Visual Inspection of Cervix With Acetic Acid as a Screening Modality for Cervical Cancer.

Abstract

OBJECTIVE:

To assess feasibility and suitability of visual inspection of cervix with acetic acid (VIA) in detecting cervical intraepithelial neoplasia (CIN), and compare it with Papanicolaou test.

METHODS:

This was a diagnostic accuracy cross-sectional study conducted at an Egyptian teaching hospital, where 784 women were offered Papanicolaou test, VIA, colposcopy, and cervical biopsy.

RESULTS:

Histopathologically confirmed CIN 2/3 was noted in 26 cases (3.3%) and cervical cancer in 3 cases (0.4%). Twenty-seven (93.1%) of these 29 cases of CIN 2+, including one invasive cancer, were suggested by VIA. The test sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) to detect CIN 2+ were 93.1%, 90.6%, 26.6%, and 99.7%, respectively. Positive likelihood ratio (LR +) and negative likelihood ratio (LR-) for VIA were 9.90 (95% confidence interval [CI], 7.77-12.62) and 0.08 (95% CI, 0.02-0.29), respectively. Twenty-six cases (89.7%) of CIN 2+ were suggested by Papanicolaou test, whereas all 3 cancers were missed by this test. Papanicolaou test sensitivity, specificity, PPV, and NPV to detect CIN 2+ were 89.7%, 99.1%, 78.8%, and 99.6%, respectively. Positive likelihood ratio and LR- for the Papanicolaou test were 96.7 (95% CI, 45.78-204.23) and 0.10 (95% CI, 0.04-0.3), respectively. Colposcopy suggested 28 cases (96.6%) of CIN 2+, including 2 cancers. Colposcopy sensitivity, specificity, PPV, and NPV to detect CIN 2+ were 96.6%, 99.2%, 82.4%, and 99.9%, respectively.

CONCLUSION:

Visual inspection of the cervix with acetic acid is a feasible and suitable screening test for cervical cancer in under-resourced settings in developing countries. Its performance is comparable to the Papanicolaou test.

• Authors: Ahmed M Nooh, Mohamed El-Sayed Mohamed, Yehia El-Alfy
• Journal: Journal of lower genital tract disease (J Low Genit Tract Dis) Vol. 19 Issue 4 Pg. 340-4 (Oct 2015) ISSN: 1526-0976 [Electronic] United States
• PMID: 26247262 (Publication Type: Comparative Study, Evaluation Study, Journal Article)

Chemical References

• Acetic Acid

Topics

• Acetic Acid (metabolism)
• Adult
• Cervix Uteri (pathology)
• Colposcopy (methods)
• Cross-Sectional Studies
• Early Detection of Cancer (methods)
• Egypt
• Female
• Hospitals, Teaching
• Humans
• Middle Aged
• Papanicolaou Test
• Uterine Cervical Dysplasia (diagnosis)