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Single visit approach for management of cervical intraepithelial neoplasia by visual inspection & loop electrosurgical excision procedure.

Singla S, Mathur S, Kriplani A, Agarwal N, Garg P, Bhatla N - Indian J. Med. Res. (2012)

Bottom Line: For detection of CIN2+ lesion, detection rates of VIA, VILI and cytology were 20, 22.2 and 22.2 per 1000 women, respectively.There were no major complications.The sensitivity of VIA/VILI was comparable to cytology.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT

Background & objectives: Developing a feasible and sustainable model of cervical cancer screening in developing countries continues to be a challenge because of lack of facilities and awareness in the population and poor compliance with screening and treatment. This study was aimed to evaluate a single visit approach (SVA) for the management of cervical intraepithelial neoplasia (CIN) using visual inspection with acetic acid (VIA) and Lugol's iodine (VILI) along with loop electrosurgical excision procedure (LEEP) in women attending Gynaecology OPD in a tertiary care hospital in north India.

Methods: In this hospital-based study, 450 women receiving opportunistic screening by conventional Pap cytology were also screened by VIA and VILI. VIA/VILI positive cases underwent same-day colposcopy and biopsy of all lesions. If the modified Reid score was >3, the patient underwent LEEP at the same visit.

Results: Of the 450 women screened, 86 (19.1%) and 92 (20.5%) women were VIA and VILI positive, respectively. Detection rates of VIA, VILI and cytology findings at ASCUS threshold were 33.3, 35.5 and 24.4 per 1000, women, respectively to detect a lesion >CIN1. For detection of CIN2+ lesion, detection rates of VIA, VILI and cytology were 20, 22.2 and 22.2 per 1000 women, respectively. Sixteen patients with Reid score >3 underwent the "See-and-treat" protocol. The overtreatment rate was 12.5 per cent and the efficacy of LEEP was 81.3 per cent. There were no major complications.

Interpretation & conclusions: The sensitivity of VIA/VILI was comparable to cytology. A single visit approach using visual screening methods at community level by trained paramedical personnel followed by a combination of ablative and excisional therapy can help to decrease the incidence of cervical neoplasia.

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Related in: MedlinePlus

Algorithm: Study design and outcomes. The number of cases of high grade disease (CIN 2+) diagnosed on histology in each arm is shown in the shaded boxes. VIA, visual inspection with acetic acid; VILI, visual inspection with Lugol's iodine; CIN, cervical intraepithelial neoplasia; ASCUS, atypical squamous cells of undetermined significance; LSIL, low-grade squamous intraepithelial lesion; HSIL, high-grade squamous intraepithelial lesion.
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Figure 1: Algorithm: Study design and outcomes. The number of cases of high grade disease (CIN 2+) diagnosed on histology in each arm is shown in the shaded boxes. VIA, visual inspection with acetic acid; VILI, visual inspection with Lugol's iodine; CIN, cervical intraepithelial neoplasia; ASCUS, atypical squamous cells of undetermined significance; LSIL, low-grade squamous intraepithelial lesion; HSIL, high-grade squamous intraepithelial lesion.

Mentions: The Fig. shows the algorithm of the study design followed in the present study and the outcomes obtained. Both VIA/VILI and Pap smear missed only one case of high grade CIN each.


Single visit approach for management of cervical intraepithelial neoplasia by visual inspection & loop electrosurgical excision procedure.

Singla S, Mathur S, Kriplani A, Agarwal N, Garg P, Bhatla N - Indian J. Med. Res. (2012)

Algorithm: Study design and outcomes. The number of cases of high grade disease (CIN 2+) diagnosed on histology in each arm is shown in the shaded boxes. VIA, visual inspection with acetic acid; VILI, visual inspection with Lugol's iodine; CIN, cervical intraepithelial neoplasia; ASCUS, atypical squamous cells of undetermined significance; LSIL, low-grade squamous intraepithelial lesion; HSIL, high-grade squamous intraepithelial lesion.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3401690&req=5

Figure 1: Algorithm: Study design and outcomes. The number of cases of high grade disease (CIN 2+) diagnosed on histology in each arm is shown in the shaded boxes. VIA, visual inspection with acetic acid; VILI, visual inspection with Lugol's iodine; CIN, cervical intraepithelial neoplasia; ASCUS, atypical squamous cells of undetermined significance; LSIL, low-grade squamous intraepithelial lesion; HSIL, high-grade squamous intraepithelial lesion.
Mentions: The Fig. shows the algorithm of the study design followed in the present study and the outcomes obtained. Both VIA/VILI and Pap smear missed only one case of high grade CIN each.

Bottom Line: For detection of CIN2+ lesion, detection rates of VIA, VILI and cytology were 20, 22.2 and 22.2 per 1000 women, respectively.There were no major complications.The sensitivity of VIA/VILI was comparable to cytology.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT

Background & objectives: Developing a feasible and sustainable model of cervical cancer screening in developing countries continues to be a challenge because of lack of facilities and awareness in the population and poor compliance with screening and treatment. This study was aimed to evaluate a single visit approach (SVA) for the management of cervical intraepithelial neoplasia (CIN) using visual inspection with acetic acid (VIA) and Lugol's iodine (VILI) along with loop electrosurgical excision procedure (LEEP) in women attending Gynaecology OPD in a tertiary care hospital in north India.

Methods: In this hospital-based study, 450 women receiving opportunistic screening by conventional Pap cytology were also screened by VIA and VILI. VIA/VILI positive cases underwent same-day colposcopy and biopsy of all lesions. If the modified Reid score was >3, the patient underwent LEEP at the same visit.

Results: Of the 450 women screened, 86 (19.1%) and 92 (20.5%) women were VIA and VILI positive, respectively. Detection rates of VIA, VILI and cytology findings at ASCUS threshold were 33.3, 35.5 and 24.4 per 1000, women, respectively to detect a lesion >CIN1. For detection of CIN2+ lesion, detection rates of VIA, VILI and cytology were 20, 22.2 and 22.2 per 1000 women, respectively. Sixteen patients with Reid score >3 underwent the "See-and-treat" protocol. The overtreatment rate was 12.5 per cent and the efficacy of LEEP was 81.3 per cent. There were no major complications.

Interpretation & conclusions: The sensitivity of VIA/VILI was comparable to cytology. A single visit approach using visual screening methods at community level by trained paramedical personnel followed by a combination of ablative and excisional therapy can help to decrease the incidence of cervical neoplasia.

Show MeSH
Related in: MedlinePlus