than $2,000 using commercially available optical components including filters, an LED and triplet lenses assembled in a 3D-printed opto-mechanical mount. We show that the mobile high-resolution microendoscope achieves similar resolution and signal-to-background ratio as previously reported high-resolution microendoscope systems using traditional cameras and computers to detect and display images. Finally, we demonstrate the ability of the mobile high-resolution microendoscope to image normal and precancerous squamous epithelium of the cervix in vivo in a gynecological referral clinic in Barretos, Brazil.
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10
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Vu M, Yu J, Awolude OA, Chuang L. Cervical cancer worldwide. Curr Probl Cancer 2018; 42:457-465. [DOI: 10.1016/j.currproblcancer.2018.06.003] [Citation(s) in RCA: 170] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 05/18/2018] [Accepted: 06/05/2018] [Indexed: 10/28/2022]
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11
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Comparing sensitivity and specificity of medical imaging tests when verification bias is present: The concept of relative diagnostic accuracy. Eur J Radiol 2017; 98:32-35. [PMID: 29279167 DOI: 10.1016/j.ejrad.2017.10.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 10/23/2017] [Accepted: 10/25/2017] [Indexed: 11/20/2022]
Abstract
Medical imaging plays a key role in all stages of cancer management. In evaluating a new imaging modality, the optimal design involves a comparison with standard test results as well as a gold standard, such as a pathological evaluation to determine disease status. However, when both the standard and experimental test results are negative, a gold standard may not always be performed, especially if it involves an invasive and/or costly procedure. In this situation, true disease status cannot be verified, which creates an estimation problem for sensitivity and specificity. The aim of this article is to present the concept of relative accuracy which permits to remove the bias when only patients with at least one positive test receive the gold standard.
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12
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Detection of Specular Reflection and Segmentation of Cervix Region in Uterine Cervix Images for Cervical Cancer Screening. Ing Rech Biomed 2017. [DOI: 10.1016/j.irbm.2017.08.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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13
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Catarino R, Schäfer S, Vassilakos P, Petignat P, Arbyn M. Accuracy of combinations of visual inspection using acetic acid or lugol iodine to detect cervical precancer: a meta-analysis. BJOG 2017; 125:545-553. [PMID: 28603909 DOI: 10.1111/1471-0528.14783] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Visual inspection of the cervix with acetic acid (VIA) or with Lugol's iodine (VILI) have been evaluated for cervical cancer screening in developing countries. OBJECTIVES To assess the diagnostic accuracy and clinical utility of visual methods to detect cervical intraepithelial neoplasia grade 2+ (CIN2+) using: (1) VIA alone; (2) VILI alone; (3) co-testing; and (4) VILI as a triage test of a positive VIA result. SEARCH STRATEGY PubMed, EMBASE, and the Cochrane Library were searched up to May 2016. SELECTION CRITERIA All reports on the accuracy of VIA and VILI, or combinations of VIA/VILI, to detect CIN2+ were identified. Histology and colposcopy when no biopsy was taken were used as the reference standard. DATA COLLECTION AND ANALYSIS Selected studies were scored on methodological quality, and sensitivity and specificity were computed. Clinical utility was assessed from the positive predictive value (PPV) and the complement of the negative predictive value (cNPV). MAIN RESULTS We included 23 studies comprising 101 273 women. The pooled sensitivity and specificity of VILI was 88 and 86%, respectively. VILI was more sensitive, but not less specific, compared with VIA (relative sensitivity = 1.11; 95% confidence interval, 95% CI, 1.06-1.16; relative specificity = 0.98; 95% CI 0.95-1.01). Co-testing was hardly more sensitive, but significantly less specific, than VILI alone. VILI to triage VIA-POSITIVE women was not less sensitive, but more specific, compared with VIA alone (relative sensitivity = 0.98, 95% CI 0.96-1.01; relative specificity = 1.04, 95% CI 1.02-1.05). The average PPVs were low (range 11-16%), whereas the cNPV varied between 0.3% (VILI, co-testing) and 0.6% (triage). CONCLUSIONS Although imperfect, VILI alone appeared to be the most useful visual screening strategy. TWEETABLE ABSTRACT VILI alone seems to be the most useful visual screening test for cervical cancer screening.
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Affiliation(s)
- R Catarino
- Department of Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - S Schäfer
- Department of Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - P Vassilakos
- Geneva Foundation for Medical Education and Research, Geneva, Switzerland
| | - P Petignat
- Department of Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - M Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium
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14
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Implementing community-based cervical cancer screening programs using visual inspection with acetic acid in India: A systematic review. Cancer Epidemiol 2017; 49:161-174. [PMID: 28704717 DOI: 10.1016/j.canep.2017.06.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 06/13/2017] [Accepted: 06/15/2017] [Indexed: 11/20/2022]
Abstract
The objective of this review was to systematically appraise the existing published literature about community-based cervical cancer screening programs that have used visual inspection methods using acetic acid (VIA) in India. All peer reviewed journal articles till December 2015 were searched per PRISMA guidelines. Articles reporting results from cervical cancer screening programs in community-based settings, conducted in India, and using VIA were included in this review. The search resulted in 20 articles to be included in the review with a total of 313,553 women at 12 unique urban and rural sites across India. Seventeen (85%) studies were cross-sectional and three studies were randomized controlled trials; most studies compared accuracy of VIA with other screening tests such as visual inspection using Lugol's Iodine (VILI), HPV DNA, and cytology. Of studies that reported test accuracy for CIN Grade 2+, the VIA sensitivity values ranged from 16.6-82.6% and specificity ranged from 82.1-96.8%. Women between age groups of 30-59 years were recruited using motivational one-on-one counseling and local support staff. All studies conducted diagnostic follow-up using colposcopy and guided biopsies, when necessary. Three major themes were identified that facilitated implementation of screening programs in a community-based setting: standardized training that maintained competency of test providers; collaborations with community-based organizations that used health education for recruitment of participants; and employing the screen-and-treat method to reduce loss to follow-up. Summarized evidence presented in this review could substantially influence future implementation and sustainment of cervical cancer screening programs at a national level.
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Ratcliffe A, Baker A, Smith D. Successful management of 70% acetic acid ingestion on the intensive care unit: A case report. J Intensive Care Soc 2017; 19:56-60. [PMID: 29456603 DOI: 10.1177/1751143717711062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Acetic acid is an organic acid available in concentrations from 2 to 80%. Whilst lower concentrations of 2-6% are more commonly used as the table top condiment, vinegar, much stronger solutions are regularly used in Eastern Europe as food preservatives and cleaning solutions. Oral ingestion of greater than 12% has been reported to cause haemolysis, renal failure, shock and death. Most reported cases of deliberate or accidental poisoning are from Russia and Eastern Europe in the 1980s, with very little currently in western publications. We present the case of a female patient who attempted suicide by drinking 250 ml of 70% acetic acid. Her widespread gastrointestinal injuries were managed conservatively, and despite suffering extensive upper airway and renal complications, she was successfully decannulated and discharged home after a prolonged intensive care and hospital stay.
