Efficacy of visual inspection of the cervix using acetic acid in cervical cancer screening: A comparison with cervical cytology

Abstract

Screening programmes for the early detection of premalignant lesions of the cervix are expensive and technically difficult, especially in resource-challenged settings. There is a need for cheaper and equally effective alternative screening methods. This study compared the efficacy of visual inspection of the cervix using acetic acid (VIA) with the Pap smear method. A total of 186 subjects had a Pap smear followed by visual inspection of the cervix using 3 - 5% acetic acid with biopsies taken from suspicious acetowhite positive lesions. Cases of abnormal cytology were recalled for biopsies. A total of 150 subjects were negative for both tests; 30 (16.2%) were positive for VIA, while six were positive for both VIA and Pap smear. VIA detected one lesion missed by Pap smear on biopsy. The sensitivity of VIA was 100%, while that of Pap smear was 85.7%. The negative predictive value of VIA was 100%, while the positive predictive value was 20%. The sensitivity of VIA equals the reported rates for Pap smear. VIA is proposed as a credible alternative to Pap smear in resource-challenged settings.

Reliability of Visual Inspection After Acetic Acid Staining in Screening for Cervical Pre-malignant Lesion Among Female Subjects in a Rural Tertiary Hospital in Nigeria

“…VIA detected one lesion missed by Pap smear. [29] Similarly studies done in some other Africa countries like Egypt and Kenya revealed higher level of sensitivity of VIA. [23,30] Though, histology was not done in our study, but this is significantly high enough to validate VIA in a criterion validity.…”

Visual Inspection of Cervix with Acetic Acid as a Screening Test for Premalignant and Malignant Lesions of Cervix

“…[5][6][7][8][9] One of the major reasons for wide variation in results of VIA is that it is observer dependent. It is thus necessary that standard training should be given to all healthcare providers before we use it as part of a national screening program to maintain quality control.…”

Comparative efficacy of visual inspection with acetic acid versus cytology for cervical cancer screening in Ogbomoso, Nigeria

“…7,[22][23][24] The VIApositivity rates noted in the published studies from other regions and in some developing countries ranged from 5.7% to 28.0%. 7,9,[22][23][24][25][26][27] The wide variation in rates in the various studies may be due to different criteria and different cadres of health personnel used for screening and the different populations. 28,29 It may also depend on the study population, since few studies were done on symptomatic hospital based population, health workers and others as a mass screening test.…”

“…The Pap smearpositive rates noted in published studies within our local environment ranged between 3.1% and 10.0%. 9,22,26,27 With Denny et al reporting an incidence of 8.2% for abnormal Pap smear in South Africa. 30 In comparison of the diagnostic values of VIA with Pap smear, VIA seems to have a lower pre-cancerous lesion detection rate in this study.…”

“…28,29 It may also depend on the study population, since few studies were done on symptomatic hospital based population, health workers and others as a mass screening test. 7,9,[22][23][24][25][26] The inherent variability of the appearance of the cervix may have led to different subjective interpretations of the results among different health workers.…”