From Assiut U-Egypt: Reliability of unaided naked-eye examination as a screening test for cervical lesions in a developing country setup

http://www.ncbi.nlm.nih.gov/pubmed/23519287

J Low Genit Tract Dis. 2013 Apr;17(2):182-6. doi: 10.1097/LGT.0b013e31826009ac.

Reliability of unaided naked-eye examination as a screening test for cervical lesions in a developing country setup.

Darwish AM, Abdulla SA, Zahran KM, Abdel-Fattah NA.

Source

1Woman's Health University Hospital, and 2Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.

Abstract

OBJECTIVE:

This study aimed to test the reliability of unaided naked-eye examination (UNEE) of the cervix as a sole cervical cancer screening testin a developing country setup compared with the standard cervical cytology.

MATERIALS AND METHODS:

A total of 3,500 nonpregnant women aged between 25 and 55 years were included. An unlubricated bivalve speculum was inserted into the vagina under good light to visualize the cervix. A thorough UNEE of the cervix was done to detect any apparent lesions. Cervicalsmears were obtained using the long tip of an Ayre spatula. An additional endocervical sample was obtained by cytobrush. Women with abnormalPap smears or visible cervical lesions by UNEE were scheduled for colposcopic examination. A biopsy specimen was obtained in every abnormal colposcopic examination.

RESULTS:

Of 3,500 cases, there were 9 (2.57%) preinvasive cervical lesions (cervical intraepithelial neoplasia 1-3) diagnosed with various diagnostic tools used in the study and confirmed by histopathologic examination. Of 3,500 cases, invasive cervical lesions were diagnosed in 6 (1.71%). The sensitivity of UNEE is much better than that of Pap smear (80% vs 60%) but less than that of colposcopy (86.7%). However, the specificity of UNEE (100%) is lower than that of Pap smear (91.16%) and better than that colposcopy (83.12%). The UNEE has a poor positive predictive value (3.75%) when compared with Pap smear (100%) and colposcopy (20%). The negative predictive values of the 3 tests were nearly comparable.

CONCLUSIONS:

Whenever access to Pap smear is limited, UNEE performed by general gynecologists and well-trained nurses is an acceptable alternative for detecting cervical premalignant or malignant lesions especially in low-resource settings.