Liquid-based cytology for the detection of cervical intraepithelial lesions in Jimma town, Ethiopia.

BACKGROUND: Cervical cancer is the second leading type of female cancer in Ethiopia. Screening for cervical cancer is primarily conducted using visual inspection with 5% acetic acid (VIA). Liquid-based cytology (LBC) is not yet widely used in Ethiopia. METHOD: Women aged 21-65 years were tested using LBC and VIA to detect cervical dysplasia. Logistic regression analysis was conducted to identify associated factors. Cohen's Kappa test was conducted to test agreement between LBC and VIA. RESULTS: Forty-two percent (n = 188) of 448 participants were 31 to 40 years of age and only two participants were above 60. Of the 448 participants, 419 (93.5%) were tested with LBC, 294 (65.6%) VIA and 272 (60.7%) with both LBC and VIA. Among women screened using LBC, 305 (72.8%) were negative for intraepithelial lesion or malignancy (NILM), 97 (23.2%) had low-grade squamous intraepithelial lesion (LSIL) and 17 (4.1%) had high-grade squamous intraepithelial lesion (HSIL). Presence of cervical lesions was generally lower in younger and older women. Majority, 39 (40%) of women with LSIL and 10 (59%) with HSIL were 41-50 years of age. Women aged 51-60 were more likely to have abnormal intraepithelial lesions compared to women aged 21-30 (AOR = 20.9, 95% CI = [7.2-60.9], p = 0.00). Out of 47 (10.8%) HIV-positive women, 14 (32.56%) had intraepithelial lesions of which 10 (23.3%) and 4 (9.3%) had LSIL and HSIL, respectively. Among women screened with VIA, 18 (6.1%) were positive; among the 272 (60.7%) women screened using both LBC and VIA, 6 (2.2%) were positive on both LBC and VIA tests. The level of agreement between the two tests was weak at a statistically significant level (kappa value = 0.155, p = 0.006). CONCLUSION: LBC demonstrated high rates of cervical squamous intra-epithelial lesions in our study. VIA was a less reliable predictor of cervical squamous intra-epithelial lesions than LBC. Evaluating diagnostic accuracy of both LBC and VIA against a histological endpoint should be completed before adopting either or both screening modalities.

Detection of acid fast bacilli (AFB) in tuberculous lymphadenitis among adult Ethiopians.

BACKGROUND: The sensitivity of conventional methods used in mycobacteriology laboratories may not exceed 40% in extrapulmonary cases of tuberculosis. Fine needle aspiration cytology (FNAC) is the best and affordable alternative method of diagnosing tuberculous (TB) lymphadenitis. However detection of acid fast bacilli (AFB) remains the corner stone of confirming diagnosis of TB. OBJECTIVES: To investigate the detection rate of AFB in FNAC specimens using the Ziehl Neelsen staining method and see if bacillary detection depends on cytomorphologic features of inflammation. METHODS: All consecutive adult patients having solitary or multiple peripheral lymphnode enlargements and diagnosed cytologically as TB lymphadenitis were included in the study. Aspirated samples were expressed on two glass slides and one is stained with Wright's stain for cytology, while the other is stained using the Ziehl Neelsen method for AFB. Cytologic findings were categorized in to three groups as non-caseating granuloma, caseating granuloma and pyo-histiocytic inflammation. RESULTS: Only 52 (21.9%) aspirated samples were found to be positive for AFB. The most interesting finding in this study is that among the 52 AFB positive cases, 47 (53.4%) were cytomorphologically of the pyo-histiocytic type. CONCLUSION: Detection of AFB varies with the cytomorphology of inflammation, being very high in pyo-histiocytic type.