TY - JOUR
T1 - Diagnosing cervical neoplasia in rural Brazil using a mobile van equipped with in vivo microscopy
T2 - A cluster-randomized community trial
AU - Hunt, Brady
AU - Fregnani, Jose Humberto Tavares Guerreiro
AU - Schwarz, Richard A.
AU - Pantano, Naitielle
AU - Tesoni, Suelen
AU - Possati-Resende, Julio Cesar
AU - Antoniazzi, Marcio
AU - De Oliveira Fonseca, Bruno
AU - De Macêdo Matsushita, Graziela
AU - Scapulatempo-Neto, Cristovam
AU - Kerr, Ligia
AU - Castle, Philip E.
AU - Schmeler, Kathleen
AU - Richards-Kortum, Rebecca
N1 - Publisher Copyright:
© 2018 American Association for Cancer Research.
PY - 2018/6
Y1 - 2018/6
N2 - Cervical cancer is a leading cause of death in underserved areas of Brazil. This prospective randomized trial involved 200 women in southern/central Brazil with abnormal Papanicolaou tests. Participants were randomized by geographic cluster and referred for diagnostic evaluation either at a mobile van upon its scheduled visit to their local community, or at a central hospital. Participants in both arms underwent colposcopy, in vivo microscopy, and cervical biopsies. We compared rates of diagnostic follow-up completion between study arms, and also evaluated the diagnostic performance of in vivo microscopy compared with colposcopy. There was a 23% absolute and 37% relative increase in diagnostic follow-up completion rates for patients referred to the mobile van (102/117, 87%) compared with the central hospital (53/83, 64%; P = 0.0001; risk ratio = 1.37, 95% CI, 1.14–1.63). In 229 cervical sites in 144 patients, colposcopic examination identified sites diagnosed as cervical intraepithelial neoplasia grade 2 or more severe (CIN2þ; 85 sites) with a sensitivity of 94% (95% CI, 87%–98%) and specificity of 50% (95% CI, 42%–58%). In vivo microscopy with realtime automated image analysis identified CIN2þ with a sensitivity of 92% (95% CI, 84%–97%) and specificity of 48% (95% CI, 40%–56%). Women referred to the mobile van were more likely to complete their diagnostic follow-up compared with those referred to a central hospital, without compromise in clinical care. In vivo microscopy in a mobile van provides automated diagnostic imaging with sensitivity and specificity similar to colposcopy.
AB - Cervical cancer is a leading cause of death in underserved areas of Brazil. This prospective randomized trial involved 200 women in southern/central Brazil with abnormal Papanicolaou tests. Participants were randomized by geographic cluster and referred for diagnostic evaluation either at a mobile van upon its scheduled visit to their local community, or at a central hospital. Participants in both arms underwent colposcopy, in vivo microscopy, and cervical biopsies. We compared rates of diagnostic follow-up completion between study arms, and also evaluated the diagnostic performance of in vivo microscopy compared with colposcopy. There was a 23% absolute and 37% relative increase in diagnostic follow-up completion rates for patients referred to the mobile van (102/117, 87%) compared with the central hospital (53/83, 64%; P = 0.0001; risk ratio = 1.37, 95% CI, 1.14–1.63). In 229 cervical sites in 144 patients, colposcopic examination identified sites diagnosed as cervical intraepithelial neoplasia grade 2 or more severe (CIN2þ; 85 sites) with a sensitivity of 94% (95% CI, 87%–98%) and specificity of 50% (95% CI, 42%–58%). In vivo microscopy with realtime automated image analysis identified CIN2þ with a sensitivity of 92% (95% CI, 84%–97%) and specificity of 48% (95% CI, 40%–56%). Women referred to the mobile van were more likely to complete their diagnostic follow-up compared with those referred to a central hospital, without compromise in clinical care. In vivo microscopy in a mobile van provides automated diagnostic imaging with sensitivity and specificity similar to colposcopy.
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U2 - 10.1158/1940-6207.CAPR-17-0265
DO - 10.1158/1940-6207.CAPR-17-0265
M3 - Article
C2 - 29618459
AN - SCOPUS:85048629212
SN - 1940-6207
VL - 11
SP - 359
EP - 369
JO - Cancer Prevention Research
JF - Cancer Prevention Research
IS - 6
ER -