Neena Gupta

Uterine cavity evaluation in infertile patients with transvaginal sonography, saline infusion sonography and hysteroscopy

Background: To compare diagnostic accuracy of Transvaginal sonography (TVS), Saline infusion sonography (SIS) and hysteroscopy in infertile women. Methods: In a prospective study, 250 women with complaint of infertility underwent TVS and SIS. Diagnostic and operative hysteroscopy under general anaesthesia was then performed. Results: Hysteroscopy with directed biopsy was considered as the gold standard. Endometrial polyp (n=25, 10%), submucosal fibroid (n=12, 4.8%), suspected intrauterine adhesions (n=4, 1.6%) and congenital uterine anamoly (n=2, 0.8%) were detected with TVS. In the evaluation with SIS results Endometrial polyp (n=34, 13.6%), submucosal fibroid (n=20, 18.1%), suspected intrauterine adhesions (n=5, 2%) and congenital uterine anamoly (3, 1.2%). Hysteroscopy results detected Endometrial polyp (n=32, 12.8%), submucosal fibroid (n=19, 7.6%), suspected intrauterine adhesions (n=8, 3.2%) and congenital uterine anamoly (n=5, 2%). Conclusions: TVS is the primary investigative method for evaluating every infertile couple by means of uterine cavity and ovaries. Hysteroscopy is superior to SIS in diagnosis of intracavitatory abnormalities. However SIS has the advantage of being noninvasive, cheap, affordable, short duration and accurate method for uterine cavity evaluation.

Visual inspection with acetic acid for cervical cancer screening in a tertiary health care centre

Background: Cervical cancer is one of the most prevalent malignant neoplasms among women in developing countries. Invasive cervical cancer is preceded by a long premalignant phase known as cervical intraepithelial neoplasia (CIN). The goal of cervical cancer screening is the detection and treatment of precancereous lesions before cancer develops. The objective of the study was to assess visual inspection with acetic acid (VIA) as a screening tool for use in a well-equipped health center , to evaluate VIA as an alternative or adjunct to the Papanicolaou (Pap) smear, and to determine if VIA can play a role in settings other than low resource ones. Methods: This was a prospective study of 1520 asymptomatic women, carried out in 2014-2015. The study was performed at a tertiary care center equipped with the latest-generation technology and highly trained oncologists. The women underwent a complete clinical evaluation, including a Pap smear and VIA. Participants with any positive test were referred for colposcopy and biopsy. Results: More women tested positive by VIA than on the Pap smear (6.9% vs. 4.2%; P =0.0001). There were 27 women with histologic cervical intraepithelial neoplasia grade 1 (CIN1); of these, 12 were detected by Pap and 15 by VIA (P = 0.4). A diagnosis of CIN 2 or 3 (CIN2–3) was confirmed in a total of 11 cases; Pap detected 4 of the cases and VIA 9 of the cases (P = 0.06). The positive predictive value for detection of CIN 2+ was 8.5% for VIA and 6.2% for Pap (P = 0.5). Most importantly, while only 2.8% of patients with a positive VIA were lost to follow-up before colposcopy that was true for 26.5% of the women with a positive Pap smear (P < 0.0001). Conclusions: VIA is useful for detection of precursor lesions of cervical cancer not only in low-resource settings but also in well-equipped health centers and cancer centers. In these non low-resource settings, VIA has a positive predictive value comparable to the conventional Pap smear, but it is more likely to achieve earlier diagnosis, follow-up, and treatment than cytology based screening.