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Affiliation(s)
| | - Andrew Baker
- Bradford Teaching Hospitals Foundation Trust, Bradford, UK
| | - Daniel Smith
- Bradford Teaching Hospitals Foundation Trust, Bradford, UK
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Hughes G, Webber MA. Novel approaches to the treatment of bacterial biofilm infections. Br J Pharmacol 2017; 174:2237-2246. [PMID: 28063237 DOI: 10.1111/bph.13706] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 11/15/2016] [Accepted: 12/10/2016] [Indexed: 12/31/2022] Open
Abstract
Bacterial infection remains a major challenge to healthcare and is responsible for significant morbidity and mortality. This situation is becoming complicated by an increasingly ageing and susceptible population and large numbers of bacterial isolates, which have developed resistance to antibiotics. Bacteria that form biofilms and colonize or infect medical devices or wounds are particularly hard to treat as biofilms are inherently highly antibiotic resistant. Most infections have a component where bacteria exist as a biofilm and as a result, prevention or treatment of biofilm-associated infections is highly important. A number of novel strategies to kill biofilms have been in development; these include the use of weak organic acids, photo irradiation and the application of bacteriophage. All have promise and are able to effectively kill biofilms in model systems, but for each there are still unanswered questions. This review summarizes the main features of biofilm infections, each of these novel approaches and the evidence that is still lacking before these potential treatments can be incorporated into clinical usage. LINKED ARTICLES This article is part of a themed section on Drug Metabolism and Antibiotic Resistance in Micro-organisms. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v174.14/issuetoc.
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Affiliation(s)
- Gareth Hughes
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
| | - Mark A Webber
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK.,Institute of Food Research, Norwich, UK
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Ngelangel CA, Limson GM, Cordero CP, Abelardo AD, Avila JM, Festin MR. Acetic-acid guided visual inspection vs. cytology-based screening for cervical cancer in the Philippines. Int J Gynaecol Obstet 2017; 83:141-50. [PMID: 14550588 DOI: 10.1016/s0020-7292(03)00265-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare the validity and acceptability of acetic-acid visualization (VIA), magnified acetic-acid visualization (VIAM), spatula+cotton swab-Papanicolaou (Pap) smear (SS), and cervical brush-Pap smear (CB) in the detection of precursor/early cervical cancer lesions. METHODS A total of 12992 women aged between 25 and 65 years from 14 Philippine centers were randomly allocated to the four tests. The gold standard was colposcopy with biopsy for positive/suspicious cases. RESULTS Sensitivity rates [95% confidence intervals (CIs)] were 37 (CI, 26.8-48.5), 34.1 (CI, 24.8-44.8), 14.3 (CI, 6.4-27.8), and 19.1 (CI, 9.2-34.6) for VIA, VIAM, SS, and CB, respectively. Specificity rates were 90.7 (CI, 89.6-91.7), 90.7 (CI, 89-91.1), 97.5 (CI, 96.8-98), and 97.9 (CI, 97.3-98.4), respectively. Kappa for the Pap smear (PS) within centers ranged from -0.154 to 0.783, and between centers from -0.028 to 0.364. Screeners preferred CB; screened-women preferred VIA. CONCLUSIONS The acetic-acid visualization and VIAM methods are recommended for initial cervical cancer screening in the Philippines.
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Affiliation(s)
- C A Ngelangel
- University of the Philippines Department of Health, Cervical Cancer Screening Health Operations Study Group, National Institutes of Health, Pedro Gil, Ermita, Manila, Philippines
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Real-Time Monitoring and Evaluation of a Visual-Based Cervical Cancer Screening Program Using a Decision Support Job Aid. Diagnostics (Basel) 2016; 6:diagnostics6020020. [PMID: 27196932 PMCID: PMC4931415 DOI: 10.3390/diagnostics6020020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/26/2016] [Accepted: 05/06/2016] [Indexed: 12/03/2022] Open
Abstract
In many developing nations, cervical cancer screening is done by visual inspection with acetic acid (VIA). Monitoring and evaluation (M&E) of such screening programs is challenging. An enhanced visual assessment (EVA) system was developed to augment VIA procedures in low-resource settings. The EVA System consists of a mobile colposcope built around a smartphone, and an online image portal for storing and annotating images. A smartphone app is used to control the mobile colposcope, and upload pictures to the image portal. In this paper, a new app feature that documents clinical decisions using an integrated job aid was deployed in a cervical cancer screening camp in Kenya. Six organizations conducting VIA used the EVA System to screen 824 patients over the course of a week, and providers recorded their diagnoses and treatments in the application. Real-time aggregated statistics were broadcast on a public website. Screening organizations were able to assess the number of patients screened, alongside treatment rates, and the patients who tested positive and required treatment in real time, which allowed them to make adjustments as needed. The real-time M&E enabled by “smart” diagnostic medical devices holds promise for broader use in screening programs in low-resource settings.
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Comparative Study of the Role of Visual Inspection with Acetic Acid and Pap Smear in Screening of Cervical Cancer in Low Resource Setting in a Tertiary Care Hospital. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2015. [DOI: 10.1007/s40944-015-0024-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Nessa A, Nahar KN, Begum SA, Anwary SA, Hossain F, Nahar K. Comparison between visual inspection of cervix and cytology based screening procedures in Bangladesh. Asian Pac J Cancer Prev 2014; 14:7607-11. [PMID: 24460341 DOI: 10.7314/apjcp.2013.14.12.7607] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cervical cancer continues to be a major problem in Bangladesh with approximately 18,000 new cases annually of which over 10,000 women die from it. Visual inspection of the cervix after 3-5% acetic acid (VIA) application is a simple and easy to learn method for cervical cancer screening, although cytology-based screening is more often applied in developed countries where it has successfully reduced the prevalence of cervical cancer. OBJECTIVE To compare the efficacy of VIA and cytology-based primary methods for cervical cancer screening in Bangladesh. MATERIALS AND METHODS This hospital based comparative study was conducted at the VIA centre and Colposcopy Clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU) from October 2008 to October 2010. RESULTS Among 650 women, 74 (11.4%) were VIA+ve and 8 (1.2%) had abnormalities in their Pap smear reports. During colposcopy, 38 (7.7%) women had different grades of CIN and 4 (0.6%) had cervical cancer. The gold standard histology findings proved 20 women had CIN I, 14 had CIN II/II and 4 had cervical cancer. Among the 38 histology diagnosed abnormalities, VIA test could identify 30 abnormalities including two cervical cancers. However, Pap smear could detect only 8 cases of histological abnormalities (2 low grade and 6 had high grade lesion) and it missed all the cervical cancer cases. The sensitivity and specificity of VIA were 88.9% and 52.1%. The positive predictive value (PPV) and negative predictive value (NPV) were 41.0%, and 92.6% respectively. Moreover, the sensitivity, specificity, PPV and NPV of Pap smear were 33.3%, 95.8%, 75.0% and 79.3%, respectively. CONCLUSIONS VIA test should be used as the primary screening tool even with its low sensitivity and specificity in low resource countries like Bangladesh. False positive results may be greater, but overtreatment can be minimized by colposcopy evaluation of the VIA positive women.
