Aided Visual Inspection With Acetic Acid (VIA) and HPV Detection as Optional Screening Tools for Cervical Cancer and its Precursor Lesions

Abstract

This study was conducted to evaluate 3 different methods, used alone or in combination, of screening for cervical intraepithelial neoplasia (CIN), and to compare the outcomes with colposcopic findings. Eight hundred nine patients were recruited to undergo cervical screening with visual inspection of the cervix using acetic acid (VIA), human papillomavirus (HPV) testing using hybrid capture II (HCII), and conventional Pap smear. Social and demographic information and clinical history were obtained at the enrollment visit by interview and questionnaire before pelvic examination. After collection of Pap and HCII samples, VIA was conducted 1 minute after application of 5% acetic acid to the cervix. Cervical abnormalities were recorded according to the Atlas of Visual Inspection. The presence of areas suggestive of condyloma, CIN 1, CIN 2, CIN 3, or cancer was recorded as positive VIA results. All patients underwent colposcopy after pelvic examination, and suspicious areas were biopsied. There were 99 (12%) patients with positive VIA results, of which 28% were suspected condyloma, 57% were thought to be CIN 1, 13% were suspicious for CIN 2/3, and one was a potential case of invasive cancer. In all, there were 57 (7%) positive Pap smear results, including 22 atypical squamous cells of undetermined significance (ASCUS) (38% of abnormalities), 20 low-grade squamous intraepithelial lesions (LSIL) (35%), 14 high-grade intraepithelial lesions (HSIL) (25%), and one diagnosis of atypical glandular cells (AGC) (2%). One smear was inadequate for evaluation. HPV testing identified 151 (19%) patients positive for high-risk HPV. In the final histologic diagnoses, 40 (5%) women had cervical neoplasia, including 29 CIN 1, 7 CIN 2, 3 CIN 3, and one invasive cancer. The sensitivity and specificity for each test alone or in combination are shown in Tables 1 and 2. For identifying CIN 2 or worse, HCII had the highest sensitivity (73%) and Pap smear was the most specific (93%). Together, Pap and HCII had the highest sensitivity (82%) for detection of CIN 2 or worse. The highest specificity was seen in the combination of VIA and Pap smear (83%).TABLE 1: Performance of VIA, Pap test and HCII in detecting CIN 1 or worse or/CIN 2 or worseTABLE 2: Association of screening methods in detecting CIN 1 or worse/CIN 2 or worse