Journal of Obstetrics and Gynaecology
ISSN: 0144-3615 (Print) 1364-6893 (Online) Journal homepage: http://www.tandfonline.com/loi/ijog20
VIA screening for cervical cancer in developing countries: Potential role of the light source V. Singh, A. Parashari & A. Sehgal To cite this article: V. Singh, A. Parashari & A. Sehgal (2013) VIA screening for cervical cancer in developing countries: Potential role of the light source, Journal of Obstetrics and Gynaecology, 33:8, 898-899 To link to this article: http://dx.doi.org/10.3109/01443615.2013.823389
Published online: 12 Nov 2013.
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Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ijog20 Download by: [University of Wisconsin Oshkosh]
Date: 05 November 2015, At: 17:42
Journal of Obstetrics and Gynaecology, November 2013; 33: 898–899 © 2013 Informa UK, Ltd. ISSN 0144-3615 print/ISSN 1364-6893 online DOI: 10.3109/01443615.2013.823389
GYNAECOLOGY
VIA screening for cervical cancer in developing countries: Potential role of the light source V. Singh, A. Parashari & A. Sehgal
Downloaded by [University of Wisconsin Oshkosh] at 17:42 05 November 2015
Institute of Cytology and Preventive Oncology (ICMR), Noida, Uttar Pradesh, India
A total of 385 symptomatic patients presenting to the gynaecology and obstetrics outpatient department were screened by two sources of light: the yellow light of the tungsten bulb and the white light of the halogen bulb (100 Watt, 12 Volt), fitted with KODAK 80B filter and diffuser in an instrument called a ‘Magnivisualizer’® (developed by our Institute). Colposcopic examination was the gold standard for visualisation of the cervix. This study clearly brings out the significance of visual examination of the cervix using white light; as, in addition to having perfect correlation with colposcopy (0.86 for white vs 0.53 for yellow light), white light enables us to select the correct site of biopsy. Most of the rural clinics use torch or ordinary tungsten bulb, thus missing many significant lesions. In the light of our research findings, we strongly recommend the use of white light (complete spectrum of light) for screening purposes. Keywords: Cervical cancer screening, visual inspection, visual inspection with acetic acid
Visual inspection with acetic acid has been recommended as a feasible modality for screening for cervical cancer in developing countries. The test has been shown to have low reproducibility and wide variation in accuracy (Sankaranarayanan et al. 2012; Arbyn et al. 2008). One important factor for this variation could have been the source of light in visualising the cervix. We report our experience of performing VIA screening using two different sets of light (yellow and white light). A total of 385 symptomatic patients reporting to our gynaecology and obstetrics outpatient department of the LN Hospital, New Delhi, were screened by two sources of light: the yellow light of a tungsten bulb and the white light of a halogen bulb (100 Watt, 12 Volt), fitted with KODAK 80B filter and diffuser in a instrument called a ‘Magnivisualizer’® (developed by our Institute). A torch light, due to its tungsten bulb, gives yellow light with a colour temperature of 4000–4500 K only, whereas, the Magnivisualizer has a colour temperature of white light in between 5500–6000 K. Because the torch light lacks the complete spectrum of light, it has a masking effect when visualising the lesions. Colposcopic examination was done for all patients. Lesions observed with yellow light and white light were compared and correlated with that of colposcopic examinations (a gold standard for visualisation of cervix) using kappa statistics.
The agreement for lesions between colposcopy and the yellow light was observed in 325 out of 385 patients (proportion agreement 84.4%) and the kappa statistic was only 0.533 (moderate agreement). The corresponding agreement between colposcopy and white light of the Magnivisualizer was observed in 362 out of 385 patients (proportion agreement 94.0%) and the kappa statistic was 0.86 (almost perfect agreement). In addition, the white light was extremely helpful in deciding on the biopsy site for the lesion. Figures 1 and 2 show a photographic representation of a lesion seen in white light and yellow light. It can be seen that in the tungsten light, only one poorlydemarcated lesion is visualised, which on biopsy revealed condylomatous changes only. In sharp contrast, the same cervix when viewed in white light, detected a well-demarcated white flat lesion at 6 o’clock positions, in addition to the condylomatous lesion at the 4 o’clock position. Biopsy of the flat white lesion revealed CIN III pathology. Thus, in the absence of white light, we would have missed a high-grade lesion, a precursor of invasive cancer. In yellow light, one would have detected only a condylomatous lesion, thus giving a false sense of assurance of screening to the women.