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Affiliation(s)
- Ashrafun Nessa
- Gyne-oncology Unit, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh E-mail :
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Abstract
OBJECTIVE To evaluate the accuracy of visual inspection with acetic acid (VIA) in determining the site, the size, and the number of cervical biopsies in patients with positive cervical cytology. METHODS This study included 486 patients with positive cervical cytology who presented to the Gynaecological Oncology Unit of Minia Maternity University Hospital, Egypt, in the period between January 2008 and September 2011. Visual inspection with acetic acid was done for all patients. They were classified into 2 groups according to the results of VIA. Group 1 included VIA-negative women, whereas group 2 included VIA-positive women. All patients were reexamined with colposcopy to prove or disprove the presence of lesions. Cervical biopsies were taken from patients with positive VIA or colposcopically confirmed lesions using punch biopsy forceps. Biopsies were sent for histologic examination. RESULTS In group 1, 100 patients were VIA-negative, 66 of them were histopathologically free, whereas 34 patients had positive biopsy results. Group 2 included 386 patients: 31 were histologically free, 239 had cervical intraepithelial neoplasia (CIN) 1, whereas 116 had CIN 2 or worse. CONCLUSIONS Visual inspection with acetic acid is a good test for aiding the diagnosis of CIN and may be helpful in determining the site, the size, and the number of biopsies in patients with positive cytologic results. Instead of colposcopy, VIA can be used in developing countries where colposcopic services are not available.
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[Differential diagnosis between keloid and hypertrophic scars: a new approach by full-field optical coherence tomography]. ANN CHIR PLAST ESTH 2014; 59:253-60. [PMID: 24698338 DOI: 10.1016/j.anplas.2014.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 02/05/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the efficacy of full-field optical coherence tomography to differentiate hypertrophic and keloid scars on ex-vivo tissues. PATIENTS AND METHODS All patients who underwent resection of pathological scar from November 2012 to September 2013 were analyzed. The scars were fixed in formalin and analyzed by conventional histology and full-field optical coherence tomography. The criteria for evaluation were: presence of dermal nodules, presence of cells and hyalinization of collagen. RESULTS Nineteen pathological scars were analyzed. Histology found 7 keloid scars, 7 mixed and 3 hypertrophic scars. The sensitivity of optical coherence tomography for the detection of dermal nodules was 100%. This technology was not helpful for detection of cells and hyalinized collagen. CONCLUSION In the present state of technology, optical coherence tomography did not identify the presence of cells, which makes the differential diagnosis difficult in the case of hypertrophic and keloid scars.
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Shekhar S, Sharma C, Thakur S, Raina N. Cervical cancer screening: knowledge, attitude and practices among nursing staff in a tertiary level teaching institution of rural India. Asian Pac J Cancer Prev 2014; 14:3641-5. [PMID: 23886159 DOI: 10.7314/apjcp.2013.14.6.3641] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Assessment of the nursing staff knowledge, attitude and practices about cervical cancer screening in a tertiary care teaching institute of rural India. MATERIALS AND METHODS A cross sectional, descriptive, interview- based survey was conducted with a pretested questionnaire among 262 staff nurses of a tertiary care teaching and research institute. RESULTS In this study 77% respondents knew that Pap smear is used for detection of cervical cancer, but less than half knew that Pap smear can detect even precancerous lesions of cervix. Only 23.4% knew human papilloma virus infection as a risk factor. Only 26.7% of the respondents were judged as having adequate knowledge based on scores allotted for questions evaluating knowledge about cervical cancer and screening. Only 17 (7%) of the staff nurses had themselves been screened by Pap smear, while 85% had never taken a Pap smear of a patient. Adequate knowledge of cervical cancer and screening, higher parity and age >30 years were significantly associated with self screening for cervical cancer. Most nurses held a view that Pap test is a doctor procedure, and nearly 90% of nurses had never referred a patient for Pap testing. CONCLUSIONS The majority of nursing staff in rural India may have inadequate knowledge about cervical cancer screening, and their attitude and practices towards cervical cancer screening could not be termed positive.
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Affiliation(s)
- Shashank Shekhar
- Department of Obstetrics and Gynecology, AIIMS Jodhpur, Rajasthan, India
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Belinson JL, Wang G, Qu X, Du H, Shen J, Xu J, Zhong L, Yi J, Yi X, Wu R. The development and evaluation of a community based model for cervical cancer screening based on self-sampling. Gynecol Oncol 2014; 132:636-42. [PMID: 24440471 DOI: 10.1016/j.ygyno.2014.01.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 01/06/2014] [Accepted: 01/07/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To develop and implement a community based model for cervical cancer prevention that allows the communities to manage the screening and the healthcare system to focus resources on evaluation and management of the positives. METHODS Using self-sampling and the concepts founded in Community Based Participatory Research (CBPR), we progressively developed a model to efficiently reach the women, especially rural communities; and collect the volume of samples needed to support high throughput centralized low cost per case processing. RESULTS 8382 eligible women, ages 35 to 59, in 130 rural communities participated. The screening was organized by the local government administration and conducted by the community leaders (CLs). The model used was progressively designed through detailed assessment of key elements at 6 decision points in 26 workshops that were used to train the CLs and the local promoters. The communities were able to accurately conduct the screening; in the final model a local medical worker conducted a 50-minute workshop featuring instructional posters and structured role-play. A manual and a workshop DVD were created for distribution to and implementation by local governments. The average callback rate was 84.3%, without involvement of the local doctors in the management of the positives. CONCLUSION An efficient community based model capable of massive screening events was developed. We believe that the callback rate will be further improved when local doctors are trained in the management of the positives. Many elements impact coverage and further research is needed to define the influence of the identified key variables.
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Affiliation(s)
- Jerome L Belinson
- Preventive Oncology International, Cleveland Heights, OH, USA; The Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Guixiang Wang
- Dept of Ob/Gyn, Peking University Shenzhen Hospital, Shenzhen, PR China
| | - Xinfeng Qu
- Preventive Oncology International, Cleveland Heights, OH, USA
| | - Hui Du
- Dept of Ob/Gyn, Peking University Shenzhen Hospital, Shenzhen, PR China
| | - Jingjing Shen
- Dept of Ob/Gyn, Peking University Shenzhen Hospital, Shenzhen, PR China
| | | | - Liqun Zhong
- The Maternity and Child Health Hospital, Heshan, Guangdong, PR China
| | - Ji Yi
- BGI Shenzhen, Shenzhen, PR China
| | - Xin Yi
- BGI Shenzhen, Shenzhen, PR China
| | - Ruifang Wu
- Dept of Ob/Gyn, Peking University Shenzhen Hospital, Shenzhen, PR China
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Gupta S, Singh V, Sehgal A, Sodhani P. Cervical cancer in resource-limited settings: preventable but not yet prevented. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17474108.2.4.515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Nakao KI, Ro A, Kibayashi K. Evaluation of the morphological changes of gastric mucosa induced by a low concentration of acetic acid using a rat model. J Forensic Leg Med 2013; 22:99-106. [PMID: 24485432 DOI: 10.1016/j.jflm.2013.12.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 11/01/2013] [Accepted: 12/07/2013] [Indexed: 10/25/2022]
Abstract
Oral ingestion of concentrated acetic acid causes corrosive injury of the gastrointestinal tract. To assess the effects of a low concentration of acetic acid on gastric mucosa, we examined the gastric mucosal changes in rats at 1 and 3 days after the injection of 5% or 25% acetic acid into the gastric lumen. The area of the gastric ulcerative lesions in the 25% acetic acid group was significantly larger than that in the 5% acetic acid group. The lesion area was reduced significantly at 3 days after injection in the 5% acetic acid group, whereas no significant difference in lesion area was observed at 1 and 3 days in the 25% acetic acid group. Histologically, corrosive necrosis was limited to the mucosal layer in the 5% acetic acid group, whereas necrosis extended throughout the gastric wall in the 25% acetic acid group. At 3 days post-injection, the 25% acetic acid group showed widespread persistent inflammation, whereas the 5% acetic acid group showed widespread appearance of fibroblasts indicative of a healing process. These results indicate that a low concentration of acetic acid damages the gastric mucosa and that the degree of mucosal damage depends on the concentration of acetic acid.
