Comparison of Visual Inspection with Acetic Acid and the Pap Smear for Cervical Cancer Screening

Sinha, Parul; Srivastava, Pritika; Srivastava, Anand

doi:10.1159/000484036

Cited by 12 publications

(7 citation statements)

References 23 publications

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“…Limitations of this study include the lack of cytologic data for all participants with hrHPV infections, as well as the absence of cervical biopsy correlation, as cytology alone has imperfect sensitivity, and may classify precancerous lesions incorrectly (Solomon and Nayar, 2004; Sinha et al, 2018; Bigoni et al, 2015). In addition, this study was designed to characterize hrHPV prevalence and type distribution at a population level in rural Zimbabwe and did not evaluate the hrHPV types present in cervical cancers in this population.…”

Section: Discussionmentioning

confidence: 99%

hrHPV prevalence and type distribution in rural Zimbabwe: A community-based self-collection study using near-point-of-care GeneXpert HPV testing

Fitzpatrick

Mandishora

Katzenstein

et al. 2019

International Journal of Infectious Diseases

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Objectives: High-risk human papilloma viruses (hrHPV) are the causative agents of cervical cancer, the leading cause of cancer deaths among Zimbabwean women. The objective of this study was to describe the hrHPV types found in Zimbabwe for consideration in cervical cancer screening and vaccination efforts. Design and methods: To determine hrHPV prevalence and type distribution in Zimbabwe we implemented a community-based cross-sectional study of self-collected cervicovaginal samples with hrHPV screening using near-point-of-care Cepheid GeneXpert HPV. Results: The hrHPV prevalence was 17% (112/643); 33% (41/123) vs. 14% (71/520) among HIV-1-positive and -negative participants, respectively ( p = 2.3E-07). Typing via Xpert HPV showed very good overall agreement (77.2%, kappa = 0.698) with the Seegene Anyplex II HPV HR Detection kit. The most common types were HPV16, HPV18, HPV35, HPV52, HPV58, HPV68, HPV18, and HPV51, each of which appeared in 14–20% of infections. 37% (28/76) of women with positive cytology results (ASCUS+) had a type not included in the basic vaccine and 25% (19/76) had a type not currently in the nine-valent vaccine. Conclusions: hrHPV type distribution includes less common high-risk types in rural Zimbabwe. The distribution and carcinogenicity of hrHPV type distribution should be considered during screening assay design, program development, as well as vaccine distribution and design.

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Section: Discussionmentioning

confidence: 99%

hrHPV prevalence and type distribution in rural Zimbabwe: A community-based self-collection study using near-point-of-care GeneXpert HPV testing

Fitzpatrick

Mandishora

Katzenstein

et al. 2019

International Journal of Infectious Diseases

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“…One study was multinational (1; 8.3%) and represented participants from Mali, the Congo Republic, Guinea, Niger, Burkina Faso, and India (Table 1 and S1 to S4 Data). The quality of all studies was rated as high, as determined by the NIH Quality Assessment Tool (S1 Table) [13]. Eleven (91.7%) studies were cross sectional and 1 (8.33%) was a randomized controlled trial.…”

Section: Characteristics Of All Included Studiesmentioning

confidence: 99%

“…The most common practice in LMIC settings is VIA which is considered cost-effective and feasible-requiring less provider training and produces immediate results, reducing patient loss to follow-up and allowing for a screen-and-treat approach [12]. That said, there are limited data comparing the performance of VIA with more commonly used screening methods such as the Pap smear with or without reflex HPV testing and primary HPV testing (either laboratory-based or point-of-care) alone [13]. VIA or VILI alone or rapid resulting point-of-care HPV testing or a combination of these have the potential to transform cervical cancer screening to a screen-and-treat approach in resource limited settings.…”

Section: Introductionmentioning

confidence: 99%

Performance of screening tools for cervical neoplasia among women in low- and middle-income countries: A systematic review and meta-analysis

