Value Of Colposcopic Cervicography On Community-based Cervical Cancer Screening

Background:Cervical cancer is one of the most common malignant tumors among women. At present, Early diagnosis and treatment is still the focus of cervical cancer prevention and control, although no single screening test is perfect with high sensitivity and specificity. WHO recommend visual inspection and traditional Pap smear as preferred method of cervical cancer screening. However, visual inspection lacks repeatability and global data based on large sample. Pap smears is known for its high false negative rate and also, in large-scale screening perfect laboratory equipment and large number of pathologists are needed. Our study is to evaluate if colposcopic cervicography can be an effective primary screening test for community-based cervical cancer screening.Methods:In Hongkou District of Shanghai, suitable women were invited to participate in our study, screening tests are as follows:â‘ VIA/VILI;â‘¡colposcopic cervicography;â‘¢Pap smears. Cervical biopsy (including ECC) is done when any of the results is positive. Further treatment is followed for those with CIN and second screening is carried out for those without CIN in the next year. We use SPSS 11.0 to finish statistical analysis. Sensitivity, specificity, positive predictive value, negative predictive value, youden'index is calculated. The statistical significance was assessed by chi-square test.P<0.05 is considered as significant.Results:â‘ 2505 women were involved in our study,410 biopsies were done in the first year,17 CINâ… ,15 CINâ…¡,4 CINâ…¢were found. The sensitivity of Pap smears, visual inspection and colposcopic cervicography to diagnose high grade CIN is 31.6%,78.9%,94.7%, specificity is 97.4%,61.4%,76,2%, positive predictive value is 62.5%,9.0%,16.2%, negative predictive value is 96.7%,98.4%,99.7%, youden'index is 0.29,0.34,0.71. The sensitivity of colposcopic cervicography is higher than that of Pap smears(P<0.05),but while compared with visual inspection,there is no statistical significance. The specificity of colposcopic cervicography is between that of Pap smears and visual inspection(P<0.05).â‘¡Combination of colposcopic cervicography and Pap smears cannot increase sensitivity or specificity. Statistical significance was found when colposcopic cervicography was carried out on those with positive visual inspection results(P>0.05).â‘¢There is no statistical significance between VIA and VILI in sensitivity and specificity,both for colposcopic cervicography and visual inspection.â‘£1369 women with negative results were involved in second screening and 4 CINâ… ,2 CINâ…¡,2 CINâ…¢were diagnosed.Conclusions:â‘ Colposcopic cervicography has relatively higher sensitivity and specificity in cervical cancer screening. It can be easily mastered by LMO(local medical offer) and it is low cost. So colposcopic cervicography can be an effective primary screening test for community-based cervical cancer screening and can replace Pap smears.â‘¡The accuracy of VIA and VILI are similar. VIA has time limit while VILI hasn't.â‘¢Further studies are needed to evaluate the long-term effects and screening intervals of colposcopic cervicography.