Comparison between liquid based cervical cytology screening performed on self-collected tampons and healthcare worker-collected cytology samples at Dr George Mukhari Academic Hospital
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Abstract
INTRODUCTION
Cervical cancer is caused by persistent infection with high-risk human papilloma virus types. Screening is possible and has resulted in decreased incidence rates of cervical cancer by more than 50% from the mid 1970s to the mid 2000s in screened populations. Optimal screening options need to be identified. Objectives: To compare the sensitivity of self-collected to healthcare worker (HCW) collected liquid based cytology (LBC) in detecting premalignant lesions, and to assess if self-collection with a tampon can be used as an additional sampling tool for cytology screening for cancer of the cervix.
METHOD
A cross sectional descriptive study was conducted among women aged 18 years and older. Self-sampling consisted of ilex tampon use. The tampon was removed by a HCW and placed in a vial containing saline solution followed by subsequent pelvic examination using a speculum for collection of a endo-cervical sample using Cervarix brush placed in a PreserCyt solution. Both samples were sent for cytology analysis. A two-sided statistical test comparing HCW collected with self-collected samples. P-value of <0.05 was regarded as statistically significant.
RESULTS
A total of 220 women were enrolled in the study. HCW collected LBC samples had more abnormal cervical lesions 50.9% vs self-collected samples of 19.5%. Women aged 30-49 had high prevalence of abnormal cervical lesions LSIL (22.7% vs 3.2%), HSIL (17.5% vs 3.8%) and ASCUS (10.4% vs 7.7%) in both HCW and self-collected samples respectively. There was 51.4% agreement between the two methods and a kappa score of 0.3 was obtained, which is an agreement that is fair. HCW collected samples had a sensitivity of 78.0% compared to 47.1 % of the self-collected samples for detection of pre-malignant lesions
CONCLUSION
This study demonstrated a fair diagnostic correlation between self-sampling and HCW collected sampling for the diagnosis of premalignant cervical lesions. Self-sampling using the ilex tampon device had a low sensitivity in detecting premalignant lesions compared to doctor collected LBC samples.