Accuracy of Visual Tests for Primary Cervical Cancer Screening in Rural Nepal

  • Niresh Thapa Department of Gynecological Oncology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, 430071, P. R. China; Karnali Academy of Health Sciences, Jumla, Nepal http://orcid.org/0000-0003-3641-5622
  • Muna Maharjan HOPE School of Nursing, Zhongnan Hospital of Wuhan University, Wuhan, China http://orcid.org/0000-0001-8601-8620
  • Girishma Shrestha Department of Pathology, Patan Hospital, Patan Academy of Health Sciences, Nepal http://orcid.org/0000-0002-1660-6694
  • Narayani Maharjan Department of Clinical Laboratory Science, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China http://orcid.org/0000-0002-8930-7409
  • Deborah Lindell Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA https://orcid.org/0000-0001-6587-1139
  • Na Zuo Department of Gynecological Oncology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, 430071, P. R. China http://orcid.org/0000-0002-8149-9274
  • Jing Yang Department of Gynecological Oncology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center, Hubei Key laboratory of Tumor Biological Behaviors, Wuhan, 430071, P. R. China http://orcid.org/0000-0001-6211-7886
  • Ninu Maskey Department of Haemato-Pathology, Zhongnan Hospital of Wuhan University, Wuhan, China https://orcid.org/0000-0002-9331-2841
  • Hongbing Cai Department of Gynecological Oncology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, 430071, P. R. China http://orcid.org/0000-0001-7664-912X
Keywords: accuracy; cervical cancer; cytology; screening; visual tests

Abstract

Introduction: In Nepal, cervical cancer is the most common female cancer. Unfortunately, there is no uniform effective screening system available all around the country. The objective of this study is to evaluate the cytology, Visual Inspection with Acetic Acid and with Lugol’s Iodine alone or in combination to detect a pre-cancerous lesion in rural Nepal.
Methods: It is an analytical cross-sectional study. Convenience sampling technique was used to select participants who were apparently healthy, married, non- pregnant women of aged 20-65 years for cervical cancer screening program. Screening tests were performed on all eligible women (n=2143) after socio-demographic and reproductive health data collection. A biopsy was applied as a gold standard test. Cross-tabulations were used to describe the test sensitivity, specificity, positive predictive value, and negative predictive value at a 95% confidence interval. Diagnostic odds ratio was also calculated.
Results: A majority, 2143 (94%), of women accepted and participated in this study. The sensitivity vs specificity of cytology, VIA, and VILI was 57.1% vs 98.3%, 71.4% vs 88.8% and 78.6% vs 85.1%, and of the co-testing of ‘Both positive VIA and VILI’ and ‘Either positive VIA or VILI’ was 64.3% vs 85.7% and 90.1% vs 83.7% respectively. Negative predictive value of all tests exceeded 99.7%. Cytology had the highest Diagnostic odds ratio (64.9), followed by the co-test ‘Either positive VIA or VILI’ (27.7).
Conclusions: Cervical cancer screening by co-testing ‘Either positive VIA or VILI’ is more useful than cytology; VIA and or VILI are easy, safe, feasible and well-accepted tests in a low resource setting, Nepal.

Published
2018-12-31
How to Cite
Thapa, N., Maharjan, M., Shrestha, G., Maharjan, N., Lindell, D., Zuo, N., Yang, J., Maskey, N., & Cai, H. (2018). Accuracy of Visual Tests for Primary Cervical Cancer Screening in Rural Nepal. Journal of Nepal Medical Association, 56(214), 917-923. https://doi.org/10.31729/jnma.3857
Section
Original Article

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