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Clinical Trial
. 2023 Feb:9:e2200241.
doi: 10.1200/GO.22.00241.

Transformation Zone Assessment Using Visual Inspection With Acetic Acid Before and After Thermal Ablation: Implications for Follow-Up

Christine Balli  1 , Bruno Kenfack  2 , Apollinaire Horo  3 , Jose Jeronimo  4 , Esther Abatsong  2 , Ania Wisniak  1 , Pierre Vassilakos  1   5 , Patrick Petignat  1
Affiliations
Clinical Trial

Transformation Zone Assessment Using Visual Inspection With Acetic Acid Before and After Thermal Ablation: Implications for Follow-Up

Christine Balli et al. JCO Glob Oncol. 2023 Feb.

Abstract

Purpose: Thermal ablation (TA) has become the conventional method for treatment of precancerous cervical lesions in low-resource settings. After TA, both the squamocolumnar junction (SCJ) and the transformation zone (TZ) may be subject to change. Our aim was to evaluate SCJ and TZ variability after TA.

Methods: Study data were collected in a large prospective trial of a cervical cancer screening campaign in Cameroon. For each patient, two sets of cervical photos (native and with acetic acid) were taken before and 6-12 months after TA. The SCJ and TZ were evaluated independently by three observers according to the WHO nomenclature. When discordances were observed between the type of TZ and SCJ selected by each observer, a corrected TZ was established on the basis of the SCJ categorization. Interobserver agreement for TZ interpretation was evaluated using Cohen's kappa coefficient for agreement between two observers and Fleiss' kappa between three observers.

Results: Fifty consecutive participants were included in the analysis. Seventy-six percent were interpreted as TZ1-2, and 24% as TZ3 before TA. In 56% of cases, the entire SCJ could not be entirely visualized after TA, thus being recategorized as TZ3. Interobserver agreement was fair for diagnosis before TA (Kappa coefficient, 0.34; 95% CI, 0.27 to 0.45) and moderate for diagnosis after TA (Kappa coefficient, 0.40; 95% CI, 0.30 to 0.50). After TA, 36% progressed from TZ1-2 to TZ3, with a moderate interobserver agreement (Kappa coefficient, 0.44; 95% CI, 0.40 to 0.54).

Conclusion: We observed a shift of the SCJ into the endocervical canal after TA. A significant proportion of participants had TZ 3 after treatment, raising the question of visual inspection with acetic acid's applicability as a first-line follow-up examination method after TA.

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Conflict of interest statement

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO’s conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/go/authors/author-center.

Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments).

No potential conflicts of interest were reported.

Figures

FIG 1
FIG 1
Cervical appearance before and 6-12 months after TA. (A) Cervical appearance before treatment (native). (B) Cervical appearance before treatment after acetic acid application. (C) Cervical appearance 12 months after treatment (native). (D) Twelve months after treatment after acetic acid application. Notably, this situation was interpreted as TZ type 1 at the first visit and TZ type 3 at the follow-up visit after treatment by TA. The new SCJ had moved much closer to the internal OS after treatment. The SCJ is visible as a distinct white line after the application of 5% acetic acid because of the presence of immature squamous metaplastic epithelium adjacent to the new SCJ. SCJ, squamocolumnar junction; TA, thermal ablation; TZ, transformation zone.
FIG 2
FIG 2
Cervical appearance before and immediately after TA. (A) Cervical appearance before treatment (native). (B) Cervical appearance before treatment after acetic acid application. (C) Cervical appearance immediately after treatment. Notably, after TA, the entire transformation zone is destroyed. TA, thermal ablation.
FIG 3
FIG 3
Shift of the TZ type before and after TA. TA, thermal ablation; TZ, transformation zone.
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