Diagnostic value of acetic acid comparing with conventional Pap smear in the detection of colposcopic biopsy-proved CIN

Department of Obstetrics and Gynaecology, A. J. Institute of Medical Sciences, Deralakatte, Mangalore, Karnataka, India.
Journal of cancer research and therapeutics (Impact Factor: 0.79). 10/2011; 7(4):454-8. DOI: 10.4103/0973-1482.92019
Source: PubMed


To assess the role of visual inspection with acetic acid as an alternative to Pap smear and in screening program for cervical cancer in low resource settings.
A total of 225 women in the reproductive age group attending the Department of Gynecology were enrolled in the study. A Papanicolaou smear and visual inspection of the cervix with acetic acid was done. All patients who tested positive on screening then underwent a colposcopy-guided biopsy. The Pap smear of a low-grade squamous intraepithelial lesion (LSIL) and above was taken as abnormal. The statistical test used was the chi-square test and results were computed using Statistical Package for the Social Sciences (SPSS) version 12.0.
Out of 225 patients, acetic acid (VIA) was positive in 27 (12%) patients and the Pap smear was abnormal in 26 (11.7%). There were 15 LSIL, 6 high grade squamous intraepithelial lesions (HSIL) and 5 were squamous cell carcinoma. On biopsy, there were 15 mild dysplasia, 2 moderate dysplasia, 4 severe dysplasia, and 3 squamous cancers. The Pap smear had a sensitivity of 83%, specificity of 98%, and positive predictive value of 80% and negative predictive value of 97.9%. VIA had a sensitivity of 70.8%, specificity of 95%, and positive predictive value of 62.9% and negative predictive value of 96.5%.
Since diagnostic values of VIA is comparable to Pap smear, and it performs well in detecting a high grade lesion, we conclude that VIA can be used as a screening modality for cervical cancer in low resource settings.

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Available from: Prasanna Shetty, Nov 11, 2015
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    • "A single HPV test has been shown to be more sensitive than a single Pap smear for the detection of pre-cancerous lesions [15] [16]. However, the sensitivity of Pap test, often reported as marginally over 50%, has been demonstrated to be 80% and over in studies conducted in Italy as well as in other countries [17] [18]. Moreover, a single round of cytology was not substantially less effective in preventing cervical cancer mortality than a single round of HPV testing [19] [20]. "
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    ABSTRACT: The purpose of a cervical screening program is to reduce morbidity and mortality from invasive cervical cancer. High-risk HPV DNA testing is more sensitive but less specific than conventional cytology. The increase in sensitivity results in doubling of positive subjects compared with Pap smear. However, lowgrade epithelial anomalies are over-represented when using HPV testing. Investigation and eventual treatment of many self-limiting conditions that would regress spontaneously result in needless psychological morbidity and increased costs. The same holds true for false positive results caused by a reduction in specificity. Moreover, the difference in sensitivity in favour of HPV testing has been demonstrated mainly at single testing. However, performance of repeated Pap smears at pre-determined time intervals greatly improves the accuracy of cytology. Limited adherence to prevention programs of women in lower socio-economic strata is among the risks related to the increase in cost of screening. The widespread utilization of different molecular tests not applied consistently according to the rules of good scientific practice has an economic, social, and psychological impact that seems to have greatly outweighed benefits. Indeed, a true reduction in mortality from invasive cervical cancer after the introduction of HPV testing has not yet been demonstrated. In addition, there is no general agreement on appropriate triage test for a positive HPV result, and guidelines are often not followed in general practice. Inappropriate testing increases costs without benefit, and potentially results in overtreatment. In European countries as well as in those countries where infrastructures are available, cytology is likely to remain the most cost-effective strategy in cervical cancer prevention, together with the implementation of HPV vaccination programs.
    Current Women s Health Reviews 12/2014; 10(2).
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    • "Visual inspection with acetic acid (VIA) and visual inspection with Lugol iodine have been established as simple and cost-effective alternatives to cytology-based screening in low-resource countries [4] [5] [6]. WHO, the "
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    ABSTRACT: To compare the effectiveness of cryotherapy and loop electrosurgical excision procedure without colposcopy (visual LEEP) in treating cervical lesions detected through visual inspection with acetic acid (VIA). In rural southeast Nigeria, women with VIA-positive lesions who were eligible for ablative treatment were selected to undergo immediate cryotherapy with nitrous oxide. Women with VIA-positive lesions who were not eligible for ablative treatment were selected to undergo visual LEEP at the same visit. A portable diathermy machine was used for LEEP. Participants were re-evaluated 6months later using VIA. The main outcome measures included persistent VIA positivity at 6months, duration of procedure, second clinic visits for complications, and patient acceptability. In total, 304 women completed the study. Persistent VIA-positivity rates, duration of procedure, second clinic visits for complications, and patient acceptability were similar in the 2 groups. Visual LEEP and cryotherapy have similar efficacy and patient acceptability in see-and-treat management of VIA-positive cervical lesions. In see-and-treat VIA-based cervical cancer prevention programs in low-resource countries, visual LEEP can be used to treat women who do not meet the criteria for ablative treatment. This would increase the treatment coverage of women with VIA-positive lesions and improve program efficiency.
    International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 02/2014; 125(2). DOI:10.1016/j.ijgo.2013.10.023 · 1.54 Impact Factor
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    • "The Papanicolau smear test is the most widely used cervical cancer screening test, having a higher sensitivity and specificity compared to other tests [11]. However, currently, Visual Inspection with Acetic acid has been advocated as an alternative screening method to the Papanicolau smear in developing countries and this test has high sensitivity and specificity [12]. "
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    ABSTRACT: Cancer of the cervix rank the second most common cause of cancer related deaths among women in Sub-Saharan Africa. It is estimated that 529, 409 new cases are diagnosed annually with a mortality rate approaching 274,883 per year. Cervical Intraepithelial Neoplasia (CIN) precedes almost all cervical cancers. The incidence rate of CIN among HIV infected women is five times higher as compared to the rate in HIV negative women. The screening for cervical dysplasia and an appropriate management in women with CIN are effective methods for preventing cervical cancer. This study was done to determine the prevalence and predictors of CIN among a HIV infected women attending Care and Treatment centre (CTC) at Bugando Medical Centre (BMC). A cross sectional survey was undertaken among HIV infected women aged 18 years and above attending at BMC CTC clinic between February and March 2013. Visual Inspection with Acetic acid (VIA) was used as the screening method for detection of CIN. Socio-demographic, reproductive and clinical information was obtained from participants and the blood was collected for CD4 lymphocyte count. Cervical punch biopsy for histological examination was performed for those who had VIA positive test. Data were entered and analyzed using STATA Version 12.0 soft ware. A total number of 95 (26.8%) participants had positive VIA test among three hundred and fifty-five (355) HIV infected women. Histology results showed; 4(4.2%) were normal, 26 (27.4%) had an inflammatory lesion, 58(61.1%) had CIN and 7(7.3%) had invasive cervical cancer. CIN was found to be associated with a history of multiple sexual partners (P<0.001), a history of genital warts (P<0.001), and a history of STI (P = 0.010). The Cervical Intraepithelial Neoplasia is a problem among HIV infected women. A history of multiple sexual partners, a history of genital warts, a history STI and a low baseline CD4 T lymphocyte were significant predictors for CIN. Screening for Cervical Intraepithelial Neoplasia is recommended for all women with HIV.
    Infectious Agents and Cancer 11/2013; 8(1):45. DOI:10.1186/1750-9378-8-45 · 2.36 Impact Factor
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