Comparison between liquid based cervical cytology screening performed on self-collected tampons and healthcare worker-collected cytology samples at Dr George Mukhari Academic Hospital

Abstract

Introduction: Cervical cancer is caused by persistent infection with high-risk human papilloma virus types.
Screening is possible and has resulted in decreased incidence rates of cervical cancer by more than 50%
from the mid 1970s to the mid 2000s in screened populations. Optimal screening options need to be identifi ed.
Objectives: To compare the sensitivity of self-collected to healthcare worker (HCW) collected liquid based
cytology (LBC) in detecting premalignant lesions, and to assess if self-collection with a tampon can be used
as an additional sampling tool for cytology screening for cancer of the cervix.
Method: A cross sectional descriptive study was conducted among women aged 18 years and older. Selfsampling
consisted of ilex tampon use. The tampon was removed by a HCW and placed in a vial containing
saline solution followed by subsequent pelvic examination using a speculum for collection of a endo-cervical
sample using Cervarix brush placed in a PreserCyt solution. Both samples were sent for cytology analysis. A
two-sided statistical test comparing HCW collected with self-collected samples. P-value of <0.05 was regarded
as statistically signifi cant.
Results: A total of 220 women were enrolled in the study. HCW collected LBC samples had more abnormal
cervical lesions 50.9% vs self-collected samples of 19.5%. Women aged 30-49 had high prevalence of
abnormal cervical lesions LSIL (22.7% vs 3.2%), HSIL (17.5% vs 3.8%) and ASCUS (10.4% vs 7.7%) in both
HCW and self-collected samples respectively. There was 51.4% agreement between the two methods and a
kappa score of 0.3 was obtained, which is an agreement that is fair. HCW collected samples had a sensitivity
of 78.0% compared to 47.1 % of the self-collected samples for detection of pre-malignant lesions
Conclusion: This study demonstrated a fair diagnostic correlation between self-sampling and HCW collected
sampling for the diagnosis of premalignant cervical lesions. Self-sampling using the ilex tampon device had a
low sensitivity in detecting premalignant lesions compared to doctor collected LBC samples.