Epidemiological and Histopathological Aspect of Precancerous and Cancerous Lesions of the Cervix in the Health District of Commune 5 of Bamako, the CHU of Point “G” and the Gabriel TouréUniversity Hospital of Bamako in Mali

Objective: The aim was to take stock of the screening and treatment of precancerous and cancerous lesions of the cervix in the health district of commune V of Bamako, the “G” point and the Gabriel Touré University Hospital in Bamako, Mali. Patients and Methods: This was a descriptive, cross-sectional, analytical study with retrospective and prospective data collection over an 8-year period from January 1, 2010 to December 31, 2017. This was a multi-center study. Results: From January 1, 2010 to December 31, 2017, 42,492 women were screened, representing a frequency of 24.30%. The median age of the women screened was 32 years;25% were under the age of 25. Three-fourth of the women screened was in the 20 - 49 age group. Of the 22,842 women screened, 90.1% of them had a normal col to IVA/IVL. However, 4.1% of cervical positivity had with acetic acid and 5.1% of positivity to Lugol. 0.7% of the women screened clinically had cancerous lesions. Histologically, 96.5% of the women screened had a normal cervix with benign lesions. For pathological histological findings, we noted 2.6% of precancerous lesions and 0.8% of squamous cell carcinomas and 0.1% of adenocarcinoma. Conclusion: Improved screening indicators with IVA/IV reduce the rate of morbidity and mortality from cervical cancer.

Diagnostic Accuracy of Colposcopically Directed Biopsy and Loop Electrosurgical Excision Procedure for Cervical Lesions

Objective:The aim of this study is to evaluate the diagnostic accuracy of colposcopically directed biopsy(CDB)and loop electrosurgical excision procedure(LEEP)for cervical lesions and assess their ability to detect glandular involvement.Methods:This retrospective study reviewed 4689 cervical lesions that were tested by CDB and LEEP at a tertiary hospital.The sensitivity,specificity,and predictive value of CDB and LEEP and the ratio of glandular involvement detected by these two methods were analyzed.Results:CDB and LEEP had sensitivities of 95.4%and 80.0%,respectively,for diagnosing high-grade intraepithelial or more severe lesions(HSIL+)(P=0.000)and 31.8%and 87.9%,respectively,for diagnosing adenocarcinoma in situ or more severe lesions(AIS+)(P=0.001).CDB and LEEP had sensitivities of 18.1%and 90.2%,respectively,for diagnosing invasive squamous cell carcinoma(P=0.000)and 5.9%and 98.0%,respectively,for diagnosing invasive adenocarcinoma(P=0.000).The negative predictive values of CDB and LEEP for diagnosing HSIL+were 88.6%and 64.4%,respectively(P=0.000).The ratios of glandular involvement were 0.2%(CDB)and 2.4%(LEEP)in low-grade intraepithelial lesions(LSILs)and 8.9%(CDB)and 59.0%(LEEP)(P=0.000)in HSIL+.Conclusions:LEEP is superior to CDB for diagnosing AIS and detecting early invasive cancer.It should be offered as an additional investigation to all patients with AIS,HSIL,or LSIL with glandular involvement on CDB.