Figure 1. Cervical lesion in yellow light (tungsten bulb). A warty lesion poorly visible in yellow light (encircled at the 4 o’ clock position).
Correspondence: V. Singh, Institute of Cytology and Preventive Oncology (ICMR), Plot No. I-7, Sector 9, Noida, Uttar Pradesh 201 301, India. E-mail: [email protected]
VIA screening for cervical cancer in developing countries 899 This study clearly brings about the significance of visual examination of the cervix using white light; as in addition, to have perfect correlation with colposcopy (0.86 for white vs 0.53 for yellow light), white light enables to select the correct site of biopsy. Most of the rural clinics use torch or an ordinary tungsten bulb, thus missing out many significant lesions. In the light of our research findings, we strongly recommend the use of white light (having the complete spectrum of light) for screening purposes. Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. This study was funded by an institutional regular fund.
Downloaded by [University of Wisconsin Oshkosh] at 17:42 05 November 2015
References
Figure 2. Same cervical lesion in white light. A visible aceto-white epithelium of the cervix, (encircled at the 6 o’ clock position) and an obvious visible warty lesion of cervix (at the 4 o’ clock position).
Arbyn M, Sankaranarayanan R, Muwonge R, Keita N, Dolo A, Mbalawa CG et al. 2008. Pooled analysis of the accuracy of five cervical cancer screening tests assessed in eleven studies in Africa and India. International Journal of Cancer 123:153–160. Sankaranarayanan R, Nessa A, Esmy PO, Dangou JM. 2012. Visual inspection methods for cervical cancer prevention. Best Practice and Research. Clinical Obstetrics and Gynaecology 26:221–232.
ISSN: 0144-3615 (Print) 1364-6893 (Online) Journal homepage: http://www.tandfonline.com/loi/ijog20
VIA screening for cervical cancer in developing countries: Potential role of the light source V. Singh, A. Parashari & A. Sehgal To cite this article: V. Singh, A. Parashari & A. Sehgal (2013) VIA screening for cervical cancer in developing countries: Potential role of the light source, Journal of Obstetrics and Gynaecology, 33:8, 898-899 To link to this article: http://dx.doi.org/10.3109/01443615.2013.823389
Published online: 12 Nov 2013.
Submit your article to this journal
Article views: 36
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ijog20 Download by: [University of Wisconsin Oshkosh]
Date: 05 November 2015, At: 17:42
Journal of Obstetrics and Gynaecology, November 2013; 33: 898–899 © 2013 Informa UK, Ltd. ISSN 0144-3615 print/ISSN 1364-6893 online DOI: 10.3109/01443615.2013.823389
GYNAECOLOGY
VIA screening for cervical cancer in developing countries: Potential role of the light source V. Singh, A. Parashari & A. Sehgal
Downloaded by [University of Wisconsin Oshkosh] at 17:42 05 November 2015
Institute of Cytology and Preventive Oncology (ICMR), Noida, Uttar Pradesh, India
A total of 385 symptomatic patients presenting to the gynaecology and obstetrics outpatient department were screened by two sources of light: the yellow light of the tungsten bulb and the white light of the halogen bulb (100 Watt, 12 Volt), fitted with KODAK 80B filter and diffuser in an instrument called a ‘Magnivisualizer’® (developed by our Institute). Colposcopic examination was the gold standard for visualisation of the cervix. This study clearly brings out the significance of visual examination of the cervix using white light; as, in addition to having perfect correlation with colposcopy (0.86 for white vs 0.53 for yellow light), white light enables us to select the correct site of biopsy. Most of the rural clinics use torch or ordinary tungsten bulb, thus missing many significant lesions. In the light of our research findings, we strongly recommend the use of white light (complete spectrum of light) for screening purposes. Keywords: Cervical cancer screening, visual inspection, visual inspection with acetic acid