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Affiliation(s)
- Ken-ichiro Nakao
- Department of Legal Medicine, School of Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
| | - Ayako Ro
- Department of Legal Medicine, School of Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
| | - Kazuhiko Kibayashi
- Department of Legal Medicine, School of Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
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Sanad AS, Kamel HH, Hasan MM. Prevalence of cervical intraepithelial neoplasia (CIN) in patients attending Minia Maternity University Hospital. Arch Gynecol Obstet 2013; 289:1211-7. [PMID: 24305750 DOI: 10.1007/s00404-013-3109-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 11/21/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cervical cancer is the second most common cancer of the genital tract. Wide use of screening programs can help in prevention of cervical cancer. OBJECTIVE To screen and evaluate the prevalence of cervical intraepithelial neoplasia (CIN) by visualization of the cervix after application of 5 % acetic acid (VIA) in Minia Maternity University Hospital. PATIENTS AND METHODS The study included 3,600 women from outpatient clinics of Minia Maternity University Hospital. They were screened for cervical cancer with the use of visual inspection of the cervix after application of 5 % acetic acid (VIA). Positive cases were subjected to colposcopy after referral to the colposcopy unit in the same hospital. Colposcopy-guided biopsies were done for colposcopic positive patients. One hundred and twenty women with negative VIA as control were randomly examined with colposcopy to evaluate the effectiveness of the test used, and no cases experienced cervical lesion. RESULTS The prevalence was 5.8 % for cervical lesions, 1.4 % for HPV infection alone, 3.3, 0.84 and 0.27 % for CIN I, CIN II and CIN III, respectively. The prevalence of CIN II or higher was 1.11 % (40/3,600). CONCLUSIONS Prevalence of CIN in the study population was 138 out of 1,800 cases (7.7 %). Pre-invasive high-grade lesions represent 1.3 % in participant women. VIA can be used in national programs for cervical cancer screening.
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Affiliation(s)
- Ahmad Sameer Sanad
- Department of Gynaecology and Obstetrics, Faculty of Medicine, Minia University, El-Minia, Egypt,
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Denny L, Kuhn L, Wright TC. Cervical cancer screening in non-industrialised countries. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/095741903225003037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Filleron T, Dalenc F, Courbon F, Feillel V, Kramar A. Breast imaging: understanding how accuracy is measured when lesion are the unit of analysis. Breast J 2013; 19:225-6. [PMID: 23458221 DOI: 10.1111/tbj.12093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Background: We performed a cross-sectional study in Indonesia to evaluate the performance of a single-visit approach of cervical cancer screening, using visual inspection with acetic acid (VIA), histology and cryotherapy in low-resource settings. Methods: Women having limited access to health-care facilities were screened by trained doctors using VIA. If the test was positive, biopsies were taken and when eligible, women were directly treated with cryotherapy. Follow-up was performed with VIA and cytology after 6 months. When cervical cancer was suspected or diagnosed, women were referred. The positivity rate, positive predictive value (PPV) and approximate specificity of the VIA test were calculated. The detection rate for cervical lesions was given. Results: Screening results were completed in 22 040 women, of whom 92.7% had never been screened. Visual inspection with acetic acid was positive in 4.4%. The PPV of VIA to detect CIN I or greater and CIN II or greater was 58.7% and 29.7%, respectively. The approximate specificity was 98.1%, and the detection rate for CIN I or greater was 2.6%. Conclusion: The single-visit approach cervical cancer screening performed well, showing See and Treat is a promising way to reduce cervical cancer in Indonesia.
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Nuranna L, Aziz MF, Cornain S, Purwoto G, Purbadi S, Budiningsih S, Siregar B, Peters AAW. Cervical cancer prevention program in Jakarta, Indonesia: See and Treat model in developing country. J Gynecol Oncol 2012; 23:147-52. [PMID: 22808356 PMCID: PMC3395009 DOI: 10.3802/jgo.2012.23.3.147] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Revised: 05/22/2012] [Accepted: 05/22/2012] [Indexed: 11/30/2022] Open
Abstract
Objective The purpose of this study was to describe the implementation of single visit approach or See-visual inspection of the cervix with acetic acid (VIA)-and Treat-immediate cryotherapy in the VIA positive cases-model for the cervical cancer prevention in Jakarta, Indonesia. Methods An observational study in community setting for See and Treat program was conducted in Jakarta from 2007 until 2010. The program used a proactive and coordinative with VIA and cryotherapy (Proactive-VO) model with comprehensive approach that consists of five pillars 1) area preparation, 2) training, 3) awareness, 4) VIA and cryotherapy, and 5) referral. Results There were 2,216 people trained, consist of 641 general practitioners, 678 midwives, 610 public health cadres and 287 key people from the society. They were trained for five days followed by refreshing and evaluation program to ensure the quality of the test providers. In total, 22,989 women had been screened. The VIA test-positive rate was 4.21% (970/22,989). In this positive group, immediate cryotherapy was performed in 654 women (67.4%). Conclusion See and Treat program was successfully implemented in Jakarta area. The Proactive-VO model is a promising way to screen and treat precancerous lesions in low resource setting.
