A research report submitted to the Faculty of Health Sciences, University of the Witwaters-rand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Med-icine in Obstetrics and Gynaecology. Johannesburg 2019 / Background and objectives Cervical cancer can be prevented by screening and treatment of cervical cancer precursor lesions. Women with an abnormal Pap smear are referred to colposcopy for diagnosis and are then treated immediately in many South African colposcopy clinics. Hence accurate colposcopic diagnosis is important. The aim of this study was to determine the accuracy of diagnosing cervical intraepithelial neoplasia with either the Reid Colposcopic Index or the Swede score in HIV infected women. The components of the Reid colposcopic index are acetowhiteness, margins, vascular patterns and iodine staining. The Swede score has all the components of the Reid score with the addition of lesion size as a fifth compo-nent. Methods This was a secondary data analysis of the South African arm of the “HPV in Africa Research Partnership (HARP) study” comparing different screening tests in the prevention of cervical cancer in HIV infected women. Women were recruited from primary health care clinics and HIV treatment centres in Hillbrow, Johannesburg. All women had a Pap smear, Human papil-lomavirus testing, and visual inspection with lugol’s iodine and with acetic acid. All women with any positive screening test were referred to colposcopy. At colposcopy a four-quadrant biopsy and directed biopsies of any visible lesions were performed. The colposcopist rec-orded the colposcopy findings using the Swede score. For this study, the information from the Swede score was used to determine the Reid colposcopy index. Data was extracted from the HARP study database. Results A total of 624 women were eligible for the study in the South African arm, only 577 women were included for this study. The mean age was 34 years (SD±5.89). Antiretroviral therapy was used by 370 (64%) women. Abnormal Pap smears were found in 484 (88%) women, VIA was positive in 162 (28%), VILI was positive in 219 (37%) and HR HPV DNA was found in 374 (65%) women re-spectively. Histological findings showed that 263 (46%) of the women had no CIN, 185 (32%) had CIN 1, 76 (13%) had CIN 2 and 53 (9%) had CIN 3. The Swede score of 5 had a sensitivity of 72.9%, specificity of 71.9%, PPV of 42.7%and NPV of 90.2% respectively. A Reid score of 4 had a sensitivity of 72.9%, specificity of 69.4%, PPV of 40.7% and NPV of 89.9%. In comparison, the Area under the curve was higher for the Swede score compared to the Reid and this differ-ence was statistically significant. Conclusion This study shows that the Swede score when compared to the Reid score performs better in terms of accuracy for predicting CIN≥2 lesions. The addition of the lesion size has been shown to have an added advantage in the performance of the scoring. Both scores also demonstrated flexibility. There is a higher likelihood of HIV infected women to be referred for colposcopy as they have a higher incidence of cervical cancer precursor lesions. There was no difference in the performance of the Swede or Reid score by antecedent Pap smear and there was no difference in colposcopy findings on women with the presence of HR-HPV or no HR-HPV. / E.K. 2019

