الفهرس 
Screening for Cervical CancerOnly 14 pages are availabe for public view
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Abstract
Objective: To compare between single step diagnosis of premalignant cervical lesions as suspected by VIA and colposcopy followed by immediate treatment using loop diathermy versus the golden standard method of diagnosis by colposcopic directed punch biopsy (CDB) and subsequent treatment by loop diathermy of the proven premalignant lesions. Patients and Methods: During the period from April, 2004 through July, 2007, screening by VIA was carried out. Patients with suspicious positive VIA (60 patients) were divided into two groups, A (included 31 patients) and B (included 29 patients). Patients in both groups were then subjected to colposcopic examination. In group A, when colposcopic examination showed abnormal TZ, patients were subjected to LEEP immediately (25 cases = group A1). In group B, when colposcopic examination showed abnormal TZ, patients were subjected to the classic CDB and histopatholgical examination at first and then management according by LEEP (19 cases = group B1). Results: In our study, VIA as a screening test was found that it has a sensitivity of 91.1% and a specificity of 69.35% as shown in. Positive predictive value was 68.33% and negative predictive value was 91.49%. By adding colposcopy the sensitivity became 93.33% and the specificity 88.71%. Positive predictive value was 85.71% and negative predictive value was 94.83%. There was a significant difference in the interval between the 1st visit and the management in both groups (p=0.001); in group A1 the mean interval was 2.375 days while that for group B1 it was 60.84 days. Four cases in group A1 were proved by histopathological examination to be over-treated (either CIN1 or chronic cervicites). These cases with over-treatment represents 16% of group A1 cases (n=25). But when compared with the rate of negative LEEP biopsy after positive punch biopsy (15.7%) in group B1, it shows no statistical difference. There was no drop-out cases in group A1 while there were 5 cases (20.83%) in group B1. This difference was statistically significant (p=0.01). Conclusion: VIA followed by colposcopy with immediate LEEP for cases suspicious for high grade CIN gave an accepted results in our study as regards the rate of over-treatment in comparison to management drop-out cases. This method of ”screen and treat” may share in the limitation of the ”No. one” cancer in developing countries