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BJOG ; 125(10): 1321-1329, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29893472

RESUMO

OBJECTIVE: Our goal was to develop a tele-colposcopy platform for primary-care clinics to improve screening sensitivity and access. Specifically, we developed a low-cost, portable Pocket colposcope and evaluated its performance in a tertiary healthcare centre in Peru. DESIGN AND SETTING: Images of the cervix were captured with a standard-of-care and Pocket colposcope at la Liga Contra el Cáncer in Lima, Peru. POPULATION: Two hundred Peruvian women with abnormal cytology and/or human papillomavirus positivity were enrolled. METHODS: Images were collected using acetic acid and Lugol's iodine as contrast agents. Biopsies were taken as per standard-of-care procedures. MAIN OUTCOME MEASURES: After passing quality review, images from 129 women were sent to four physicians who provided a diagnosis for each image. RESULTS: Physician interpretation of images from the two colposcopes agreed 83.1% of the time. The average sensitivity and specificity of physician interpretation compared with pathology was similar for the Pocket (sensitivity = 71.2%, specificity = 57.5%) and standard-of-care (sensitivity = 79.8%, specificity = 56.6%) colposcopes. When compared with a previous study where only acetic acid was applied to the cervix, results indicated that adding Lugol's iodine as a secondary contrast agent improved the percent agreement between colposcopes for all pathological categories by up to 8.9% and the sensitivity and specificity of physician interpretation compared with pathology by over 6.0 and 9.0%, respectively. CONCLUSIONS: The Pocket colposcope performance was similar to that of a standard-of-care colposcope when used to identify precancerous and cancerous lesions using acetic acid and Lugol's iodine during colposcopy examinations in Peru. TWEETABLE ABSTRACT: The Pocket colposcope performance was similar to that of a standard-of-care colposcope when identifying cervical lesions.


Assuntos
Ácido Acético/farmacologia , Colposcópios , Colposcopia , Detecção Precoce de Câncer/métodos , Iodetos/farmacologia , Doenças do Colo do Útero/diagnóstico , Adulto , Biópsia/métodos , Colposcopia/instrumentação , Colposcopia/métodos , Meios de Contraste/farmacologia , Desenho de Equipamento , Feminino , Humanos , Aumento da Imagem/métodos , Pessoa de Meia-Idade , Peru/epidemiologia , Sistemas Automatizados de Assistência Junto ao Leito , Atenção Primária à Saúde/métodos , Doenças do Colo do Útero/classificação , Doenças do Colo do Útero/epidemiologia
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