Research Article ISSN 2639-8478

Research Article Cancer Science & Research

Precancerous Lesions of Cervix in The Lekoumou and Niari Departments

(Congo Brazzaville)
Ngatali Christian F.S1*., Bolenga Liboko A.F2., Mabiala Y2, Doukaga Moussavou R.A3., Moukassa D4., and
Nkoua Mbon J.B2
Department of oncology and Internal Medicine, Loandjili
1

General Hospital (Congo).

*
Correspondence:
2
Department of oncology, CHU Brazzaville (Congo). Dr. Ngatali Christian, Faculty of Health Sciences Brazzaville and
Loandjili General Hospital.
3
Department of gynecology, Tié-Tié Basic Hospital (Congo).
Received: 14 Dec 2021; Accepted: 06 Jan 2022; Published: 10 Jan 2022
Pathology
4
anatomy laboratory, Loandjili General
Hospital,Pointe Noire (Congo).

Citation: Christian NFS, Liboko BAF, Mabiala Y, et al. Precancerous Lesions of Cervix in The Lekoumou and Niari Departments
(Congo Brazzaville). Cancer Sci Res. 2022; 5(1): 1-5.

ABSTRACT
Objective: To determine the prevalence of precancerous lesions in the Lekoumou and Niari departments.

Patients and Methods: this was a descriptive and cross-sectional study over a period of 7 months from January
to July 2020 in the department of of lekoumou, The analyzes were made in the Laboratory of Medical and
Morphological Analysis of the General Hospital of Loandjili. Our study involved a population of 100 women
ranging in age from 16 to 73 years old. All of these women voluntarily benefited from a cervico-uterine sample.
The cytological study was based on the international classification of BETHESDA 2001, taking into account the
quality of the sample and the cell morphology. The variables studied were: age, marital status, level of education,
cytology. Bivariate analyze was done between age and cytology. All the results of this study were statistically
analyzed from the Chi-square test or Fisher's exact test using Epi-InfoTM software version 7.1.1.14, USA (http://
www.epiinfo.com).

Results: The mean age of the patients was 34.6 ± 11.9 with extremes ranging from 16 to 73 years. The most
represented age groups were 20-29 years old (31%) and 30-39 years old (29%). Our study population was
predominantly college, accounting for 53% of cases. The proportion of uneducated women represented 11% of our
study population. Almost ¾ of our study population were married women (74%). Singles represented only 22% of
the study population. More than half of our study population, 58%, had normal cytology. Benign and reactive cell
changes were diagnosed in 20% of cases. Low-grade and high-grade precancerous lesions were observed in 8%
and 12% of cases, respectively. High-grade intraepithelial lesions were more represented in patients aged between
27 and 36 years 50%, high-grade lesions represented in 47% of cases. there were no statistically significant result
between age and cytology.

Conclusion: prevalence of precancerous lesions is relatively high It is well known that intraepithelial neoplasia
precedes invasive carcinoma after a period of about 10 years. knowledge of these precancerous lesions is necessary
for optimal prevention of cervical cancer.

