Diagnosing cervical neoplasia in rural Brazil using a mobile van equipped with in vivo microscopy: A cluster-randomized community trial

Brady Hunt, Jose Humberto Tavares Guerreiro Fregnani, Richard A. Schwarz, Naitielle Pantano, Suelen Tesoni, Julio Cesar Possati-Resende, Marcio Antoniazzi, Bruno De Oliveira Fonseca, Graziela De Macêdo Matsushita, Cristovam Scapulatempo-Neto, Ligia Kerr, Philip E. Castle, Kathleen Schmeler, Rebecca Richards-Kortum

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)359-369
Number of pages11
JournalCancer Prevention Research
Volume11
Issue number6
DOIs
StatePublished - Jun 2018

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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