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Affiliation(s)
- Laila Nuranna
- Department of Obstetrics and Gynecology, Faculty of Medicine University of Indonesia, Jakarta, Indonesia
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Comparison of conventional cervical cytology versus visual inspection with acetic acid among human immunodeficiency virus-infected women in Western Kenya. J Low Genit Tract Dis 2012; 16:92-7. [PMID: 22126834 DOI: 10.1097/lgt.0b013e3182320f0c] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This study aimed to determine the accuracy of visual inspection with acetic acid (VIA) versus conventional Pap smear as a screening tool for cervical intraepithelial neoplasia/cancer among human immunodeficiency virus (HIV)-infected women. MATERIALS AND METHODS A total of 150 HIV-infected women attending the Moi Teaching and Referral Hospital HIV clinic in Eldoret underwent conventional Pap smear, VIA, colposcopy, and biopsy. Both VIA and Pap smears were done by nurses, whereas colposcopy and biopsy were done by a physician. Receiver operating characteristic analysis was conducted to compare the accuracies between VIA and Pap smear in sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS Among the study participants: VIA was abnormal in 55.3% (83/150, 95% confidence interval [CI] = 47.0%-63.5%); Pap smear showed atypical squamous cells of undetermined significance or worse in 43.7% (59/135, 95% CI = 35.2%-52.5%) and 10% (15/150) of the Pap smears were unsatisfactory. Of the abnormal Pap smears, 3% (2/59) had atypical squamous cells of undetermined significance, 7% (4/59) had high-grade atypical squamous cells, 60% (35/59) had low-grade squamous intraepithelial lesions, 29% (17/59) had high-grade squamous intraepithelial lesions, and 2% (1/59) was suspicious for cervical cancer. Using cervical intraepithelial neoplasia 2 or higher disease on biopsy as an end point, VIA has a sensitivity of 69.6% (95% CI = 55.1%-81.0%), specificity of 51.0% (95% CI = 41.5%-60.4%), PPV of 38.6% (95% CI = 28.8%-49.3%), and NPV of 79.1% (95% CI = 67.8%-87.2%). For conventional Pap smear, sensitivity was 52.5% (95% CI = 42.1%-71.5%), specificity was 66.3% (95% CI = 52.0%-71.2%), PPV was 39.7% (95% CI = 27.6%-51.8%), and NPV was 76.8% (95% CI = 67.0%-85.6%). CONCLUSIONS Visual inspection with acetic acid is comparable to Pap smear and acceptable for screening HIV-infected women in resource-limited settings such as Western Kenya.
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Duraipandian S, Zheng W, Ng J, Low JJH, Ilancheran A, Huang Z. Simultaneous fingerprint and high-wavenumber confocal Raman spectroscopy enhances early detection of cervical precancer in vivo. Anal Chem 2012; 84:5913-9. [PMID: 22724621 DOI: 10.1021/ac300394f] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Raman spectroscopy is a vibrational spectroscopic technique capable of nondestructively probing endogenous biomolecules and their changes associated with dysplastic transformation in the tissue. The main objectives of this study are (i) to develop a simultaneous fingerprint (FP) and high-wavenumber (HW) confocal Raman spectroscopy and (ii) to investigate its diagnostic utility for improving in vivo diagnosis of cervical precancer (dysplasia). We have successfully developed an integrated FP/HW confocal Raman diagnostic system with a ball-lens Raman probe for simultaneous acquistion of FP/HW Raman signals of the cervix in vivo within 1 s. A total of 476 in vivo FP/HW Raman spectra (356 normal and 120 precancer) are acquired from 44 patients at clinical colposcopy. The distinctive Raman spectral differences between normal and dysplastic cervical tissue are observed at ~854, 937, 1001, 1095, 1253, 1313, 1445, 1654, 2946, and 3400 cm(-1) mainly related to proteins, lipids, glycogen, nucleic acids and water content in tissue. Multivariate diagnostic algorithms developed based on partial least-squares-discriminant analysis (PLS-DA) together with the leave-one-patient-out, cross-validation yield the diagnostic sensitivities of 84.2%, 76.7%, and 85.0%, respectively; specificities of 78.9%, 73.3%, and 81.7%, respectively; and overall diagnostic accuracies of 80.3%, 74.2%, and 82.6%, respectively, using FP, HW, and integrated FP/HW Raman spectroscopic techniques for in vivo diagnosis of cervical precancer. Receiver operating characteristic (ROC) analysis further confirms the best performance of the integrated FP/HW confocal Raman technique, compared to FP or HW Raman spectroscopy alone. This work demonstrates, for the first time, that the simultaneous FP/HW confocal Raman spectroscopy has the potential to be a clinically powerful tool for improving early diagnosis and detection of cervical precancer in vivo during clinical colposcopic examination.
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Affiliation(s)
- Shiyamala Duraipandian
- Optical Bioimaging Laboratory, Department of Bioengineering, Faculty of Engineering, National University of Singapore, Singapore
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Yoo H, Kang D, Katz AJ, Lauwers GY, Nishioka NS, Yagi Y, Tanpowpong P, Namati J, Bouma BE, Tearney GJ. Reflectance confocal microscopy for the diagnosis of eosinophilic esophagitis: a pilot study conducted on biopsy specimens. Gastrointest Endosc 2011; 74:992-1000. [PMID: 21944314 PMCID: PMC3425354 DOI: 10.1016/j.gie.2011.07.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 07/14/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND Diagnosis of eosinophilic esophagitis (EoE) currently requires endoscopic biopsy and histopathologic analysis of the biopsy specimens to count intraepithelial eosinophils. Reflectance confocal microscopy (RCM) is an endomicroscopy technology that is capable of obtaining high-resolution, optically sectioned images of esophageal mucosa without the administration of exogenous contrast. OBJECTIVE In this study, we investigated the capability of a high-speed form of RCM, termed spectrally encoded confocal microscopy (SECM), to count intraepithelial esophageal eosinophils and characterize other microscopic findings of EoE. DESIGN A total of 43 biopsy samples from 35 pediatric patients and 8 biopsy samples from 8 adult patients undergoing EGD for EoE were imaged by SECM immediately after their removal and then processed for routine histopathology. Two SECM readers, trained on adult cases, prospectively counted intraepithelial eosinophils and detected the presence of abscess, degranulation, and basal cell hyperplasia on SECM images from the pediatric patients. A pathologist blinded to the SECM data analyzed the same from corresponding slides. SETTING The Gastrointestinal Unit, Massachusetts General Hospital. RESULTS Eosinophils by SECM demonstrated a higher reflectance than the surrounding cells and other inflammatory cells. There was good correlation between SECM and histology maximum eosinophil counts/high-power field (R = 0.76, P < .0001). Intra- and interobserver correlations for SECM counts were very good (R = 0.93 and R = 0.92, respectively; P < .0001). For the commonly used eosinophil count cutoff of 15 per high-power field, the sensitivity and specificity of SECM for EoE were 100%. The sensitivity and specificity for abscess, degranulation, and basal cell hyperplasia were 100% and 82%, 91% and 60%, and 94% and 80%, respectively. Intra- and interobserver agreements for these microscopic features of EoE were very good (κ = 0.9/0.9, 0.84/1.0, 0.91/0.81, respectively). LIMITATION Ex vivo study. CONCLUSIONS This study demonstrates that RCM can be used to accurately count intraepithelial eosinophils and identify other microscopic abnormalities associated with EoE on freshly excised biopsy samples. These findings suggest that RCM may be developed into a tool for assessing eosinophilic infiltration in the esophagus in vivo.
