Background: Although it is well established that organized cytological screening programs are the mainstay for cancer cervix control but the financial and logistic burden of operating such a program is considerable. This has prompted the evaluation of alternative feasible techniques. Early and ongoing comparative studies worldwide showed visual inspection with acetic acid (VIA) as potential alternatives to cervical cytology because of their low cost, the ease of use, high sensitivity and immediate result allowing see and treat at first visit.
Objectives: To evaluate the performance of VIA and its comparison with cytology in cervical cancer screening.
Materials and Methods: A total of 400 non-pregnant reproductive age women were subjected to papanicolaou Pap smear) and VIA in this prospective study done in a tertiary-care centre in Delhi. Reference standard used for all was colposcopy and colposcopic-directed biopsy (when required).
Results: Of 400 Pap smears done 11.75% were normal, 77.5% inflammatory, 5.5% had atypical squamous cells (ASC) atypical glandular cells of undetermined significance (AGUS), 0.25% ASC-H, 0.5% AGUS, 2% low-grade squamous intraepithelial lesions (LSIL), 1.5% high-grade squamous intraepithelial lesion (HSIL), and invasive cancer in 0.5%. With LSIL and above smears as significant, the sensitivity and specificity of Pap were 50% and 97.66%, respectively. VIA was positive according to two thresholds. When high threshold was used then only well demarcated, opaque white areas near the squamocolumnar junction were taken as positive whereas in low-threshold criterion faint or ill-defined ace to white anywhere and well-defined areas away from squamocolumnar junction was also taken as positive. 29.3% were positive with low-threshold criterion for VIA and 9.3% with high-threshold criterion. The sensitivity with low-threshold criteria was 100% and specificity 72.7%.
Conclusion: The sensitivity with low-threshold criteria was 100% and specificity 72.7%. With high-threshold sensitivity and specificity were 85.7% and 95%, respectively. Conclusion: VIA with low-threshold criteria had high sensitivity (100%), but specificity (72.7%) was low, but with high-threshold criteria for positivity, the specificity increases up to 95% which is comparable to cytology. The gynecologists in tertiary-care centers can use the high-threshold criterion effectively, and patient with significant lesions can be directly subjected to further treatment at the earliest thus reducing loss to follow-up.
Key words: Cervical Cancer; Screening; Colposcopy; Sensitivity; Specificity