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Background <p>India accounts for 25% of incidence and mortality of cervical cancer when compared to world’s burden. Carcinoma cervix is preventable. In developing countries like India, the ideal screening test should be inexpensive, have a high sensitivity, specificity, PPV and be relatively easy to evaluate and should provide immediate results. Papanicalaou (PAP) smear, though popular and reliable requires huge infrastructure, medical personnel, counseling and follow-up and have logistic problems. Visual inspection of acetic acid (VIA) has potential advantage over PAP smear being simple, provides results immediately and even can be done by trained medical personnel and suits better in poor resource settings. Hence, there is a need to find an ideal screening test which overcome the logistic problems of PAP smear and give results immediately with same accuracy.</p> Objectives <p>To evaluate the sensitivity, specificity, PPV of cervical cytology and VIA as screening method for premalignant and malignant lesions of cervix. To compare accuracy of VIA &amp; cervical cytology in predicting premalignant and malignant lesions of cervix.</p> Methods <p>This was hospital based prospective non randomized study done at department of OBG, VIMS Ballari. 500 patients were selected from OPD. All study population were subjected for PAP smear followed by VIA with 5% acetic acid. Abnormal Pap smear (Bethesda system) was subjected to biopsy. VIA-positive patients were subjected to biopsy from abnormal areas. Biopsy considered positive if CIN 1 and above lesions. Biopsy reports were taken as reference standards for statistical analysis in predicting sensitivity, specificity and accuracy.</p> Results <p>In our study of 500 women, 105 showed positive cervical cytology (21%) and among them 83.8% patients showed precancerous and cancerous lesions. 265 were VIA positive (53%) out of which 172 (64.9%) patients showed precancerous and cancerous lesions on biopsy. The sensitivity of VIA was 93.9% with 70.6% specificity and PPV 64.9%. The sensitivity of PAP smear was 48% with 94.6% specificity and PPV 83.8%. The accuracy of PAP smear was 77.6% and VIA is 79.2% which is comparable.</p> Conclusion <p>Since diagnostic values of VIA is comparable to PAP smear, accuracy of both procedures are comparable, VIA can be used as an alternative to PAP smear in low-resource settings.</p>

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“Prospective Analytical Comparative Study of Visual Inspection of Cervix with Acetic Acid with Cervical Cytology in Screening Cancer Cervix at Tertiary Care Centre VIMS,Ballari”

  • 期刊论文

  • 发表日期：

    2025年1月19日

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  • H. C. Shivakumar,
  • H. L. Sheela,
  • C. Shaila,
  • V. Kavya

摘要

Background

India accounts for 25% of incidence and mortality of cervical cancer when compared to world’s burden. Carcinoma cervix is preventable. In developing countries like India, the ideal screening test should be inexpensive, have a high sensitivity, specificity, PPV and be relatively easy to evaluate and should provide immediate results. Papanicalaou (PAP) smear, though popular and reliable requires huge infrastructure, medical personnel, counseling and follow-up and have logistic problems. Visual inspection of acetic acid (VIA) has potential advantage over PAP smear being simple, provides results immediately and even can be done by trained medical personnel and suits better in poor resource settings. Hence, there is a need to find an ideal screening test which overcome the logistic problems of PAP smear and give results immediately with same accuracy.

Objectives

To evaluate the sensitivity, specificity, PPV of cervical cytology and VIA as screening method for premalignant and malignant lesions of cervix. To compare accuracy of VIA & cervical cytology in predicting premalignant and malignant lesions of cervix.

Methods

This was hospital based prospective non randomized study done at department of OBG, VIMS Ballari. 500 patients were selected from OPD. All study population were subjected for PAP smear followed by VIA with 5% acetic acid. Abnormal Pap smear (Bethesda system) was subjected to biopsy. VIA-positive patients were subjected to biopsy from abnormal areas. Biopsy considered positive if CIN 1 and above lesions. Biopsy reports were taken as reference standards for statistical analysis in predicting sensitivity, specificity and accuracy.

Results

In our study of 500 women, 105 showed positive cervical cytology (21%) and among them 83.8% patients showed precancerous and cancerous lesions. 265 were VIA positive (53%) out of which 172 (64.9%) patients showed precancerous and cancerous lesions on biopsy. The sensitivity of VIA was 93.9% with 70.6% specificity and PPV 64.9%. The sensitivity of PAP smear was 48% with 94.6% specificity and PPV 83.8%. The accuracy of PAP smear was 77.6% and VIA is 79.2% which is comparable.

Conclusion

Since diagnostic values of VIA is comparable to PAP smear, accuracy of both procedures are comparable, VIA can be used as an alternative to PAP smear in low-resource settings.