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Affiliation(s)
- Hongki Yoo
- Wellman Center for Photomedicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA,Department of Dermatology Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - DongKyun Kang
- Wellman Center for Photomedicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA,Department of Dermatology Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Aubrey J. Katz
- Department of Gastrointestinal Unit, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA,Food Allergy Center, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gregory Y. Lauwers
- Department of Pathology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Norman S. Nishioka
- Department of Gastrointestinal Unit, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Yukako Yagi
- Department of Pathology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Pornthep Tanpowpong
- Department of Gastrointestinal Unit, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA,Food Allergy Center, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jacqueline Namati
- Wellman Center for Photomedicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA,Department of Dermatology Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Brett E. Bouma
- Wellman Center for Photomedicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA,Harvard-MIT Health Sciences and Technology, Cambridge, Massachusetts, USA
| | - Guillermo J. Tearney
- Wellman Center for Photomedicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA,Department of Dermatology Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA,Harvard-MIT Health Sciences and Technology, Cambridge, Massachusetts, USA
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Sankaranarayanan R, Sauvaget C, Ramadas K, Ngoma T, Teguete I, Muwonge R, Naud P, Nessa A, Kuhaprema T, Qiao Y. Clinical trials of cancer screening in the developing world and their impact on cancer healthcare. Ann Oncol 2011; 22 Suppl 7:vii20-vii28. [DOI: 10.1093/annonc/mdr422] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Buys TPH, Cantor SB, Guillaud M, Adler-Storthz K, Cox DD, Okolo C, Arulogon O, Oladepo O, Basen-Engquist K, Shinn E, Yamal JM, Beck JR, Scheurer ME, van Niekerk D, Malpica A, Matisic J, Staerkel G, Atkinson EN, Bidaut L, Lane P, Benedet JL, Miller D, Ehlen T, Price R, Adewole IF, MacAulay C, Follen M. Optical technologies and molecular imaging for cervical neoplasia: a program project update. ACTA ACUST UNITED AC 2011; 9:S7-24. [PMID: 21944317 DOI: 10.1016/j.genm.2011.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 08/02/2011] [Indexed: 12/23/2022]
Abstract
There is an urgent global need for effective and affordable approaches to cervical cancer screening and diagnosis. In developing nations, cervical malignancies remain the leading cause of cancer-related deaths in women. This reality may be difficult to accept given that these deaths are largely preventable; where cervical screening programs have been implemented, cervical cancer-related deaths have decreased dramatically. In developed countries, the challenges of cervical disease stem from high costs and overtreatment. The National Cancer Institute-funded Program Project is evaluating the applicability of optical technologies in cervical cancer. The mandate of the project is to create tools for disease detection and diagnosis that are inexpensive, require minimal expertise, are more accurate than existing modalities, and can be feasibly implemented in a variety of clinical settings. This article presents the status and long-term goals of the project.
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Affiliation(s)
- Timon P H Buys
- Imaging Unit, Department of Integrative Oncology, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada.
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Duraipandian S, Zheng W, Ng J, Low JJH, Ilancheran A, Huang Z. In vivo diagnosis of cervical precancer using Raman spectroscopy and genetic algorithm techniques. Analyst 2011; 136:4328-36. [PMID: 21869948 DOI: 10.1039/c1an15296c] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This study aimed to evaluate the clinical utility of applying near-infrared (NIR) Raman spectroscopy and genetic algorithm-partial least squares-discriminant analysis (GA-PLS-DA) to identify biomolecular changes of cervical tissues associated with dysplastic transformation during colposcopic examination. A total of 105 in vivo Raman spectra were measured from 57 cervical sites (35 normal and 22 precancer sites) of 29 patients recruited, in which 65 spectra were from normal sites, while 40 spectra were from cervical precancerous lesions (i.e., 7 low-grade CIN and 33 high-grade CIN). The GA feature selection technique incorporated with PLS was utilized to study the significant biochemical Raman bands for differentiation between normal and precancer cervical tissues. The GA-PLS-DA algorithm with double cross-validation (dCV) identified seven diagnostically significant Raman bands in the ranges of 925-935, 979-999, 1080-1090, 1240-1260, 1320-1340, 1400-1420, and 1625-1645 cm(-1) related to proteins, nucleic acids and lipids in tissue, and yielded a diagnostic accuracy of 82.9% (sensitivity of 72.5% (29/40) and specificity of 89.2% (58/65)) for precancer detection. The results of this exploratory study suggest that Raman spectroscopy in conjunction with GA-PLS-DA and dCV methods has the potential to provide clinically significant discrimination between normal and precancer cervical tissues at the molecular level.
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Affiliation(s)
- Shiyamala Duraipandian
- Optical Bioimaging Laboratory, Department of Bioengineering, Faculty of Engineering, National University of Singapore, 9, Engineering Drive 1, Singapore 117576
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Adequacy of visual inspection with acetic acid in women of advancing age. Int J Gynaecol Obstet 2011; 113:68-71. [DOI: 10.1016/j.ijgo.2010.10.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 10/21/2010] [Accepted: 12/17/2010] [Indexed: 11/24/2022]
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Sauvaget C, Fayette JM, Muwonge R, Wesley R, Sankaranarayanan R. Accuracy of visual inspection with acetic acid for cervical cancer screening. Int J Gynaecol Obstet 2011; 113:14-24. [PMID: 21257169 DOI: 10.1016/j.ijgo.2010.10.012] [Citation(s) in RCA: 155] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 10/13/2010] [Accepted: 12/15/2010] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To provide an updated estimation of the accuracy of visual inspection with acetic acid (VIA) in detecting true disease. METHODS A PubMed search provided original studies on VIA accuracy in which the gold standard for confirmatory testing was histology alone or colposcopy followed by biopsy. The numbers of true-positive, false-positive, false-negative, and true-negative results were extracted from each study. Meta-analyses were then performed with different categories of studies according to confirmatory diagnosis threshold, category of women who received confirmatory testing, and whether a medical condition that could affect VIA accuracy was present at screening. The reference category consisted of 26 studies in which VIA was performed on asymptomatic women who all underwent confirmatory testing and in which the disease threshold was cervical intraepithelial neoplasia grade 2. RESULTS We report an 80% sensitivity (range, 79%-82%) and a 92% specificity (range, 91%-92%) for VIA. Study region, capacity of screener, or size of the study population did not modify VIA accuracy. The positive predictive value was 10% (range, 9%-10%). CONCLUSION Screening for precancerous and cancerous cervical lesions using VIA is a simple, low-cost, and efficient alternative to cytologic testing in low-resource areas.
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Affiliation(s)
- Catherine Sauvaget
- Early Detection & Prevention Section, Screening Group, International Agency for Research on Cancer, Lyon, France.
