title: Evaluation of the accuracy in detecting cervical lesions by nurses versus doctors using a stationary colposcope and Gynocular in a low-resource setting.
abstract: OBJECTIVE
  Evaluation of the performance of VIA (visual inspection with acetic acid) trained nurses to learn colposcopy and the Swede score method to detect cervical lesions by using stationary colposcope or a portable, hand-held colposcope; the Gynocular, as compared to doctors.
  
  
  METHODS
  A crossover randomised clinical trial.
  
  
  METHODS
  The Colposcopy Clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh.
  
  
  METHODS
  932 women attending the clinic as either screening naïve for VIA screening (404) or women referred as VIA positive (528) from other VIA screening centres in the Dhaka region.
  
  
  METHODS
  VIA trained nurses were trained on-site in colposcopy and in the Swede score systematic colposcopy method. The Swede score grade cervical acetowhiteness, margins plus surface. vessel pattern, lesion size and iodine staining. The women were randomised to start the examination by either a stationary colposcope or the Gynocular. Swede scores were first obtained by a nurse and the same patient was equally evaluated by a doctor.
  
  
  METHODS
  Agreement between nurses and doctors in Swede scores was evaluated using the weighted κ statistic for the Gynocular and standard colposcope. The ability to predict CIN 2+ (CIN 2, CIN 3 and invasive cervical cancer) using Swede scores was evaluated using receiver-operating characteristic curves.
  
  
  RESULTS
  The Swede scores obtained by nurses and doctors using the Gynocular and stationary colposcope showed high agreement with a κ statistic of 0.858 and 0.859, respectively, and no difference in detecting cervical lesions in biopsy. Biopsy detected CIN 2+ in 39 (4.2%) women.
  
  
  CONCLUSIONS
  Our study showed that VIA nurses can perform colposcopy. There was no significant differences compared to doctors in detecting cervical lesions by stationary colposcope or the Gynocular using the Swede score system. Swede scores obtained by nurses using the Gynocular could offer an accurate cervical diagnostic approach in low resource settings.
  
  
  BACKGROUND
  ISRCTN53264564.
authors.affiliation: Department of Obstetrics and Gynecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh.
authors.forename: Ashrafun
authors.initials: A
authors.lastname: Nessa
authors.affiliation: Department of Obstetrics and Gynaecology, Green life Medical College Hospital, Dhaka, Bangladesh.
authors.forename: Joya Shree
authors.initials: JS
authors.lastname: Roy
authors.affiliation: Department of Obstetrics and Gynecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh.
authors.forename: Most Afroza
authors.initials: MA
authors.lastname: Chowdhury
authors.affiliation: Department of Obstetrics and Gynecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh.
authors.forename: Quayuma
authors.initials: Q
authors.lastname: Khanam
authors.affiliation: Department of Obstetrics and Gynecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh.
authors.forename: Romena
authors.initials: R
authors.lastname: Afroz
authors.affiliation: Departments of Obstetrics and Gynecology and Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Wistrand
authors.affiliation: Statisticon, Uppsala, Sweden.
authors.forename: Marcus
authors.initials: M
authors.lastname: Thuresson
authors.affiliation: Departments of Obstetrics and Gynecology and Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
authors.forename: Malin
authors.initials: M
authors.lastname: Thorsell
authors.affiliation: Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Isaac
authors.initials: I
authors.lastname: Shemer
authors.affiliation: Departments of Obstetrics and Gynecology and Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
authors.forename: Elisabeth Andrea
authors.initials: EA
authors.lastname: Wikström Shemer
mesh_terms: D000328:Adult; D020681:Colposcopes; D018592:Cross-Over Studies; D003944:Diagnostic Techniques, Obstetrical and Gynecological / Q000295:instrumentation; D004867:Equipment Design; D005260:Female; D006295:Health Resources; D006801:Humans; D009726:Nurses; D010820:Physicians; D015203:Reproducibility of Results; D002577:Uterine Cervical Diseases / Q000473:pathology*
keywords: GYNAECOLOGY