Abstract
ObjectivesA simple system for visual inspection with acetic acid assessment, named ABCD criteria, has been developed to increase accuracy for triaging of high-risk human papillomavirus (HPV)-positive women. This study aimed to determine the accuracy of ABCD criteria for the detection of histologically confirmed cervical intraepithelial neoplasia grade two or worse (CIN2+) in HPV-positive women living in a low-resource setting.DesignProspective study of diagnostic accuracy.SettingCervical cancer screening programme based on a 3T-Approach (test, triage and treat) in the Health District of Dschang, West Cameroon.ParticipantsAsymptomatic non-pregnant women aged 30–49 years were eligible to participate. Exclusion criteria included history of CIN treatment, anogenital cancer or hysterectomy. A total of 1980 women were recruited (median age, 40 years; IQR 35–45 years), of whom 361 (18.4%) were HPV-positive and 340 (94.2%) completed the trial.InterventionsHPV-positive women underwent a pelvic examination for visual assessment of the cervix according to ABCD criteria. The criteria comprised A for acetowhiteness, B for bleeding, C for colouring and D for diameter. The ABCD criteria results were codified as positive or negative and compared with histological analysis findings (reference standards).Primary outcome measureDiagnostic performance of ABCD criteria for CIN2+, defined as sensitivity, specificity, negative and positive predictive values.ResultsABCD criteria had a sensitivity of 77.5% (95% CI 61.3% to 88.2%), specificity of 42.0% (95% CI 36.5% to 47.7%), positive predictive value of 15.1% (95% CI 10.8% to 20.8%), and negative predictive value of 93.3% (95% CI 87.6% to 96.5%) for detection of CIN2 +lesions. Most (86.7%) of the ABCD-positive women were treated on the same day.ConclusionsABCD criteria can be used in the context of a single-visit approach and may be the preferred triage method for management of HPV-positive women in a low-income context.Trial registration numberNCT03757299.
Funder
Comité des affaires humanitaires, Geneva University Hospitals
ESTHER Switzerland
Solidarité Internationale Genève
Reference30 articles.
1. GLOBOCAN 2020. Global Cancer Observatory. International Agency for Research on Cancer [online]. Available: https://gco.iarc.fr/ [Accessed 16 Nov 2021].
2. Efficacy of HPV-based screening for prevention of invasive cervical cancer: follow-up of four European randomised controlled trials
3. World Health Organization . WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention, second edition [online]. Geneva, Switzerland. Available: https://www.who.int/publications-detail-redirect/9789240030824 [Accessed 1 Nov 2021].
4. Accuracy of visual inspection with acetic acid for cervical cancer screening
5. World Health Organization . Cervical cancer elimination initiative [online]. Available: https://www.who.int/initiatives/cervical-cancer-elimination-initiative [Accessed 9 Nov 2021].
Cited by
6 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献