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Aggarwal P, Batra S, Gandhi G, Zutshi V. Comparison of Papanicolaou test with visual detection tests in screening for cervical cancer and developing the optimal strategy for low resource settings. Int J Gynecol Cancer 2010; 20:862-8. [PMID: 20606535 DOI: 10.1111/igc.0b013e3181e02f77] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To compare the sensitivity, specificity, positive and negative predictive values, and accuracy of Papanicolaou test with visual inspection with acetic acid (VIA)/VIA using magnification devices (VIAM) and develop the best strategy for screening in low resource settings. MATERIALS AND METHODS This is a prospective cross-sectional study on 408 symptomatic multiparous women in the reproductive age group, sequentially using the Papanicolaou test, the VIA, and the VIAM for screening. Women with a positive screening test underwent guided biopsy and endocervical curettage. The site of biopsy was recorded. Histopathological findings were taken as the "gold" standard in comparing the methods. RESULTS The mean (SD) age was 32.3 (6.8) years (range, 15-49 years), whereas the mean (SD) parity was 2.9 (1.2) (range, 1-9). Abnormal cytological findings were detected in 2.9% patients, whereas the remaining smears were negative for any intraepithelial lesion or malignancy. A total of 113 cases were screened positive by one/all methods. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the Papanicolaou test, the VIA, and the VIAM were 24, 98, 42, 96, and 94%; 95, 78, 19, 99, and 79%; and 95, 78, 19, 99, and 79%, respectively, for high-grade lesions. CONCLUSIONS The Papanicolaou test had low sensitivity but high specificity, whereas visual detection methods had a high sensitivity in addition to being cheaper. Alternative methods of screening such as VIA/VIAM can be a valuable alternative to the Papanicolaou test for cervical cancer screening in low resource settings. Visual inspection using magnification devices may be of benefit over VIA in doubtful cases.
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Affiliation(s)
- Pakhee Aggarwal
- Department of Obstetrics and Gynaecology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.
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Carr KC, Sellors JW. Cervical Cancer Screening in Low Resource Settings Using Visual Inspection With Acetic Acid. J Midwifery Womens Health 2010; 49:329-37. [PMID: 15236713 DOI: 10.1016/j.jmwh.2004.02.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cervical cancer is one of the leading causes of death for middle-aged women in the developing world, yet it is almost completely preventable, if precancerous lesions are identified and treated in a timely manner. Cervical cancer screening based on cytologic examination is largely unavailable in developing countries or made available to a small, select group of women in private facilities, maternal child health sites, or family-planning clinics, missing the age groups at highest risk for precancerous lesions. Visual inspection with acetic acid (VIA) can be used to screen women. It can be done by nurses or midwives with appropriate training. Although still under investigation, research results show that VIA is simple, accurate, cost-effective, and acceptable to most women. This article reviews the natural history of cervical cancer and important aspects to consider related to cervical cancer screening in low resource settings. The VIA technique is described in detail.
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Belinson SE, Belinson JL. Human papillomavirus DNA testing for cervical cancer screening: practical aspects in developing countries. Mol Diagn Ther 2010; 14:215-22. [PMID: 20799763 DOI: 10.1007/bf03256376] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Cervical cancer is the second most common cancer in women worldwide, and the most common cause of death from cancer in women in the developing world. Cervical cancer represents the only gynecologic cancer that can be prevented through regular screening. Although there are established screening programs in the Western world that have effectively reduced the burden of cervical cancer, these programs have relied on insensitive screening technologies that depend on the long preinvasive phase of cervical carcinogenesis. The developing world faces specific additional challenges in implementing a successful cervical cancer screening program. The association between cervical cancers and human papillomavirus (HPV) make testing for the presence of HPV DNA a valuable screening tool. This review focuses on practical aspects of the implementation and delivery of HPV testing as the primary cervical cancer screening strategy in the developing world, and attempts to offer some solutions to the real-world challenges faced in these regions.
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Affiliation(s)
- Suzanne E Belinson
- Preventive Oncology International, Inc., Cleveland Heights, Ohio 44118, USA.
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Cytology versus visual inspection with acetic acid among women treated previously with cryotherapy in a low-resource setting. Int J Gynaecol Obstet 2010; 111:249-52. [DOI: 10.1016/j.ijgo.2010.06.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 06/21/2010] [Accepted: 07/20/2010] [Indexed: 11/20/2022]
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Gravitt PE, Paul P, Katki HA, Vendantham H, Ramakrishna G, Sudula M, Kalpana B, Ronnett BM, Vijayaraghavan K, Shah KV. Effectiveness of VIA, Pap, and HPV DNA testing in a cervical cancer screening program in a peri-urban community in Andhra Pradesh, India. PLoS One 2010; 5:e13711. [PMID: 21060889 PMCID: PMC2965656 DOI: 10.1371/journal.pone.0013711] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Accepted: 10/03/2010] [Indexed: 01/28/2023] Open
Abstract
Background While many studies have compared the efficacy of Pap cytology, visual inspection with acetic acid (VIA) and human papillomavirus (HPV) DNA assays for the detection cervical intraepithelial neoplasia and cancer, few have evaluated the program effectiveness. Methods and Findings A population-based sample of 5603 women from Medchal Mandal in Andhra Pradesh, India were invited to participate in a study comparing Pap cytology, VIA, and HPV DNA screening for the detection of CIN3+. Participation in primary screening and all subsequent follow-up visits was rigorously tracked. A 20% random sample of all women screened, in addition to all women with a positive screening test result underwent colposcopy with directed biopsy for final diagnosis. Sensitivity, specificity, positive and negative predictive values were adjusted for verification bias. HPV testing had a higher sensitivity (100%) and specificity (90.6%) compared to Pap cytology (sensitivity = 78.2%; specificity = 86.0%) and VIA (sensitivity = 31.6%; specificity = 87.5%). Since 58% of the sample refused involvement and another 28% refused colposcopy or biopsy, we estimated that potentially 87.6% of the total underlying cases of CIN3 and cancer may have been missed due to program failures. Conclusions We conclude that despite our use of available resources, infrastructure, and guidelines for cervical cancer screening implementation in resource limited areas, community participation and non-compliance remain the major obstacles to successful reduction in cervical cancer mortality in this Indian population. HPV DNA testing was both more sensitive and specific than Pap cytology and VIA. The use of a less invasive and more user-friendly primary screening strategy (such as self-collected swabs for HPV DNA testing) may be required to achieve the coverage necessary for effective reduction in cervical cancer mortality.
