Anupama Bahadur

Counselling to Screening: Honing an Institutional Cervical Cancer Screening Program

Cervical cancer screening is an important tool in WHO's global strategy for cervical cancer elimination. The objective of the study was to suggest and study the impact of capacity building interventions to increase cervical cancer screening rates in women aged 30-49 years attending the gynecological OPD. As part of a multicentric study, qualitative research was carried out at a tertiary care institute (from September 2021 to June 2022) to gather information regarding the existing cervical cancer screening practices, analyze factors preventing universal screening, and develop troubleshooting strategies. A fishbone analysis was done to identify barriers to cervical cancer screening. Stepwise sequential implementation of seven Plan-Do-Study-Act (PDSA) cycles which included; doctors training, policy formation, dedicated counsellor and reminders on social network groups, OPD card stamps, reading and educational material, screening in all OPD rooms and finally establishment of dedicated screening room. The effect of each on counselling and screening of eligible women was noted. With the implementation of these PDSA cycles, the rates of eligible women being screened increased from 10.6% at baseline to 44.8% at the end of the study period. The percentage of counselled women increased to 70% and it was observed that counselled women were more likely to get screened. Educating women about the importance of cervical cancer screening and the creation of a dedicated screening room were the two most important quality improvement interventions.

Evaluation of the Performance of the IOTA ADNEX Model in Discriminating Adnexal Masses Preoperatively: An Ambispective Study

To evaluate the performance of the International Ovarian Tumour Analysis (IOTA) Assessment of Different NEoplasias in the adneXa (ADNEX) model in discriminating adnexal masses preoperatively. This ambispective observational study included 112 women with at least 1 adnexal mass, from January 2016 to April 2023. Cases underwent pelvic ultrasound and CA125 level assessments prior to surgery. The masses were classified into various subcategories by the IOTA ADNEX model and compared with postoperative histopathological reports. Sensitivity, specificity, negative predictive value, positive predictive value, and diagnostic accuracy were calculated for classifying tumours into various histological subtypes. Among the 112 women, 66 (58.9%) had benign ovarian tumours, 10 (8.9%) had borderline ovarian tumours, 17 (15.2%) had stage I ovarian cancer, 15 (13.4%) had stage II-IV ovarian cancer, and 4 (3.6%) had ovarian metastasis. The area under the receiver operating characteristic curve was 0.852 (0.772-0.912) for distinguishing between benign and malignant tumours using the IOTA ADNEX model at a 50% cut-off, with a sensitivity of 84.78%, specificity of 84.85%, positive predictive value of 79.6%, and negative predictive value of 88.9%. The IOTA ADNEX model is effective in classifying adnexal masses into benign and malignant categories, making it a valuable tool for triaging adnexal masses for further management.