TITLE:
Same day colposcopic examination and loop electrosurgical excision procedure (LEEP) presents minimal overtreatment and averts delay in treatment of cervical intraepithelial neoplasia in Kenyatta National Hospital, Kenya
AUTHORS:
Kays Muruka, Mugo R. Nelly, Wanyoike Gichuhi, Kihara Anne-Beatrice, Cheserem J. Eunice, Kosgei J. Rose
KEYWORDS:
Colposcopy; Loop Electrosurgical Excision Procedure (LEEP); CIN; Cervical Cancer Screening
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.3 No.3,
May
8,
2013
ABSTRACT:
Background: Screening for cancer of the
cervix at Kenyatta National Hospital (KNH), follows the recommended
three-step strategy; Papanicolaou (Pap) smear, colposcopy/biopsy and loop
electrosurgical excision procedure (LEEP)/biopsy. This approach poses the
following challenges: multiple clinic visits, costly, time consuming, long
turnaround time to treatment, non-compliance and loss-to-follow-up. Objective: To determine the agreement
between histologies following colposcopy and LEEP amongst women in KNH as a
forerunner for opportunity to shift from the three-step approach to the
two-step “see and treat” (same-day colposcopy and LEEP) approach. Methods: This
was a retrospective descriptive cohort of Women who underwent LEEP procedure between January 2008
and 31st December 2010 following the three-step approach at KNH, Kenya. Results:
A total of 124 patients out of the 132 patients who underwent LEEP were
included in the analysis. The 8 patients excluded had missing files. HIV infected,
uninfected or unknown women are similar socio-demographically. The mean (SD)
age for the HIV infected, uninfected and unknown is 37 (6), 33 (10) and 35
(9) years respectively. Colposcopic and LEEP biopsy
histology within patients demonstrated a high weighted kappa statistics agreement of 84%. LEEP
increased diagnosis of invasive cancer. Patients had a median (IQR) 5 (4 - 6)
clinic visits from Pap smear to LEEP treatment. It
took median (IQR) 55 (27 - 116) days between Pap smear to colposcopy result and 167 (101 - 276) days between Pap
smear results to LEEP treatment. If a LEEP procedure were to be performed in
this cohort of women on the same day of the colposcopy biopsy a median (IQR) 77
(55 - 137) days could have been saved. Conclusion: There is a high agreement between colposcopy and LEEP biopsies in our setting offering a window of opportunity
to perform “See and Treat” same-day
colposcopy and LEEP treatment procedure, skipping the colposcopy biopsy
stage.