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VOLUME 6 , ISSUE 1 ( January-June, 2018 ) > List of Articles


GynocularTM as a Field Colposcope: Real-life Experiences from a VIA and HPV DNA-based Cervical Cancer Screening Program in Rural India

Ranajit Mandal, Srabani Mittal, Dipanwita Banerjee, Katayoun Taghavi, Eliane Rohner, Tapas Maji

Keywords : Field colposcope in cervical cancer screening, Gynocular in cervical cancer screening, Portable colposcope.Keywords>

Citation Information : Mandal R, Mittal S, Banerjee D, Taghavi K, Rohner E, Maji T. GynocularTM as a Field Colposcope: Real-life Experiences from a VIA and HPV DNA-based Cervical Cancer Screening Program in Rural India. J South Asian Feder Menopause Soc 2018; 6 (1):52-56.

DOI: 10.5005/jp-journals-10032-1136

Published Online: 01-07-2017

Copyright Statement:  Copyright © 2018; The Author(s).


Introduction: Gynocular is a battery-operated, portable field colposcope with three-step magnification and green filter. The present study was conducted in a community setting to evaluate accuracy and also asess the advantages and limitations of Gynocular as a field colposcope. Materials and methods: Women between 30 and 60 years were screened in the rural clinics in India using visual inspection on acetic acid (VIA) and human papillomavirus deoxyribonucleic acid (HPV DNA) test performed by trained health workers. Women positive on either test had evaluation by Gynocular by cervical punch biopsy irrespective of their Gynocular findings. A total of 12,727 women were screened using both VIA and hybrid capture 2 (HC2) test from April 2014 to February 2016. Result: A total of 1,021 women positive on either VIA or HC2 test were examined by Gynocular. A total number of 231 cases of cervical intraepithelial neoplasm 1 (CIN1), 23 cases of CIN2, 13 cases of CIN3, and 7 cases of invasive cancers were detected on histology. The sensitivity and specificity of Gynocular. at Swede Score (SS) ≥5 were 97.7% [95% confidence interval (CI):] and 78.6% (95% CI: respectively. Raising the threshold to ≥6 resulted in drop in the sensitivity to 93.0% (95% CI:, but a large improvement in specificity at 94.5% (95% CI: Conclusion: There is a great need for a technically less demanding and inexpensive colposcope to be used for programs in low- and middle-income countries (LMICs). The portability of the device, long battery back-up and ability to capture images using mobile phone are the advantages for using this device in field settings.