Smith

Nwosu²,

Edwards³

et al. 2023

PLOS Glob Public Health

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Objective To evaluate the performance of visual inspection with acetic acid (VIA) testing, visual inspection with Lugol’s iodine (VILI), primary HPV testing, and conventional Pap smear in detecting CIN2+ among non-pregnant women aged 30–65 in LMICs between 1990 and 2020. Design Systematic review and meta-analysis. Setting and participants Low- and middle-income countries, non-pregnant women aged 30–65. Methods CENTRAL (Cochrane Library), CINAHL, Embase, Global Health, PubMed, and Web of Science databases were systematically searched to identify studies evaluating the performance of cervical cancer screening methods in LMICs. A diagnostic test accuracy meta-analysis was conducted to evaluate the performance of 4 screening methods in detecting CIN2+ relative to biopsy or cytology reference standards. Pooled statistics for sensitivity, specificity, diagnostic odds ratios, and summary receiver operating characteristic curves were determined for each method. Subgroup analyses were performed to examine whether there was variation in performance based on different reference standards for defining CIN2+, specifically: colposcopy-directed biopsy, biopsy alone, colposcopy alone, or liquid-based cytology. Results Eighteen studies were identified through systematic review. Twelve studies were included in meta-analysis; 11 were cross-sectional and 1 was a randomized controlled clinical trial. The remaining six of the eighteen studies were inclided in a narrative syntehsis. Pooled estimates for sensitivity for VIA, VILI, primary HPV testing, and conventional Pap smear were 72.3%, 64.5%, 79.5%, and 60.2%, respectively; pooled estimates for specificity were 74.5%, 68.5%, 72.6%, and 97.4%, respectively; the diagnostic odds ratios were 7.31, 3.73, 10.42, 69.48, respectively; and the area under the summary receiver operating characteristic curves were 0.766, 0.647, 0.959, and 0.818, respectively. Performance of the screening method varied based on the reference standard used; pooled estimates using either colposcopy-directed biopsy or biopsy alone as the reference standard generally reported lower estimates; pooled estimates using either colposcopy alone or liquid-based cytology as references reported higher estimates. Conclusions and implications This meta-analysis found primary HPV testing to be the highest performing cervical cancer screening method in accurately identifying or excluding CIN2+. Further evaluation of performance at different CIN thresholds is warranted.

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“…Finally, demonstrating that our protocol is achievable with non-expert observers after a short training period confirmed to our team the hope of sustainability. Several studies have shown similar results with visual inspection in many sub-Saharan countries, Honduras, Vietnam, Thailand, and India among others 15–18. In all those studies, the negative predictive value after using visual inspection with acetic acid is high, but in some, the addition of Lugol’s iodine increases the rate of negative predictive value.…”

Section: Discussionmentioning

confidence: 72%

Validation of a sustainable internationally monitored cervical cancer screening system using a visual smartphone inspection in Kinshasa, Democratic Republic of Congo

Tendobi

Fernandez-Marques

Carlos

et al. 2022

Int J Gynecol Cancer

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ObjectiveTo determine the sensitivity, specificity, and positive and negative predictive values of a cervical cancer screening program based on visual inspection with acetic acid and Lugol’s iodine using a smartphone in a sub-urban area of very low resources in Kinshasa (Democratic Republic of Congo).MethodsThis cross-sectional validation study was conducted at Monkole Hospital and it included women between the ages of 25–70 years after announcing a free cervical cancer screening campaign through posters placed in the region of our hospital. Questionnaires collected sociodemographic and behavioral patients characteristics. In the first consultation, we gathered liquid-based cytology samples from every woman. At that time, local health providers performed two combined visual inspection techniques (5% acetic acid and Lugol’s iodine) while a photograph was taken with a smartphone. Two international specialists evaluated the results of the smartphone cervicography. When a visual inspection was considered suspicious, patients were offered immediate cryotherapy. Cytological samples were sent to the Pathology Department of the University of Navarra for cytological assessment and human papillomavirus (HPV) DNA genotyping.ResultsA total of 480 women participated in the study. The mean age was 44.6 years (range 25–65). Of all the patients, only 18.7% were infected with HPV (75% had high-risk genotypes). The most frequent high-risk genotype found was 16 (12.2%). The majority (88%) of women had normal cytology. After comparing combined visual inspection results with cytology, we found a sensitivity of 66.0%, a specificity of 87.8%, a positive predictive value of 40.7%, and a negative predictive value of 95.3% for any cytological lesion. The negative predictive value for high-grade lesions was 99.7%.ConclusionsCervical cancer screening through combined visual inspection, conducted by non-specialized personnel and monitored by experts through smartphones, shows encouraging results, ruling out high-grade cytological lesions in most cases. This combined visual inspection test is a valid and affordable method for screening programs in low-income areas.

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Comparison of Visual Inspection with Acetic Acid and the Pap Smear for Cervical Cancer Screening

Cited by 12 publications

References 23 publications

hrHPV prevalence and type distribution in rural Zimbabwe: A community-based self-collection study using near-point-of-care GeneXpert HPV testing

hrHPV prevalence and type distribution in rural Zimbabwe: A community-based self-collection study using near-point-of-care GeneXpert HPV testing

Performance of screening tools for cervical neoplasia among women in low- and middle-income countries: A systematic review and meta-analysis

Validation of a sustainable internationally monitored cervical cancer screening system using a visual smartphone inspection in Kinshasa, Democratic Republic of Congo

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