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Abstract：
BACKGROUND: Cervical cancer continues to disproportionately burden women in low/middle-income countries like Ghana. We examined treatment patterns and histopathological outcomes among women screened using visual inspection with acetic acid (VIA) and/or mobile colposcopy who subsequently underwent thermal ablation, large loop excision of the transformation zone (LLETZ), or cold knife conization at the Cervical Cancer Prevention and Training Centre, Battor. We also assessed the prevalence of cervical intraepithelial neoplasia 2+ (CIN2+) or micro-invasive disease and their associated factors for women who underwent excisional treatments. The treatment choices for cervical precancerous lesions suitable for resource-limited settings have also been described from the perspective of a center that manages a heterogenous population.
METHODS: We conducted an analysis of secondary data collected between June 2016 and June 2023 among women with positive findings on VIA or mobile colposcopy who subsequently underwent thermal ablation or large loop excision of the transformation zone (LLETZ). The prevalence of histopathology outcomes, including no dysplasia, CIN1 - 3, and micro-invasive disease, were estimated with 95% confidence intervals (CIs). Factors associated with histopathological findings were modeled using multinomial logistic regression.
RESULTS: For the study period, 14 (10.6%) of the total 132 participants underwent cervical lesion treatment at outreach locations, all via thermal ablation. The remaining 118 (89.4%) were treated at the Catholic Hospital, Battor using LLETZ (n = 66, 55.9%), thermal ablation (n = 51, 43.2%), and cold knife conization (n = 1, 0.9%). Among 65 women with histopathology reports, the most frequent histopathological finding was no dysplasia (47.7%; 95% CI, 35.1 - 60.5), followed by CIN2 and CIN3 (20.0%; 95% CI, 11.1 - 31.8 each), CIN1 (7.7%; 95% CI, 2.5 - 17.0) and micro-invasion (4.6%; 95% CI, 1.0 - 12.9). Those with micro-invasive disease were significantly older than those with CIN1, CIN2, and CIN3 (p = 0.036, 0.022, 0.009, respectively), but not significantly older than those who showed no dysplasia (p = 0.088). For each unit increase in age, the likelihood of CIN3 was relatively significantly reduced compared to no dysplasia (crude relative risk ratio [RRR] = 0.93; 95% CI, 0.86 - 0.99). This association was neither observed with the remaining histopathological groups nor for parity and persisted after controlling for parity (adjusted RRR = 0.92; 95% CI, 0.85 - 0.99; p = 0.025).
CONCLUSIONS: This paper largely demonstrates treatment options available to women and practitioners in LMICs. The high combined prevalence of high-grade precancerous lesions and micro-invasive disease underscores the need to increase cervical cancer awareness that would enhance screening attendance and hasten efforts at moving from opportunistic to organized screening in Ghana. This will enhance early cervical lesion detection and treatment, while simultaneously re-evaluating and cutting down on unnecessary treatment.
METHODS: We conducted an analysis of secondary data collected between June 2016 and June 2023 among women with positive findings on VIA or mobile colposcopy who subsequently underwent thermal ablation or large loop excision of the transformation zone (LLETZ). The prevalence of histopathology outcomes, including no dysplasia, CIN1 - 3, and micro-invasive disease, were estimated with 95% confidence intervals (CIs). Factors associated with histopathological findings were modeled using multinomial logistic regression.
RESULTS: For the study period, 14 (10.6%) of the total 132 participants underwent cervical lesion treatment at outreach locations, all via thermal ablation. The remaining 118 (89.4%) were treated at the Catholic Hospital, Battor using LLETZ (n = 66, 55.9%), thermal ablation (n = 51, 43.2%), and cold knife conization (n = 1, 0.9%). Among 65 women with histopathology reports, the most frequent histopathological finding was no dysplasia (47.7%; 95% CI, 35.1 - 60.5), followed by CIN2 and CIN3 (20.0%; 95% CI, 11.1 - 31.8 each), CIN1 (7.7%; 95% CI, 2.5 - 17.0) and micro-invasion (4.6%; 95% CI, 1.0 - 12.9). Those with micro-invasive disease were significantly older than those with CIN1, CIN2, and CIN3 (p = 0.036, 0.022, 0.009, respectively), but not significantly older than those who showed no dysplasia (p = 0.088). For each unit increase in age, the likelihood of CIN3 was relatively significantly reduced compared to no dysplasia (crude relative risk ratio [RRR] = 0.93; 95% CI, 0.86 - 0.99). This association was neither observed with the remaining histopathological groups nor for parity and persisted after controlling for parity (adjusted RRR = 0.92; 95% CI, 0.85 - 0.99; p = 0.025).
