Is genetic analysis useful in the routine management of hydatidiform mole?

Complete hydatidiform mole and partial hydatidiform mole are two abnormal conceptuses that may be identified by clinical, ultrasonographic, gross morphological, histological, and genetic characteristics. Among all these criteria, the specific diagnosis is generally confirmed only upon histological review. However, an accurate diagnosis based on morphological criteria is difficult and several studies have shown that misclassifications are frequent, even for experienced pathologists. An erroneous diagnosis may imply that women are either not enrolled in an adequate β‐hCG follow‐up with the risk that hydatidiform mole (HM) progresses to choriocarcinoma, or are enrolled in an unnecessary follow‐up. A reliable and complementary method to the pathologic interpretation is a genetic study of the conceptus to eliminate the diagnostic dilemma by distinguishing non‐molar spontaneous abortions from HM and to define the type of HM. The aim of our study was to review the genetic basis of HM and discuss its relevance in the routine management of the disorde

Report of the 7th international workshop on colposcopy, screening and prevention of cervical cancer, Douala, Cameroon, March 30 - 31 and April 1st 2016

Background: Authors herein report the proceedings of the 7th international workshop on colposcopy, screening and prevention of cervical cancer held in Douala (Cameroon) on March 30 - 31 and April 1, 2016.Methods: As with previous conferences of this series, the 2016 edition provided an excellent forum for exchange of information and opinions between the researchers, clinicians, laboratory scientists and regulatory bodies. It also stood as an opportunity for further training of health staff on prevention and screening of cervical cancer.Results: The workshop covered both accepted and emerging methods of preventing and screening cervical cancer with emphasis on current clinical and public health practice in low and middle-income countries.  The topic was covered by complementary sessions: cervical principles, cervical cancer epidemiology and prevention strategy; cervical cancer management and treatment; cervical cancer screening programs in Cameroon; innovations in cervical cancer screening and perspectives in cervical cancer screening. This report also summarizes the presentations done during the workshop. This 7th edition set up the record of attendance with more than 150 participants of several backgrounds (specialist physicians and nurses, laboratory technicians, socio-anthropologists, university lecturers and managers of health systems) from more than 19 local and international institutions.Conclusions: Master’s classes, free communications and discussions were fruitful and appointment was taken for March 30-31, 2017 in Yaounde (Cameroon)

Acceptability of self-collected vaginal samples for HPV testing in an urban and rural population of Madagascar

Objective: To evaluate the acceptability of self-collected vaginal samples for HPV testing in women living in rural and urban areas of Madagascar. Materials and Methods: Participants were recruited in a health care center (urban group) and smaller affiliated dispensaries (rural group). They were invited to perform unsupervised self-sampling for HPV testing and to answer a questionnaire on socio-demographic information, cervical cancer knowledge and self-sampling acceptability. Results: A total of 300 women were recruited. Median age was 44.1 years (range 29-65 years) in the urban group and 40.9 years (range 29-65 years) in the rural group. Urban women had improved knowledge on HPV, cervical cancer and cervical cancer screening (p<0.05) as compared to rural women. Urban women lived closer to a health care center (P<0.05), had fewer different sexual partners (P<0.05) and later first sexual intercourse (p=0.07). Unlike urban women, most rural women were married (p<0.05). Conclusion: Acceptability of self-sampling for HPV testing was similarly excellent in both groups despite their difference in terms of socio-demographic factors and knowledge about cervical cancer

Knowledge of cytology results affects the performance of colposcopy: a crossover study

peer reviewedAbstract Objective – To determine whether knowledge of cytology affects the colposcopist’s diagnostic accuracy in the identification of cervical intraepithelial neoplasia grade 2 and worse (≥ CIN2). Method – In this cross-over study, healthcare professionals interpreted colposcopy images from 80 patient cases with known histological diagnoses. For each case, 2 images taken with a colposcope were provided (native and after acetic acid application). Inclusion criteria consisted of women with a transformation zone type 1 or 2, who had both a cytological and histological diagnosis. Cases were distributed across two online surveys, one including and one omitting the cytology. A wash-out period of six weeks between surveys was implemented. Colposcopists were asked to give their diagnosis for each case as < CIN2 or ≥ CIN2 on both assessments. Statistical analysis was conducted to compare the two interpretations. Results – Knowledge of cytology significantly improved the sensitivity when interpreting colposcopic images, from 51.1% [95%CI: 39.3 to 62.8] to 63.7% [95%CI: 52.1 to 73.9] and improved the specificity from 63.5% [95%CI: 52.3 to 73.5] to 76.6% [95%CI: 67.2 to 84.0]. Sensitivity was higher by 38.6% when a high-grade cytology (ASC-H, HSIL, AGC) was communicated compared to a low-grade cytology (inflammation, ASC-US, LSIL). Specificity was higher by 31% when a low-grade cytology was communicated compared to a high-grade. Conclusion – Our data suggests that knowledge of cytology increases sensitivity and specificity for diagnosis of ≥ CIN2 lesions at colposcopy. Association between cytology and histology may have contributed to the findings

Study protocol for a two-site clinical trial to validate a smartphone-based artificial intelligence classifier identifying cervical precancer and cancer in HPV-positive women in Cameroon.

INTRODUCTION: Cervical cancer remains a major public health challenge in low- and middle-income countries (LMICs) due to financial and logistical issues. WHO recommendation for cervical cancer screening in LMICs includes HPV testing as primary screening followed by visual inspection with acetic acid (VIA) and treatment. However, VIA is a subjective procedure dependent on the healthcare provider's experience. Its accuracy can be improved by computer-aided detection techniques. Our aim is to assess the performance of a smartphone-based Automated VIA Classifier (AVC) relying on Artificial Intelligence to discriminate precancerous and cancerous lesions from normal cervical tissue. METHODS: The AVC study will be nested in an ongoing cervical cancer screening program called "3T-study" (for Test, Triage and Treat), including HPV self-sampling followed by VIA triage and treatment if needed. After application of acetic acid on the cervix, precancerous and cancerous cells whiten more rapidly than non-cancerous ones and their whiteness persists stronger overtime. The AVC relies on this key feature to determine whether the cervix is suspect for precancer or cancer. In order to train and validate the AVC, 6000 women aged 30 to 49 years meeting the inclusion criteria will be recruited on a voluntary basis, with an estimated 100 CIN2+, calculated using a confidence level of 95% and an estimated sensitivity of 90% +/-7% precision on either side. Diagnostic test performance of AVC test and two current standard tests (VIA and cytology) used routinely for triage will be evaluated and compared. Histopathological examination will serve as reference standard. Participants' and providers' acceptability of the technology will also be assessed. The study protocol was registered under ClinicalTrials.gov (number NCT04859530). EXPECTED RESULTS: The study will determine whether AVC test can be an effective method for cervical cancer screening in LMICs