背景:在一次就诊时检测和治疗宫颈癌前病变的更有效方法,例如低成本的共聚焦显微镜,可以改善早期诊断,从而改善预后。我们在向坎帕拉的公共宫颈癌筛查诊所展示的女性中试用了原型智能手机兼容的共聚焦显微内窥镜(SCME),乌干达。我们描述了SCME设备在下级干部人员使用的城市诊所的试点。
方法:我们筛查了18岁和60岁的女性,他在坎帕拉Kawempe国家转诊医院接受宫颈癌筛查,并评估其提供者(护士)的经验。护士接受了为期2天的培训研究医生如何使用SCME,将其添加到基于乙酸的标准视觉检查(VIA)的宫颈癌筛查中。如果VIA阴性,则使用SCME在VIA之前和之后的位置12和6点进行阴道镜检查,如果VIA阳性,则在癌前可疑病变上。我们用问卷来评估女性筛查后的经历,以及操作SCME的护士的经验。
结果:在2021年11月至2022年7月之间,我们筛查了291名平均年龄为36岁的女性,其中65.7%为HIV阳性。在接受筛查的女性中,146人符合VIA资格,123人被SCME筛选,我们获得了103名女性的共焦图像。在SCME筛选的那些人中,60%的人感到舒适,81%的人愿意再次使用它进行筛选。79%的女性的共聚焦图像显示出明显的细胞特征,而其余21%的图像分析具有挑战性。护士报告说,关于SCME对他们工作的有用性,平均得分为85%,71%的人表示他们的满意度和再次使用它的意愿,在易用性方面占63%,57%的人认为学习如何操作SCME很容易。
结论:我们的研究结果证明了在低资源环境中,较低的干部人员使用SCME来辅助诊断癌前病变的可行性。然而,需要做更多的工作,以使提供商更容易学习如何操作SCME和捕获高质量的共焦图像。
BACKGROUND: More efficient methods to detect and treat precancerous lesions of the cervix at a single visit, such as low-cost confocal microscopy, could improve early diagnosis and hence outcomes. We piloted a prototype smartphone-compatible confocal micro-endoscope (SCME) among women presenting to a public cervical cancer screening clinic in Kampala, Uganda. We describe the piloting of the SCME device at an urban clinic used by lower cadre staff.
METHODS: We screened women aged 18 and 60 years, who presented for cervical cancer screening at the Kawempe National Referral Hospital Kampala, and evaluated the experience of their providers (nurses). Nurses received a 2-day training by the study doctors on how to use the SCME, which was added to the standard Visual Inspection with Acetic acid (VIA)-based cervical cancer screening. The SCME was used to take colposcopy images before and after VIA at positions 12 and 6 O\'clock if VIA negative, and on precancer-suspicious lesions if VIA positive. We used questionnaires to assess the women\'s experiences after screening, and the experience of the nurses who operated the SCME.
RESULTS: Between November 2021 and July 2022, we screened 291 women with a median age of 36 years and 65.7% were HIV positive. Of the women screened, 146 were eligible for VIA, 123 were screened with the SCME, and we obtained confocal images from 103 women. Of those screened with the SCME, 60% found it comfortable and 81% were willing to screen again with it. Confocal images from 79% of the women showed distinguishable cellular features, while images from the remaining 21% were challenging to analyze. Nurses reported a mean score of 85% regarding the SCME\'s usefulness to their work, 71% regarding their satisfaction and willingness to use it again, 63% in terms of ease of use, and 57% concerning the ease of learning how to operate the SCME.
CONCLUSIONS: Our findings demonstrate the feasibility of using the SCME by lower cadre staff in low-resource settings to aid diagnosis of precancerous lesions. However, more work is needed to make it easier for providers to learn how to operate the SCME and capture high-quality confocal images.