Vl. Bhargava et al., A HOSPITAL-BASED STUDY ON THE USE OF PARAMEDICAL PERSONNEL FOR CLINICAL DOWNSTAGING OF CANCER CERVIX, Indian journal of medical research. Section B: Biomedical research other than infectious diseases, 98, 1993, pp. 65-68
Two auxillary nurse midwives (ANMs) were recruited and trained to reco
gnize normal and different types of abnormal cervices. A total of 2102
women were examined by a gynaecologist and ANM independently and thei
r findings were noted. Comparison of their findings showed an overall
agreement of 89.6 per cent (Kappa 0.84 with standard error of 0.015 an
d a significantly large Z value of 55.6). Gross examination of 4679 wo
men attending the Gynaecology OPD revealed normal cervix in 49.6 per c
ent and suspected lesions or malignant cervix in 3.4 per cent of women
. Cytology smears were taken in 3608 women. Adequacy of smears was 97
per cent. Comparing the group clinically diagnosed as highly suspected
or malignant to the cytologically diagnosed suspected group (atypical
and malignant), clinical examination had a sensitivity of 81.7 per ce
nt and specificity of 97.3 per cent; while comparison of the group cli
nically diagnosed as abnormal cervix to abnormal cytology (all grades
of dysplasia, atypical and malignant cells), the clinical examination
bad a sensitivity of 92.5 per cent and specificity of 37.4 per cent. I
t was concluded that paramedical staff (ANMs) can be relied upon to do
speculum examination in women in the community and take cytology smea
rs in selected cases.