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Published on: October 20, 2010
Nurse-led visual triage against histopathology in a real-world low-resource setting cervical cancer prevention
Simon M Manga1,2,3, Ivree Randolph2, Lynda Ugwu2
1Division of Global and Rural Health, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, USA.
Objective:
The objective of this study was to assess the histopathological reports from excision treatment and biopsy to identify the proportion of CIN2 + among a cohort of women who had abnormal cervical cancer visual screening reports in Cameroon and to identify potential risk factors for CIN2 + .
Methods:
This was a cross-sectional study using secondary data from women with abnormal cervical cancer visual screening who provided tissue through excision treatment/biopsy between 2007-2023 in Cameroon. The program nurses provided a presumptive pathologic diagnosis which was compared with the final pathologic diagnosis. We described baseline characteristics by estimating means, standard deviations (SD), counts, and percentages for continuous and categorical variables, as appropriate. T-tests and chi square tests were used to compare continuous and categorical variables, respectively, between women with CIN2 + and women without CIN2 + .
Results:
Of the 1,294 women with abnormal visual results, 930 (71.9%) had CIN2 + while 364 (28.1%) had no CIN2 + . Of the 724 women with lesions suspicious for Invasive Cervical Cancer (ICC), 545 (75.3%) had ICC while 53 (7.3%) had CIN3. Of the 227 women who had excision treatment, 70 (30.8%) had CIN3, followed by 53 (23.4%) with CIN2. Though the agreement between nurses' presumptive pathological diagnosis and final pathological diagnosis was fair (0.356), there was a lower level of agreement for CIN2(kappa = 0.180).
Conclusion:
The proportion of CIN2 + among these women with abnormal visual results was over 70%. Age, HIV status, and visual screening results were strong clinical predictors for CIN2 + . Nurse-led triage showed good reliability in identifying ICC but poor for CIN2.