Adequacy of visual inspection with acetic acid in women of advancing age

Abstract

Objective The present study assessed the adequacy and predictive performance of visual inspection with acetic acid (VIA) in women over the age of 50 years and compared the specificity and sensitivity of VIA with that of the conventional cytology. Methods In total, 588 Salvadoran women ages 50–79 underwent VIA, Pap smear, and cervical biopsy. VIA was considered adequate if the squamocolumnar junction was completely visible. A positive biopsy was defined as cervical intraepithelial neoplasia (CIN) 2 or worse. Results Age was negatively correlated with VIA adequacy ( P = 0.04). Nevertheless, the majority of women—even in the older age groups—had adequate examinations. The adequacy of VIA was positively correlated with gravida ( P = 0.01) and was higher in women who had been treated by cryotherapy ( P = 0.02). The rate of positive biopsies was unexpectedly low (n = 6 [1%]) making it difficult to assess the predictive performance of VIA. In this small sample, the sensitivities of VIA (17%) and Pap (33%) were low; the high number of false negatives could not be fully explained by inadequacy of the examinations. Conclusions Adequacy of VIA declined with age. However, the squamocolumnar junction was visible to the naked eye in the majority of women, indicating that they are good candidates for VIA.