Transformation Zone Assessment Using Visual Inspection With Acetic Acid Before and After Thermal Ablation : Implications for Follow-Up

Article Article scientifique Article Transformation Zone Assessment Using Visual Inspection With Acetic Acid Before and After Thermal Ablation : Implications for Follow-Up eng 2023-02 author Balli Christine 0000-0001-9261-5763 Gynecology Division, Department of Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland. 418555 author Kenfack Bruno Department of Biomedical Sciences, University of Dschang, Dschang District Hospital, Dschang, Cameroon. author Horo Apollinaire 0000-0001-6311-8848 Unit of Gynecology and Obstetrics, University Hospital (CHU) of Yopougon, Abidjan, Ivory Coast. author Jeronimo Jose Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, MD. author Abatsong Esther Department of Biomedical Sciences, University of Dschang, Dschang District Hospital, Dschang, Cameroon. author Wisniak Ania 0000-0002-3942-2134 Gynecology Division, Department of Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland. 717179 Département de Pédiatrie, Gynécologie et Obstétrique (PETRI) author Vassilakos Pierre 0000-0002-0926-4366 Gynecology Division, Department of Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland.,Geneva Foundation for Medical Education and Research, Geneva, Switzerland. 25351 author Petignat Patrick 0000-0002-6835-533X Gynecology Division, Department of Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland. 586685 Département de Pédiatrie, Gynécologie et Obstétrique (PETRI) e2200241 10.1200/go.22.00241 36854076 2687-8941 PMC10166473 https://ascopubs.org/doi/10.1200/GO.22.00241 Purpose: Thermal ablation (TA) has become the conventional method for treatment of precancerous cervical lesions in low-resource settings. After TA, both the squamocolumnar junction (SCJ) and the transformation zone (TZ) may be subject to change. Our aim was to evaluate SCJ and TZ variability after TA. Methods: Study data were collected in a large prospective trial of a cervical cancer screening campaign in Cameroon. For each patient, two sets of cervical photos (native and with acetic acid) were taken before and 6-12 months after TA. The SCJ and TZ were evaluated independently by three observers according to the WHO nomenclature. When discordances were observed between the type of TZ and SCJ selected by each observer, a corrected TZ was established on the basis of the SCJ categorization. Interobserver agreement for TZ interpretation was evaluated using Cohen's kappa coefficient for agreement between two observers and Fleiss' kappa between three observers. Results: Fifty consecutive participants were included in the analysis. Seventy-six percent were interpreted as TZ1-2, and 24% as TZ3 before TA. In 56% of cases, the entire SCJ could not be entirely visualized after TA, thus being recategorized as TZ3. Interobserver agreement was fair for diagnosis before TA (Kappa coefficient, 0.34; 95% CI, 0.27 to 0.45) and moderate for diagnosis after TA (Kappa coefficient, 0.40; 95% CI, 0.30 to 0.50). After TA, 36% progressed from TZ1-2 to TZ3, with a moderate interobserver agreement (Kappa coefficient, 0.44; 95% CI, 0.40 to 0.54). Conclusion: We observed a shift of the SCJ into the endocervical canal after TA. A significant proportion of participants had TZ 3 after treatment, raising the question of visual inspection with acetic acid's applicability as a first-line follow-up examination method after TA. Acetic Acid Early Detection of Cancer Female Follow-Up Studies Humans Prospective Studies Uterine Cervical Neoplasms / diagnosis Uterine Cervical Neoplasms / surgery Dewey 618 58 Département de pédiatrie, gynécologie et obstétrique 223 false 590 Prévention du cancer du col utérin 933 JCO global oncology 9 cdad69ed-07d8-4ef2-b6a4-6c929364ddc1 Article (Published version) Public balli-et-al-2023-transformation-zon.pdf 631913 application/pdf CC BY-4.0 74ce2779ecd4ba0119ed47829092c1c6eda9094a80b78d23f3919a578412cfe9 openAccess Faculté de médecine / Section de médecine clinique / Département de pédiatrie, gynécologie et obstétrique

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Transformation Zone Assessment Using Visual Inspection With Acetic Acid Before and After Thermal Ablation : Implications for Follow-Up	JCO global oncology			2023	2	0

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Balli, Christine