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
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/28177 |
| Date | January 2019 |
| Creators | Maringa, Vusumuzi David |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | Online resource (56 leaves), application/pdf |
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