Yuan, Qin. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2002. / Includes bibliographical references (leaves 112-119). / Abstracts in English and Chinese. / Acknowledgements --- p.III / Publications --- p.V / List of Abbreviations --- p.VI / List of Figures --- p.VII / List of Tables --- p.VIII / Abstract in English --- p.IX / Abstract in Chinese --- p.XII / Table of Contents --- p.XIII / Chapter CHAPTER1 I --- NTRODUCTION --- p.1 / Chapter 1.1 --- What is telemedicine --- p.1 / Chapter 1.2 --- What is telepathology --- p.4 / Chapter 1.2.1 --- Types of telepathology system --- p.7 / Chapter 1.2.2 --- Main events in the development of telepathology --- p.9 / Chapter 1.2.3 --- Diagnostic accuracy in telepathology and telecytology --- p.12 / Chapter 1.2.4 --- Applications of telepathology --- p.18 / Chapter 1.2.4.a --- Remote primary diagnosis --- p.18 / Chapter 1.2.4.b --- Remote expert consultation --- p.19 / Chapter 1.2.4.c --- "Image libraries, databases and archiving" --- p.20 / Chapter 1.2.4.d --- Quality assurance --- p.20 / Chapter 1.2.4.e --- Remote teaching and training --- p.21 / Chapter 1.3 --- Technical aspects of telepathology --- p.24 / Chapter 1.3.1 --- Image presentation --- p.24 / Chapter 1.3.2 --- Image acquisition and display --- p.25 / Chapter 1.3.3 --- Image compression --- p.27 / Chapter 1.3.4 --- Networking and line connections --- p.29 / Chapter 1.3.4.a --- Public (analog) telephone network --- p.29 / Chapter 1.3.4.b --- Integrated services digital network (ISDN) --- p.30 / Chapter 1.3.4.c --- Computer network --- p.30 / Chapter 1.3.4.d --- Asynchronous transfer mode (ATM) --- p.31 / Chapter 1.4 --- Legal and ethical aspects --- p.32 / Chapter 1.4.1 --- Licensure of the facility --- p.33 / Chapter 1.4.2 --- Licensure of the pathologist --- p.33 / Chapter 1.4.3 --- Accreditation --- p.34 / Chapter 1.4.4 --- The electronic medical record: privacy --- p.35 / Chapter 1.4.5 --- Malpractice liability --- p.36 / Chapter 1.4.6 --- Reimbursement --- p.38 / Chapter 1.4.7 --- Conclusion --- p.38 / Chapter 1.5 --- Telemedicine and telepathology in China --- p.40 / Chapter 1.6 --- Cytopathology practice in China --- p.42 / Chapter CHAPTER2 --- OBJECTIVES OF STUDY --- p.46 / Chapter CHAPTER3 --- MATERIALS AND METHODS --- p.48 / Chapter 3.1 --- Case materials --- p.48 / Chapter 3.2 --- Static image capture and display --- p.51 / Chapter 3.3 --- Static telecytology study --- p.55 / Chapter 3.4 --- Web-based tutorial program --- p.59 / Chapter 3.4.1 --- Pre-tutorial evaluation --- p.60 / Chapter 3.4.2 --- Cytology tutorial --- p.62 / Chapter 3.4.3 --- Post-tutorial evaluation --- p.66 / Chapter 3.4.4 --- Data analysis --- p.67 / Chapter 3.5 --- Dynamic telecytology study --- p.68 / Chapter 3.5.1 --- Equipment --- p.68 / Chapter 3.5.2 --- Trial design --- p.72 / Chapter 3.5.2a --- Telecytology diagnosis --- p.72 / Chapter 3.5.2b --- Light microscopy diagnosis --- p.73 / Chapter 3.5.2c --- Data analysis --- p.74 / Chapter CHAPTER4 --- RESULTS --- p.75 / Chapter 4.1 --- General information about participating cytology laboratories --- p.75 / Chapter 4.2 --- Static telecytology study --- p.78 / Chapter 4.2.1 --- Telecytology diagnostic agreement --- p.78 / Chapter 4.2.2 --- Confidence of telecytology diagnosis --- p.80 / Chapter 4.2.3 --- "The acceptance of the image quality, time required for each case" --- p.83 / Chapter 4.3 --- Web-based program on cervical cytology --- p.84 / Chapter 4.4 --- Dynamic telecytology study --- p.86 / Chapter 4.4.1 --- Diagnostic accuracy --- p.86 / Chapter 4.4.2 --- Time studies --- p.88 / Chapter 4.4.3 --- Diagnostic certainty --- p.89 / Chapter 4.4.4 --- Image quality --- p.91 / Chapter CHAPTER5 --- DISCUSSION --- p.92 / Chapter 5.1 --- Static image telecytology study linking 14 Mainland China hospitals --- p.93 / Chapter 5.2 --- Problems encountered in setting up links with Mainland China --- p.97 / Chapter 5.3 --- Web-based tutorial programme for remote teaching --- p.100 / Chapter 5.4 --- Dynamic image telecytology study for immediate diagnosis at a distance --- p.103 / Chapter 5.5 --- Limitations of this study --- p.105 / Chapter 5.6 --- Concluding remarks --- p.108 / REFERENCES --- p.112