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Keywords of determining the prevalence of precancerous lesions in the
Prevalence, Precancerous lesions, Cervix, Lekoumou, Niari, Lekoumou and Niari departments.
Congo Brazzaville.
Patients and Methods
Introduction We conducted a descriptive and cross-sectional study over a
According to estimates from the World Health Organization period of 7 months from January to July 2015 in the Lekoumou
(WHO) in 2019, cancer is the first or second leading cause of death department.
before the age of 70 years in 112 of 183 countries and ranks third
or fourth in a further 23 countries [1]. Cervical cancer with an The analyzes were carried out in the Laboratory of Medical and
estimated 570,000 cases and 311,000 deaths in 2018 worldwide, Morphological Analysis of the General Hospital of Loandjili. Our
this disease ranks as the fourth most frequently diagnosed cancer study involved a population of 100 women ranging in age from 16
and the fourth leading cause of cancer death in women [2]. to 73 years old. All of these women voluntarily benefited from a
cervico-uterine sample.
The highest regional incidence and mortality rates are seen in
Africa, with rates elevated in Southern Africa (eg, Swaziland, Sexually active patients aged 16 and over who have given informed
with the highest incidence rate), Eastern Africa (Malawi, with consent for adults and parental consent for minors were included.
the highest mortality rate; and Zimbabwe), and Western Africa
(Guinea , Burkina Faso, and Mali) [2]. We did not include patients who had undergone total hysterectomy
as well as those who were menstruating. We carried out a simple
The incidence of cervical cancer continues to decrease, unlike in random selection to constitute the size of our sample
developing countries, particularly in sub-Saharan Africa where
the incidence is increasing exponentially mainly due to the Method of Sampling
poor organization of screening and prevention policies. Human Each patient was placed in a gynecological position. After placing
papillomavirus (HPV) is the virtually necessary (but not sufficient) a sterile disposable speculum, two samples were taken.
cause of cervical cancer [3]. In Congo, cervical cancer is the
second most common cancer in women in terms of incidence and The sample was taken with an Ayre spatula from the exo and
the first cancer in terms of mortality [1]. endocervix. The collected cells were spread evenly and in a thin
layer on a glass slide, then fixed with a cytological fixative spray.
Cervical intraepithelial neoplasia (CIN) is a spectrum of intra-
epithelial cellular abnormality suggestive of neoplasia. The Cytological Analysis
process of dysplasia of cervical cells means abnormal maturation The coloring was done using the Papanicolaou technique.
[4]. According to Bethesda system 2014, CIN is classified into The cytological study was based on the international classification
three grades which include mild, moderate and severe degrees of BETHESDA 2001, taking into account the quality of the sample
(CIN 1, 2 and 3 respectively). The main risk factors for cervical and the cell morphology.
dysplasia include HPV infection with serotypes 16, 18, 31, 33, 35
[5]. Other risk factors include early sexual activity, smoking, high The results of the cytological reading for the detection of
parity and immunosuppression. Screening of pre-invasive disease precancerous lesions were classified into: Normal smear, Reactional
of the Cervix aims to prevent morbidity and mortality from cervical begign cellular modification, ASCUS / ASGUS, LGSIL, HGSIL.
cancer. Screening starts at the age of 21 and continues till the age
of 65years. The main screening methods of cervical cancer are: The Bethesda System the standard universal system used for
Cervical cytological screening (Pap smear); Visual inspection with interpretation of Pap smear results. Types of results using
acetic acid (VIA); Visual inspection with Lugol's iodine (VILI); Betheseda system include: Negative for intraepithelial lesion or
Colposcopy; and Cervical biopsies. The conventional method (Pap malignant atypical squamous cells. 1) Atypical squamous cells
smear): The Pap test was developed by Dr. George Papanicolaou of undetermined significance (ASC-US); 2) Atypical squamous
in 1941. Cervical screening always requires an endocervical and cells-cannot exclude HSIL (ASC-H); 3) Low grade squamous
an ectocervical sample, using wooden or plastic spatulas : Ayre intraepithelial lesion (LGSIL or LSIL); 4) High grade squamous
and extended tip or Aylesbury [6]. intraepithelial lesion (HGSIL or HSIL); 5) Squamous cell
carcinoma; 6) Atypical Glandular Cells not otherwise specified
Cervical cancer is preventable by cervical smear screening for (AGC-NOS); 7) Atypical Glandular Cells, suspicious for AIS or
intraepithelial neoplasia [7]. It is well known that intraepithelial cancer (AGC-neoplastic); 8) Adenocarcinoma in situ (AIS); 9)
neoplasia precedes invasive carcinoma after a period of about 10 Adenocarcinoma. Low grade lesions correspond to CIN1 and high
years [8]. This tissue damage is often studie d by conventional grade lesions correspond to CIN 2 and 3.
cervical smears [9-13]. Other methods are used as liquid-medium
smears [10]. No study in this department has been carried out The variables studied were: age, marital status, level of education,
to our knowledge. This is how we set ourselves the objective cytology. Bivariate analysis was done between cytology and age.

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Statistical analysis
All the results of this study were statistically analyzed from the
Chi-square test or Fisher's exact test using Epi-InfoTM software
version 7.1.1.14, USA (http://www.epiinfo.com). Qualitative data
were described using number and percent. Quantitative data were
described using range (minimum and maximum), mean, standard
deviation and median. Significance of the obtained results was
judged at the 5% level.

For all tests, the association between two variables was considered
statistically significant when p <0.05.