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Affiliation(s)
- Patti E Gravitt
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
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Wulan N, Rasool N, Belinson SE, Wang C, Rong X, Zhang W, Zhu Y, Yang B, Tresser NJ, Mohr M, Wu R, Belinson JL. Study of the Diagnostic Efficacy of Real-Time Optical Coherence Tomography as an Adjunct to Unaided Visual Inspection With Acetic Acid for the Diagnosis of Preinvasive and Invasive Neoplasia of the Uterine Cervix. Int J Gynecol Cancer 2010; 20:422-7. [DOI: 10.1111/igc.0b013e3181d09fbb] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Mittra I, Mishra GA, Singh S, Aranke S, Notani P, Badwe R, Miller AB, Daniel EE, Gupta S, Uplap P, Thakur MH, Ramani S, Kerkar R, Ganesh B, Shastri SS. A cluster randomized, controlled trial of breast and cervix cancer screening in Mumbai, India: methodology and interim results after three rounds of screening. Int J Cancer 2010; 126:976-84. [PMID: 19697326 DOI: 10.1002/ijc.24840] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cervix and Breast cancers are the most common cancers among women worldwide and extract a large toll in developing countries. In May 1998, supported by a grant from the NCI (US), the Tata Memorial Hospital, Mumbai, India, started a cluster-randomized, controlled, screening-trial for cervix and breast cancer using trained primary health workers to provide health-education, visual-inspection of cervix (with 4% acetic acid-VIA) and clinical breast examination (CBE) in the screening arm, and only health education in the control arm. Four rounds of screening at 2-year intervals will be followed by 8 years of monitoring for incidence and mortality from cervix and breast cancers. The methodology and interim results after three rounds of screening are presented here. Good randomization was achieved between the screening (n = 75360) and control arms (n = 76178). In the screening arm we see: High screening participation rates; Low attrition; Good compliance to diagnostic confirmation; Significant downstaging; Excellent treatment completion rate; Improving case fatality ratios. The ever-screened and never-screened participants in the screening arm show significant differences with reference to the variables religion, language, age, education, occupation, income and health-seeking behavior for gynecological and breast-related complaints. During the same period, in the control arm we see excellent participation rate for health education; Low attrition and a good number of symptomatic referrals for both cervix and breast.
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Kang D, Suter MJ, Boudoux C, Yoo H, Yachimski PS, Puricelli WP, Nishioka NS, Mino-Kenudson M, Lauwers GY, Bouma BE, Tearney GJ. Comprehensive imaging of gastroesophageal biopsy samples by spectrally encoded confocal microscopy. Gastrointest Endosc 2010; 71:35-43. [PMID: 19922916 PMCID: PMC3135336 DOI: 10.1016/j.gie.2009.08.026] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Accepted: 08/23/2009] [Indexed: 02/06/2023]
Abstract
BACKGROUND Spectrally encoded confocal microscopy (SECM) is a high-speed reflectance confocal microscopy technique that has the potential to be used for acquiring comprehensive images of the entire distal esophagus endoscopically with subcellular resolution. OBJECTIVE The goal of this study was to demonstrate large-area SECM in upper GI tissues and to determine whether the images contain microstructural information that is useful for pathologic diagnosis. DESIGN A feasibility study. SETTING Gastrointestinal Unit, Massachusetts General Hospital. PATIENTS Fifty biopsy samples from 36 patients undergoing routine EGD were imaged by SECM, in their entirety, immediately after their removal. RESULTS The microstructure seen in the SECM images was similar to that seen by histopathology. Gastric cardia mucosa was clearly differentiated from squamous mucosa. Gastric fundic/body type mucosa showed more tightly packed glands than gastric cardia mucosa. Fundic gland polyps showed cystically dilated glands lined with cuboidal epithelium. The presence of intraepithelial eosinophils was detected with the cells demonstrating a characteristic bilobed nucleus. Specialized intestinal metaplasia was identified by columnar epithelium and the presence of goblet cells. Barrett's esophagus (BE) with dysplasia was differentiated from specialized intestinal metaplasia by the loss of nuclear polarity and disorganized glandular architecture. LIMITATIONS Ex vivo, descriptive study. CONCLUSIONS Large-area SECM images of gastroesophageal biopsy samples enabled the visualization of both subcellular and architectural features of various upper GI mucosal types and were similar to the corresponding histopathologic slides. These results suggest that the development of an endoscopic SECM probe is merited.
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Cagle AJ, Hu SY, Sellors JW, Bao YP, Lim JM, Li SM, Lewis K, Song Y, Ma JF, Pan QJ, Zhang WH, Zhao FH, Qiao YL. Use of an expanded gold standard to estimate the accuracy of colposcopy and visual inspection with acetic acid. Int J Cancer 2009; 126:156-61. [PMID: 19585573 DOI: 10.1002/ijc.24719] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We estimate the accuracy of colposcopy and visual inspection with acetic acid (VIA) while minimizing the effects of misclassification bias, and maximizing ascertainment of disease. VIA was performed by experienced physicians on a population-based sample of women aged 30 to 49 years in rural Shanxi province, China. Each woman received VIA, liquid-based cytology (LBC) and hybrid capture 2 (hc2, QIAGEN, Gaithersburg, MD; formerly Digene Corporation). Any woman who tested positive on any test had colposcopy, endocervical curettage (ECC) with directed biopsies as necessary and 4-quadrant random biopsies from normal-appearing areas of the cervix. A standard diagnosis based on colposcopy and directed biopsy, and an expanded diagnosis including ECC and 4-quadrant random biopsy were generated for each woman. In 1,839 women, use of the expanded versus the standard diagnostic criteria increased the prevalence of histologically confirmed high-grade cervical intraepithelial neoplasia and cancer (CIN2+) from 3.2% (59/1,839) to 4.2% (77/1,839) and decreased the sensitivity of VIA for CIN2+ from 69.5% (95% CI: 56.8-79.8) to 58.4% (95% CI: 47.3-68.8%) with little change in specificity of approximately 89%. Compared with the expanded diagnostic criterion, the sensitivity of a visual diagnosis of high-grade CIN or cancer by a colposcopist was 49.4% (95% CI: 38.2-60.5). The use of an expanded diagnostic criterion in this study yielded more conservative estimates of the sensitivity of VIA and colposcopy.
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Akinola OI, Fabamwo AO, Oshodi YA, Banjo AA, Odusanya O, Gbadegesin A, Tayo A. Efficacy of visual inspection of the cervix using acetic acid in cervical cancer screening: A comparison with cervical cytology. J OBSTET GYNAECOL 2009; 27:703-5. [DOI: 10.1080/01443610701614421] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Herrero R, Ferreccio C, Salmerón J, Almonte M, Sánchez GI, Lazcano-Ponce E, Jerónimo J. New approaches to cervical cancer screening in Latin America and the Caribbean. Vaccine 2008; 26 Suppl 11:L49-58. [PMID: 18945402 DOI: 10.1016/j.vaccine.2008.05.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cervical cancer remains an important public health problem in the Latin America and Caribbean region (LAC), with an expected significant increase in disease burden in the next decades as a result of population ageing. Prophylactic human papillomavirus (HPV) vaccine is currently unaffordable in LAC countries. However, even if vaccination was implemented, an additional two decades will be required to observe its impact on HPV related disease and cancer. With some exceptions, cytology-based screening programs have been largely ineffective to control the problem in the region, and there is a need for new approaches to the organization of screening and for use of newly developed techniques. Several research groups in LAC have conducted research on new screening methods, some of which are summarized in this paper. A recommendation to reorganize screening programs is presented considering visual inspection for very low resource areas, improvement of cytology where it is operating successfully and HPV DNA testing followed by visual inspection with acetic acid (VIA) or cytology as soon as this method becomes technically and economically sustainable. This could be facilitated by the incorporation of new, low-cost HPV DNA testing methods and the use of self-collected vaginal specimens for selected groups of the population. An important requisite for screening based on HPV testing will be the quality assurance of the laboratory and the technique by validation and certification measures.
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Affiliation(s)
- Rolando Herrero
- Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, San José, Costa Rica.
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