Gynecologic Oncology

Biography

Biography: Elisabeth Wikstrom Shemer

Abstract

Objectives: After the introduction of non cytological tests like visual inspection after acetic acid (VIA) or Human Papillomavirus (HPV) test, there is a paradigm shift in screening for cervical cancer. Though ‘screen and treat’ strategy is being recommended in low resource settings, the low positive predictive values of both the tests will lead to lot of overtreatment. GynocularTM is a battery-operated, portable device with three-step magnification and green-filter. Present study was conducted in a community setting to evaluate GynocularTM in detection of cervical neoplasias.rnrnMethodology: Women between 30-60 years were screened using VIA and HPV test. Women positive on either test had evaluation by GynocularTM using IFCPC 2011 colposcopy classification and swede score. Punch biopsy was obtained from any lesion detected by GynocularTM. HPV positive women also had random punch biopsy from the cervix. The sensitivity, specificity and agreement between histology and gynocular diagnosis were estimated.rnrnResults: Total 6884 women were screened from April, 2014 to March, 2015. Total 684 women were examined by GynocularTM. A total of 28 cases of CIN2+ were detected. The sensitivity and specificity of Gynocular (IFCPC Grade-2 threshold) to detect CIN 2+ were 92.9% and 96.1% respectively. The exact agreement between Gynocular examination and histology to classify the cervical lesions was 55.5% with kappa value of 0.29 (95% C.I. 0.22–0.36) indicated ‘fair’ agreement. rnrnConclusion: There is a great need for an inexpensive colposcope to be used for programs in LMICs. The agreement of GynocularTM with histology was same as that of colposcopy reported in our earlier study conducted in the same setting. The logistic advantage of the device and ability to capture images using mobile phone are beneficial to use Gynocular TM for cervical cancer screening program. rn