Results
The mean age of the patients was 34.6 ± 11.9 with extremes Figure 2: Distribution of patients according to marital Status.
ranging from 16 to 73 years. The most represented age groups
Table 2: Distribution of Patients according to Cytology.
were 20-29 years old (31%) and 30-39 years old (29%) table 1.
Cytology Number Percentage
Our study population was predominantly college, accounting for
Normal 57 57%
53% of cases, the proportion of uneducated women represented
MCBR 21 21%
11% of cases figure 1. Almost ¾ of our study population were ASCUS 1 1%
married women (74%), Singles represented only 22% of the study LGSIL 7 7%
population and 4% were widow figure 2. More than half of our HGSIL 14 14%
study population, 58%, had normal cytology. Benign and reactive Total 100 100%
cell changes were diagnosed in 20% of cases, Low-grade and
high-grade precancerous lesions were observed in 8% and 12%
of cases, respectively table 2. High-grade intraepithelial lesions
were more represented in patients aged between 27 and 36 years
50%, high-grade lesions represented in 47% of cases. LGSIL were
most prevalent in patients aged 27 to 36 at 50%. HGSIL were 53%
represented in patients over 46 years of age and 33% in patients
aged 27 to 36 years, there were no statistically significant result
between age and cytology (Figure 3).

Table 1: Distribution of Patients according to Age.

Age Number Percentage
<20 8 8%
20-29 31 31%
30-39 29 29%
40-49 20 20% Figure 3: Distribution of patients according to age and cytology.
≥ 50 12 12% P>5% non significant result.
Total 100 100%
Discussion
Analysis of the methodology
Type and period of the study: The descriptive and transversal
nature of this study ensures an optimal quality of the results,
because the collection of information was contemporaneous with
the events described. The homogeneity of our study sample allowed
us to make a simple analysis of the results obtained, representative
of the general population of the study area.

Study population: The selection criteria were established in order

to avoid bias in the interpretation of the results. We performed
cervico-uterine smears (CDU) in women aged 16 years or older.
For adolescents aged 16 to 18, informed consent from a parent or
Figure 1: Distribution of Patients according to Level of Instruction. guardian was required to be part of the study, while those over 18
had to consent themselves. Quite similar criteria were also used by

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Xavier Castellsagué in 2002 [14], in a study on the detection of the 2. Bray F, Ferlay J, Soerjomataram I, et al. Global Cancer
HPV genotype in rural areas in Mozambique. Statistics GLOBOCAN Estimates of Incidence and Mortality
Worldwide for 36 Cancers in 185 Countries. CA A Cancer
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that observed in the Louie study population in 2009 [15] which 3. Monsonego J. Papillomavirus et cancer du col de l’utérus.
was estimated to be 33.9 years. Médecine/sciences. 1996; 12: 733.
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making a simple random selection of women from the entire rural Course of Untreated Cervical Intraepithelial Neoplasia Grade
area of the Kouilou department, representing our sampling territory. 2 under Active Surveillance Systematic Review and Meta-
The purpose of this random selection was to obtain a number of Analysis. BMJ. 2018; 360: 499.
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Analysis of the cytological diagnosis Gabon. Pan Afr Med J. 2015; 22.
According to our study, 78% of women had borderline-normal 8. Bergeron C, Cartier I, Guldner L, et al. Lésions précancéreuses
cytology (57% had normal cytology and 21% had benign and et cancers du col de l’utérus diagnostiqués par le frottis
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These results agree with those of Womack et al in 2000 in
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of normal; precancerous lesions represented 26.2% [18]. Ali-Risasi des techniques en milieu liquide et couche mince implications
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11. Schwartz D. Dépistage cytologique du cancer du col de l’utérus
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Geneva. 2002.
Moukassa et al [20] in 2013, Boumba et al in 2015 [21].
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Brazzaville with a percentage of 3.57% CIN. 115.
13. Zeggai M, Sebiane S. Gestion des FCV Frottis Cervicaux
The second focused on the comparative study of risk factors Vaginaux de CHU Tlemcen PhD Thesis. 2014.
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14. Castellsague X, Bosch FX, Munoz N, et al. Male circumcision
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penile human papillomavirus infection and cervical cancer
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Precancerous lesions of the cervix are represented by high-grade
and low-grade lesions in our resource-limited setting. Their 15. Louie KS, de Sanjose S, Mayaud P. Epidemiologie and
prevalence is relatively high in the under 36 age groups. It is well prevention of human papillomavirus and cervical cancer
known that intraepithelial neoplasia precedes invasive carcinoma in sub-saharan Africa a comprehensive review. Tropical
after a period of about 10 years. knowledge of these precancerous medicine and international health. 2009; 10: 1287-1302.
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© 2022 Christian NFS. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License

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