Accuracy of visual inspection with acetic acid in detecting high-grade cervical intraepithelial neoplasia in pre- and post-menopausal Thai women with minor cervical cytological abnormalities.

Yenrudee Poomtavorn,Komsun Suwannarurk

doi:10.7314/apjcp.2015.16.6.2327

Abstract

To determine the accuracy of visual inspection with acetic acid (VIA) in detecting high-grade cervical intraepithelial neoplasia (CIN) in pre- and post-menopausal women with atypical squamous cells of undetermined significance (ASC-US) and low grade squamous intraepithelial lesion (LSIL) Papanicolaou (Pap) smears. Two hundred women (150 pre-menopausal and 50 post-menopausal) with ASC- US and LSIL cytology who attended the colposcopy clinic, Thammasat University Hospital, between March 2013 and August 2014 were included. All women underwent VIA testing and colposcopy by gynecologic oncologists. Diagnostic values of VIA testing including sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for detecting high-grade CIN were determined using the histopathology obtained from colposcopic-directed biopsy as a gold standard. VIA testing was positive in 54/150 (36%) pre-menopausal women and 5/50 (10%) post-menopausal women. Out of 54 pre-menopausal women with positive VIA testing, 15 (27.8%) had high-grade CIN and 39 (72.2%) had either CIN 1 or insignificant pathology. Ten (10.4%), 43 (44.8%) and 43 (44.8%) out of the remaining 96 pre-menopausal women with negative VIA testing had high- grade CIN, CIN 1 and insignificant pathology, respectively. Out of 5 post-menopausal women with positive VIA testing, there were 4 (80%) women with high-grade CIN, and 1 (20%) women with insignificant pathology. Out of 45 VIA-negative post-menopausal women, 42 (93.3%) women had CIN 1 and insignificant pathology, and 3 (6.7%) had high-grade CIN. Sensitivity, specificity, PPV and NPV of the VIA testing were 59.4%, 76.2%, 32.2% and 90.8%, respectively (60%, 68.8%, 27.8% and 89.6% in pre-menopausal women and 57.1%, 97.7%, 80% and 93.3% in post-menopausal women). VIA testing may be used as a screening tool for detecting high-grade CIN in women with minor cervical cytological abnormalities in a low-resource setting in order to lower the rate of colposcopy referral.

Highlights

Cervical cytologic screening by Papanicolaou (Pap) smear is a standard method for cervical cancer screening
By using colposcopic-directed biopsy, the incidences of cervical intraepithelial neoplasia (CIN) 2-3 in patients with atypical squamous cells of undetermined significance (ASC-US) and low grade squamous intraepithelial lesion (LSIL) ranged from 7-15% and 15-30%, respectively and the incidences of cervical cancer in patients with ASC-US and LSIL were reported at 0.1-2% and 1-5%, respectively (Chute et al, 2006; Evans et al, 2006; Kantathavorn et al, 2008; Khuakoonratt et al, 2008)
The present study demonstrated a relatively high rate of high-grade CIN in both pre- and post-menopausal women with ASC-US cytology (15.0% vs 18.4%, respectively)

Summary

Introduction

Cervical cytologic screening by Papanicolaou (Pap) smear is a standard method for cervical cancer screening. The Bethesda system 2001 has categorized the abnormal cervical cytology of squamous epithelium into atypical squamous cells (ASC), low grade squamous intraepithelial lesion (LSIL), high grade squamous intraepithelial lesion (HSIL), and squamous cell carcinoma (SCC) (Solomon et al, 2002). ASC and LSIL generally have underlying low grade abnormal histopathology including inflammation, cervical intraepithelial neoplasia (CIN) 1 and human papillomavirus (HPV) infection which may spontaneously regress. Unlike ASC and LSIL, HSIL and SCC usually represent high-grade lesions including CIN 2, CIN 3 and invasive cancer requiring definite investigation and management. The options for the management of women with ASC-US cytology include reflex HPV testing and repeat the cervical cytology at 1 year following the ASC-US cytology diagnosis (Massad et al, 2013).

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