[Year:2018] [Month:April-June] [Volume:10] [Number:2] [Pages:4] [Pages No:88 - 91]
Aim: The study aims to assess the utility of visual inspection methods—visual inspection with acetic acid (VIA) and visual inspection with Lugol's iodine (VILI)—for detecting premalignant lesions of the cervix in low-resource settings.
Materials and methods: The duration of the study was 1 year from May 1, 2014 to April 31, 2015 and was conducted at Medical College, Kolkata. A total of 2,278 apparently healthy, sexually active women aged 21 to 45 years were selected for the study. A Pap smear, VIA, and VILI were performed on all patients. Colposcopy-guided biopsy (considered as gold standard investigation) was performed on patients who tested positive for any of the above screening tests. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the various screening tests were compared.
Results: A total of 2,278 women were screened, of which 382 were lost to follow-up. Of the remaining 1,896 women, positive screening test was reported with Pap smear for 162 (8.5%), VIA for 306 (16.08%), and VILI for 338 (17.83%). In the present study, the sensitivity, specificity, PPV, and NPV of Pap smear were 81.36, 93.79, 29.63 and 99.37% respectively. For VIA, sensitivity, specificity, PPV, and NPV were 86.75, 86.06, 16.34, and 99.43%, whereas for VILI were 86.44, 84.38, 15.09, and 99.49% respectively. Although the specificity and PPV of Pap smear were slightly higher than the visual inspection methods, there was no significant difference in the sensitivities and the NPV.
Conclusion: The sensitivity and specificity of VIA and VILI are comparable to cytology and do not require any cost-intensive paraphernalia. They can be easily done and interpreted by trained health workers, reducing the burden on tertiary care hospitals. Visual inspection methods like VIA and VILI are the most legitimate alternatives to cytology for screening cervical cancer, especially in low-resource settings.