title: Evaluation of stationary colposcope and the Gynocular, by the Swede score systematic colposcopic system in VIA positive women: a crossover randomized trial.
abstract: OBJECTIVE
  This study aimed to evaluate cervical lesions by the Swede coloscopy system, histologic finding, liquid-based cytology, and human papillomavirus (HPV) in women who resulted positive for visual inspection of the cervix with acetic acid (VIA) by using a pocket-sized battery-driven colposcope, the Gynocular (Gynius AB, Sweden).
  
  
  METHODS
  This study was a crossover, randomized clinical trial at the colposcopy clinic of Bangabandhu Sheikh Mujib Medical University in Dhaka, Bangladesh, with 540 VIA-positive women. Swede scores were obtained by the Gynocular and stationary colposcope, as well as samples for liquid-based cytology, HPV, and cervical biopsies. The Swede scores were compared against the histologic diagnosis and used as criterion standard. The percentage agreement and the κ statistic for the Gynocular and standard colposcope were also calculated.
  
  
  RESULTS
  The Gynocular and stationary colposcope showed high agreement in Swede scores with a κ statistic of 0.998, P value of less than 0.0001, and no difference in detecting cervical lesions in biopsy. Biopsy detected cervical intraepithelial neoplasia (CIN) 2+ (CIN2, CIN3, and invasive cancer) in 38 (7%) of the women, whereas liquid-based cytology detected CIN2+ in 13 (2.5%) of the women. Forty-four (8.6%) women who were tested resulted positive for HPV; 20 (3.9%) women had HPV-16, 2 (0.4%) had HPV-18, and 22 (4.3%) had other high-risk HPV.
  
  
  CONCLUSIONS
  Our study showed that few VIA-positive women had CIN2+ lesions or HPV infection. Colposcopy by Swede score identified significantly more CIN2+ lesions than liquid-based cytology and could offer a more accurate screening and selection for immediate treatment of cervical lesions in low-resource settings.
authors: *Department of Obstetrics and Gynecology, Bangabandhu Sheikh Mujib Medical University Hospital, Dhaka, Bangladesh; †Department of Obstetrics and Gynecology, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; ‡Statisticon, Uppsala; and §Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
authors: Ashrafun
authors: A
authors: Nessa
authors: Charlotte
authors: C
authors: Wistrand
authors: Shirin Akter
authors: SA
authors: Begum
authors: Marcus
authors: M
authors: Thuresson
authors: Isaac
authors: I
authors: Shemer
authors: Malin
authors: M
authors: Thorsell
authors: Elisabeth Andrea Wikström
authors: EA
authors: Shemer
mesh_terms: D019342:Acetic Acid; D000328:Adult; D003127:Colposcopy / Q000295:instrumentation*; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis*
chemical_list: D019342:Acetic Acid