CONCLUSIONS: This paper largely demonstrates treatment options available to women and practitioners in LMICs. The high combined prevalence of high-grade precancerous lesions and micro-invasive disease underscores the need to increase cervical cancer awareness that would enhance screening attendance and hasten efforts at moving from opportunistic to organized screening in Ghana. This will enhance early cervical lesion detection and treatment, while simultaneously re-evaluating and cutting down on unnecessary treatment.
摘要：
背景：在加纳等低收入/中等收入国家，宫颈癌继续给妇女带来不成比例的负担。我们检查了使用乙酸（VIA）和/或移动式阴道镜检查筛查的妇女的治疗模式和组织病理学结果，这些妇女随后接受了热消融，转化区的大环形切除（LLETZ），或在宫颈癌预防和培训中心进行冷刀锥切术，巴托.我们还评估了接受切除治疗的女性宫颈上皮内瘤变2（CIN2）或微侵袭性疾病的患病率及其相关因素。还从管理异质人群的中心的角度描述了适用于资源有限环境的宫颈癌前病变的治疗选择。
方法：我们对2016年6月至2023年6月期间收集的次要数据进行了分析，这些数据是经VIA或移动式阴道镜检查结果为阳性的女性，随后接受了热消融或大环形转化区切除术（LLETZ）。组织病理学结果的患病率，包括没有发育不良,CIN1-3和微创疾病，用95%置信区间(CI)估计。使用多项逻辑回归对与组织病理学结果相关的因素进行建模。
结果：在研究期间，132名参与者中有14名（10.6%）在外展地点接受了宫颈病变治疗，全部通过热消融。其余118人(89.4%)在天主教医院接受治疗,Battor使用LLETZ（n=66，55.9％），热烧蚀（n=51，43.2%），和冷刀锥化（n=1，0.9%）。在有组织病理学报告的65名女性中，最常见的组织病理学发现是无异型增生（47.7％;95％CI，35.1-60.5），其次是CIN2和CIN3（20.0%；95%CI，各11.1-31.8），CIN1（7.7%；95%CI，2.5-17.0）和微侵袭（4.6%；95%CI，1.0-12.9）。患有微侵袭性疾病的患者明显比患有CIN1，CIN2和CIN3的患者年龄大（分别为p=0.036，0.022，0.009），但不明显大于未显示发育不良的患者（p=0.088）。每增加一个单位的年龄，与无异型增生相比,CIN3的可能性相对显著降低(粗相对风险比[RRR]=0.93;95%CI,0.86-0.99).在其余的组织病理学组中，也没有观察到这种关联，并且在控制奇偶校验后仍然存在（调整后的RRR=0.92；95％CI，0.85-0.99；p=0.025）。
结论：本文主要展示了LMICs妇女和从业人员可利用的治疗选择。高级别癌前病变和微创疾病的高患病率强调了提高宫颈癌意识的必要性，这将提高筛查出勤率，并加快加纳从机会性筛查转向有组织筛查的努力。这将加强宫颈病变的早期检测和治疗，同时重新评估和减少不必要的治疗。
方法：我们对2016年6月至2023年6月期间收集的次要数据进行了分析，这些数据是经VIA或移动式阴道镜检查结果为阳性的女性，随后接受了热消融或大环形转化区切除术（LLETZ）。组织病理学结果的患病率，包括没有发育不良,CIN1-3和微创疾病，用95%置信区间(CI)估计。使用多项逻辑回归对与组织病理学结果相关的因素进行建模。
结果：在研究期间，132名参与者中有14名（10.6%）在外展地点接受了宫颈病变治疗，全部通过热消融。其余118人(89.4%)在天主教医院接受治疗,Battor使用LLETZ（n=66，55.9％），热烧蚀（n=51，43.2%），和冷刀锥化（n=1，0.9%）。在有组织病理学报告的65名女性中，最常见的组织病理学发现是无异型增生（47.7％;95％CI，35.1-60.5），其次是CIN2和CIN3（20.0%；95%CI，各11.1-31.8），CIN1（7.7%；95%CI，2.5-17.0）和微侵袭（4.6%；95%CI，1.0-12.9）。患有微侵袭性疾病的患者明显比患有CIN1，CIN2和CIN3的患者年龄大（分别为p=0.036，0.022，0.009），但不明显大于未显示发育不良的患者（p=0.088）。每增加一个单位的年龄，与无异型增生相比,CIN3的可能性相对显著降低(粗相对风险比[RRR]=0.93;95%CI,0.86-0.99).在其余的组织病理学组中，也没有观察到这种关联，并且在控制奇偶校验后仍然存在（调整后的RRR=0.92；95％CI，0.85-0.99；p=0.025）。
结论：本文主要展示了LMICs妇女和从业人员可利用的治疗选择。高级别癌前病变和微创疾病的高患病率强调了提高宫颈癌意识的必要性，这将提高筛查出勤率，并加快加纳从机会性筛查转向有组织筛查的努力。这将加强宫颈病变的早期检测和治疗，同时重新评估和减少不必要的治疗。
