A comparative study on bedside and examination under Aeasthesia clinical staging methods for certical cancer at University Teaching Hospital in Lusaka, Zambia

Abstract

Cervical cancer universally is clinically staged using the FIGO staging system performed on examination under anaesthesia (EUA). The EUA staging method is no longer thought to be mandatory but optional in staging cervical cancer. This is emerging from the on-going debate within scientific communities involved in cervical cancer management who are challenging the EUA method for bedside method. The on-going debate indicates that bedside method to stage cervical cancer be employed. However, there is still a grey area on published literature that is known on the method in terms of patient selection criteria, the sensitivity, positive predictive value and its accuracy. This may be limiting its use by clinicians who may want to employ the method. This study’s objective was to compare the bedside staging method to the current standard staging method (EUA) for cervical cancer. After ethical approval, a prospective cross section study was conducted at University Teaching Hospital (UTH), Lusaka from December 2013 to April 2014 on suspected cervical cancer patients. Twenty-three participants were recruited and data was collected using a paired data test technique. The suspected cervical cancer patients were subjected to two independent staging method- first a bedside staging and then an EUA by a clinician at the level of Registrar and above who was not aware of the findings of the bedside staging. Data was collected using a coded checklist linking data from same patient. Analysis was done using SPSS 17 statistical package. The sensitivity test, positive predictive value and the accuracy of the bedside method was calculated. Further analysis for correlation test was done. The age range of the participants was from 34 to 79 with a mean age of 51.5 years. The calculated sensitivity and positive predict value of the method was 87.5%, and 67% respectively with an accuracy of 64%. The findings are based on a small sample size recruited from one large clinical site and hence could not be generalized. However, the findings have presented an opportunity for further research on the subject. The staging of cervical cancer using EUA should not be abandoned until sufficient evidence on the accuracy and safety of the alternate bedside method is collected. For patients who are not suitable for anaesthesia and cannot undergo EUA, the bedside method is an optional method but administration of analgesia and /or anxiolytic before the staging procedure is advisable to reduce the patient related factors like pain and poor cooperation that may affect the staging process. For patients assigned to lower stages (2 or lower) on bedside method, further EUA staging is recommended because of either under or over staging on the bedside method.