Visual inspection with acetic acid has been recommended as a feasible modality for screening for cervical cancer in developing countries. The test has been shown to have low reproducibility and wide variation in accuracy (Sankaranarayanan et al. 2012; Arbyn et al. 2008). One important factor for this variation could have been the source of light in visualising the cervix. We report our experience of performing VIA screening using two different sets of light (yellow and white light). A total of 385 symptomatic patients reporting to our gynaecology and obstetrics outpatient department of the LN Hospital, New Delhi, were screened by two sources of light: the yellow light of a tungsten bulb and the white light of a halogen bulb (100 Watt, 12 Volt), fitted with KODAK 80B filter and diffuser in a instrument called a ‘Magnivisualizer’® (developed by our Institute). A torch light, due to its tungsten bulb, gives yellow light with a colour temperature of 4000–4500 K only, whereas, the Magnivisualizer has a colour temperature of white light in between 5500–6000 K. Because the torch light lacks the complete spectrum of light, it has a masking effect when visualising the lesions. Colposcopic examination was done for all patients. Lesions observed with yellow light and white light were compared and correlated with that of colposcopic examinations (a gold standard for visualisation of cervix) using kappa statistics.
The agreement for lesions between colposcopy and the yellow light was observed in 325 out of 385 patients (proportion agreement 84.4%) and the kappa statistic was only 0.533 (moderate agreement). The corresponding agreement between colposcopy and white light of the Magnivisualizer was observed in 362 out of 385 patients (proportion agreement 94.0%) and the kappa statistic was 0.86 (almost perfect agreement). In addition, the white light was extremely helpful in deciding on the biopsy site for the lesion. Figures 1 and 2 show a photographic representation of a lesion seen in white light and yellow light. It can be seen that in the tungsten light, only one poorlydemarcated lesion is visualised, which on biopsy revealed condylomatous changes only. In sharp contrast, the same cervix when viewed in white light, detected a well-demarcated white flat lesion at 6 o’clock positions, in addition to the condylomatous lesion at the 4 o’clock position. Biopsy of the flat white lesion revealed CIN III pathology. Thus, in the absence of white light, we would have missed a high-grade lesion, a precursor of invasive cancer. In yellow light, one would have detected only a condylomatous lesion, thus giving a false sense of assurance of screening to the women.
Figure 1. Cervical lesion in yellow light (tungsten bulb). A warty lesion poorly visible in yellow light (encircled at the 4 o’ clock position).
Correspondence: V. Singh, Institute of Cytology and Preventive Oncology (ICMR), Plot No. I-7, Sector 9, Noida, Uttar Pradesh 201 301, India. E-mail: [email protected]
VIA screening for cervical cancer in developing countries 899 This study clearly brings about the significance of visual examination of the cervix using white light; as in addition, to have perfect correlation with colposcopy (0.86 for white vs 0.53 for yellow light), white light enables to select the correct site of biopsy. Most of the rural clinics use torch or an ordinary tungsten bulb, thus missing out many significant lesions. In the light of our research findings, we strongly recommend the use of white light (having the complete spectrum of light) for screening purposes. Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. This study was funded by an institutional regular fund.
Downloaded by [University of Wisconsin Oshkosh] at 17:42 05 November 2015
References
Figure 2. Same cervical lesion in white light. A visible aceto-white epithelium of the cervix, (encircled at the 6 o’ clock position) and an obvious visible warty lesion of cervix (at the 4 o’ clock position).
Arbyn M, Sankaranarayanan R, Muwonge R, Keita N, Dolo A, Mbalawa CG et al. 2008. Pooled analysis of the accuracy of five cervical cancer screening tests assessed in eleven studies in Africa and India. International Journal of Cancer 123:153–160. Sankaranarayanan R, Nessa A, Esmy PO, Dangou JM. 2012. Visual inspection methods for cervical cancer prevention. Best Practice and Research. Clinical Obstetrics and Gynaecology 26:221–232.
