Visual inspection using naked eye and colposcopy as a predictor of high-grade lesions on final histology in HIV-positive and -negative South African women

Authors

Keywords:

cervical cancer, visual inspection with acetic acid (VIA), visual inspection with lugols iodine (VILI), colposcopic impression, Reid’s colposcopic index (RCI)

Abstract

Background: Although potentially preventable, cervical cancer is the fourth most common cancer among women globally and a leading cause of cancer-related deaths. Women living in resource-limited countries are especially at risk due to poor access to cervical cancer screening and treatment. Alternative cervical cancer screening methodologies have been investigated where cytology-based screening is not feasible. This study aimed to assess the test performance of naked eye visual inspection analysis, in addition to the comparative performance of physician/colposcopist clinical impression to Reid’s colposcopic index (RCI) grading system for histopathology, in the South African setting.

Methods: Women living with HIV (WLWH) and HIV-negative women aged 25 to 65 were recruited from three sites in South Africa. A cross-sectional study which assessed visual inspection with acetic acid (VIA), visual inspection with lugols iodine (VILI), colposcopic impression and RCI for the detection of histologically confirmed CIN2+ and CIN3+ was performed. Test positivity rates, sensitivity, specificity, and predictive values were calculated.

Results: Three hundred and forty-four WLWH and 409 HIV-negative women, with a median age of 40 years, were included in this analysis. Histologically confirmed CIN2+ was present in 38.51% and CIN3+ in 18.99%. Overall, positive test rates for VIA were 42.76%; VILI were 45.68%, colposcopic impression were 48.26% and RCI were 46.65%. Overall sensitivities/specificities for VIA and VILI for CIN3+ were 76.92/65.25% and 75.52/61.31%, respectively. The sensitivities however increased for WLWH (VIA 82.61%; VILI 80.43%) and decreased in HIV-negative women (VIA 66.67%; VILI 66.67%). Colposcopic impression/RCI performed better in WLWH (PPV 37.96/37.74%) than in HIV-negative women (PPV 25.63/26.80%).

Conclusion: The current study demonstrates that visual inspection methods perform better in WLWH than in HIV-negative women. VIA and VILI performed similarly within each sub-population, as did colposcopic impression and RCI. The use of visual inspection methods in cervical cancer screening in WLWH is warranted.

Author Biographies

  • RA Adams, Stellenbosch University

    Department of Obstetrics and Gynaecology and Unit for Gynaecological Oncology, Stellenbosch University, South Africa

  • G Dreyer, University of Pretoria

    Department of Obstetrics and Gynaecology and Gynaecological Oncology Unit, University of Pretoria, South Africa

  • LC Snyman, University of Pretoria

    Department of Obstetrics and Gynaecology and Gynaecological Oncology Unit, University of Pretoria, South Africa

  • C Visser, University of Pretoria

    Department of Obstetrics and Gynaecology and Gynaecological Oncology Unit, University of Pretoria, South Africa

  • GJ Dreyer, Stellenbosch University

    Department of Statistics and Actuarial Science, Stellenbosch University, South Africa

  • A Breidenthal, Stellenbosch University

    Department of Obstetrics and Gynaecology and Unit for Gynaecological Oncology, Stellenbosch University, South Africa

  • C Frenzel, Stellenbosch University

    Department of Obstetrics and Gynaecology and Unit for Gynaecological Oncology, Stellenbosch University, South Africa

  • FH van der Merwe, Stellenbosch University

    Department of Obstetrics and Gynaecology and Unit for Gynaecological Oncology, Stellenbosch University, South Africa

  • MH Botha, University of Stellenbosch

    Department of Obstetrics and Gynaecology and Unit for Gynaecological Oncology, Stellenbosch University, South Africa

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Published

2023-02-08

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Section

Original Research