Unraveling Cervical Cancer Screening Dilemmas: Histopathological Insights from VIA and LEEP at Bugando Medical Centre, Mwanza

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Abstract Background: The single-visit strategy, also known as the see-and-treat approach, is widely used to screen for cervical cancer in low- and middle-income countries. The VIA approach leads to unnecessary or inadequate treatment. Thus, a study was conducted to determine the histopathological patterns of aceto-white lesions on visual inspection with acetic acid in patients who underwent a Loop Electrosurgical Excision Procedure (LEEP) at Bugando Medical Centre between January 2016 and December 2020. Method: A 5-year retrospective cohort case record review was conducted on 329 women who had LEEP at Bugando Medical Centre following a positive VIA cervical screening test. A standard data abstraction form was used to collect patient information. For statistical analysis, STATA version 15 was used; in descriptive statistics, frequency, mean, and standard deviation were used. The Chi2 and Fisher's exact tests were used to investigate the relationship between patient characteristics and histopathological patterns, and a P-value of 0.05 was considered statistically significant in multinomial models. Results: This study looked at 329 patients who had LEEP following a VIA positive but were not eligible for cryotherapy. Our study participants had a mean age of 40 + 8.2 SD. There were 203 (61.7%) patients with benign lesions, including 4 patients with schistosomiasis and 2 patients with cervical tuberculosis. The precancerous lesions were discovered in 100 cases (30.4%), and 26 (7.9%) already had invasive cervical cancer. Out of 100 patients with precancerous lesions, 58 (17.6%) and 42 (12.8%) have high- and low-grade squamous intraepithelial (HSIL and LSIL) lesions, respectively. The presence of a precancerous lesion was found to be associated with age 31–40 years (p-value 0.004) and HIV positivity (p-value 0.042). Conclusion The majority of patients in this study had benign cervical lesions, which do not require LEEP treatment. Nonetheless, a considerable percentage of invasive cervical malignancies and rare benign diseases such as schistosomiasis and cervical tuberculosis were identified. Patients with an aceto-white lesion on the VIA test in well-equipped tertiary hospitals such as Bugando Medical Centre should consider a colposcopic guided biopsy as an alternative to straight LEEP.

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