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  1. Ginsburg OM. Breast and cervical cancer control in low and middle-income countries: human rights meet sound health policy. J Cancer Policy 2013 Sep-Dec;1(3-4):e35-e41.
  2. Denny, L.; Herrero, R.; Levin, C.; Kim, JJ. Cervical cancer. In: Gelband H, Jha P, Sankaranarayanan R, Horton S, editors. Chapter 4: Cancer: disease control priorities. 3rd ed. Vol. 3. Washington (DC): The International Bank for Reconstruction and Development/The World Bank; 2015. [cited 2015 Nov 1]. Available from: NBK343648/ doi: 10.1596/978-1-4648-0349-9_ch4.
  3. Vinay Kumar R, Bhasker S. Optimizing cervical cancer care in resource-constrained developing countries by tailoring community prevention and clinical management protocol. J Cancer Policy 2014 Jun;2(2):63-73.
  4. Pimple S, Shastri SS. Comparative evaluation of human papilloma virus-DNA test verses colposcopy as secondary cervical cancer screening test to triage screen positive women on primary screening by visual inspection with 5% acetic acid. Indian J Cancer 2014 Apr-Jun;51(2):117-123.
  5. Basu P, Meheus F, Chami Y, Hariprasad R, Zhao F, Sankaranarayanan R. Management algorithms for cervical cancer screening and precancer treatment for resource-limited settings. Int J Gynecol Obstet 2017 Jul;138(Suppl 1):26-32.
  6. Institute of Medicine (US) Committee on Cancer Control in Low- and Middle-Income Countries; Sloan, FA.; Gelband, H.; editors. Cancer control opportunities in low- and middleincome countries. In: Chapter 6: Compelling opportunities in global cancer control. Washington (DC): National Academies Press (US); 2007. Available from: https://www.ncbi.nlm.nih. gov/books/NBK54024.
  7. Ngoma T. World Health Organization cancer priorities in developing countries. Ann Oncol 2006 Jun;17(Suppl 8): viii9-viii14.
  8. Ghosh I, Mittal S, Banerjee D, Singh P, Dasgupta S, Chatterjee S, Biswas J, Panda C, Basu P. Study of accuracy of colposcopy in VIA and HPV detection-based cervical cancer screening program. Aust N Z J Obstet Gynaecol 2014 Dec;54(6):570-575.
  9. Carozzi F, Bisanzi S, Sani C, Zappa M, Cecchini S, Ciatto S, Confortini M. Agreement between the AMPLICOR human papillomavirus test and the Hybrid Capture 2 assay in detection of high-risk human papillomavirus and diagnosis of biopsy-confirmed high-grade cervical disease. J Clin Microbiol 2007 Feb;45(2):364-369.
  10. Sankarnarayan R. Screening for cancer in low and middle income countries. Ann Glob Health 2014 Sep-Oct;80(5): 412-417.
  11. Quaas J, Reich O, Frey Tirri B, Kuppers V. Explanation and use of the colposcopy terminology of the IFCPC (International Federation for Cervical Pathology and Colposcopy) Rio 2011. Geburtshilfe Frauenheilkd 2013 Sep;73(9):904-907.
  12. Strander B, Ellström-Andersson A, Franzén S, Milsom I, Rådberg T. The performance of a new scoring system for colposcopy in detecting high-grade dysplasia in the uterine cervix. Acta Obstet Gynecol Scand 2005 Oct;84(10):1013-1017.
  13. Bowring J, Strander B, Young M, Evans H, Walker P. The Swede score: evaluation of a scoring system designed to improve the predictive value of colposcopy. J Low Genit Tract Dis 2010 Oct;14(4):301-305.
  14. Nessa A, Roy JS, Chowdhury MA, Khanam Q, Afroz R, Wistrand C, Thuresson M, Thorsell M, Shemer I, Shemer EA. Evaluation of the accuracy in detecting cervical lesions by nurses versus doctors using a stationary colposcope and Gynocular in a low-resource setting. BMJ Open 2014;4(11):e005313. doi: 10.1136/bmjopen-2014-005313
  15. Basu P, Banerjee D, Mittal S, Mandal R, Ghosh I, Das P, Muwonge R, Biswas J. Evaluation of a compact, rechargeable, magnifying device to triage VIA and HPV positive women in a cervical cancer screening program in rural India. Cancer Causes Control 2016 Oct;27(10):1253-1259.
  16. Bentley J; Executive Council of the Society of Canadian Colposcopists; Special Contributors. Colposcopic management of abnormal cervical cytology and histology. J Obstet Gynaecol Can 2012 Dec;34(12):1188-1202.
  17. Sankaranarayanan R. ‘See-and-treat’ works for cervical cancer prevention: what about controlling the high burden in India? Indian J Med Res 2012 May;135(5):576-579.
  18. Bosgraaf RP, Mast PP, Struik-van der Zanden PH, Bulten J, Massuger LF, Bekkers RL Overtreatment in a see-and-treat approach to cervical intraepithelial lesions. Obstet Gynecol 2013 Jun;121(6):1209-1216.
  19. Sherman ME, Lorincz AT, Scott DR, Wacholder S, Castle PE, Glass AG, Mielzynska-Lohnas I, Rush BB, Schiffman M. Baseline cytology, human papillomavirus testing, and risk for cervical neoplasia: a 10-year cohort analysis. J Natl Cancer Inst 2003 Jan;95(1):46-52.
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