Cervicography, Cervical biopsy, Colposcopy, Pap smear, Visual inspection after acetic acid
Citation Information :
Verma A, Kashyap M, Gupta A, Kaur D. Evaluation of Visual Inspection after Acetic Acid/Cervicography as an Alternative to Colposcopy for Detection of Cervical Intraepithelial Neoplasia. J South Asian Feder Obs Gynae 2022; 14 (4):435-439.
Objective: The study was conducted to (1) find out if visual inspection after acetic acid (VIA)/cervicogram can be used as an alternative to colposcopy and (2) compare the sensitivity and specificity of VIA/cervicogram with conventional Pap smear.
Methods: A total of 540 sexually active women aged between 20 and 60 years attending gynecology outpatient (OPD) treatment were included in the study. After the complete evaluation and informed consent, the patients were subjected to the following tests: Pap smear, visual inspection after acetic acid (VIA) application, cervicography, and finally colposcopy. Cervical biopsy was done (a) in women with any of these three tests positive and (b) in patients with unsatisfactory colposcopy. Cervical tissue was obtained with the help of loop electrosurgical excision procedure (LEEP). Biopsies revealing mild dysplasia or worse lesions on histopathology were considered as true positive cases. Biopsies showing chronic cervicitis were considered negative. All results were compiled and subjected to statistical analysis.
Results: Our study revealed sensitivity, specificity, positive predictive value, negative predictive value of Pap smear for LSIL or above as 28, 99.7, 25, and 97.9. Sensitivity, specificity, positive predictive value, negative, predictive value of VIA was 71.4, 92, 20, and 99.1. The sensitivity, specificity, positive predictive value, negative predictive value of cervicography in our study was 71.4, 93.9, 23, and 99%. The sensitivity of colposcopy was 78 and specificity 56.66%.
Conclusion: Results of VIA and cervicography are quite promising and can be considered as primary screening in low-resource settings.
WHO Cervical Cancer. Available from: https://www.who.int/health-topics/cervical-cancer, Accessed: 5 August 2018.
Taheri N, Fazel A, Mahmoodzadeh H, et al. Epidemiology of female reproductive cancers in Iran: results of the Golestan population-based cancer registry. Asian Pac J Cancer Prev 2014;15:(20):8779–8782. DOI: 10.7314/apjcp.2014.15.20.8779.
Murillo R, Herrero R, Sierra MS, et al. Cervical cancer in Central and South America: burden of disease and status of disease control. Cancer Epidemiol 2016;44(Suppl. 1):S121–S130. DOI: 10.1016/j.canep.2016.07.015.
Denny L. Cervical cancer: prevention and treatment. Discov Med 2012:14(75):125–131. PMID: 22935209.
Gupta P, Tajinder–kaur T, Bedi S, et al. Visual inspection of the cervix with acetic acid and pap smear test in cervical cancer screening. J Dent Med Sc 2015;14(11):38–41. DOI: 10.9790/0853-141153841.
Mohamad K, Saad AS, Murad AWA, et al. Visual inspection after acetic acid (VIA) as an alternative screening tool for cancer cervix. Apollo Med 2016;13(4);204–207. DOI: 10.4172/2161-0932.1000336.
Pourasad–Shahrak S, Salehi–Pourmehr H, Mostafa–Garebaghi P, et al. Comparing the results of Pap smear and Direct Visual Inspection (DVI) with 5% acetic acid in cervical cancer screening. Niger Med J 2015;56(1):35–38. DOI: 10.4103/0300-1652.149168.
Vahedpoor Z, Behrashi M, Khamehchian T, et al. Comparison of the diagnostic value of the visual inspection with acetic acid (VIA) and Pap smear in cervical cancer screening, Taiwan J Obstet Gynecol 2019:58(3):345–348. DOI: 10.1016/j.tjog.2019.03.010.
Simon M, Groesbeck P, Nkoum B, et al. Cervical Cancer Screening in Cameroon, J Low Genit Tract Dis 2015:19(4);288–294. DOI: 10.1097/LGT.0000000000000133.
Patil K, Lumb L, Swamy MK, et al. Evaluation of downstaging, visual inspection with acetic acid and Lugol's iodine in screening of cervical cancer. JSAFOG 2011;3(2):63–66. DOI: 10.5005/jp-journals-10006-1130.
Patil K, Durdi G, Lakshmi KS. Comparison of diagnostic efficacy of visual inspection of cervix with acetic acid and pap smear for prevention of cervical cancer: is VIA Superseding pap smear? JSAFOG 2011;3(3):131–134. DOI: 10.5005/jp-journals-10006-1148.
Asgary R, Staderini N, Mthethwa–Hleta S, et al. Evaluating smartphone strategies for reliability, reproducibility, and quality of VIA for cervical cancer screening in the Shiselweni region of Eswatini: A cohort study. PLoS Med 2020; 17(11):e1003378. DOI: 10.1371/journal.pmed.1003378.