Comparative Analysis of Visual Inspection with Acetic Acid And Lugol’s Iodine And Liquiprep TM in Cervical Cancer Screening with Cervical Biopsy As Gold Standard

Abstract

Aim: A modified liquid-based cytological technique referred to as the “LiquiPrep TM (LP) system” requires neither expensive equipment nor complicated specimen preparation. The aim of this study was to assess the efficacy of LP in cervical cancer screening by comparing it with VIA(Visual Inspection with Acetic acid) and VILI (Visual Inspection with Lugol’s Iodine) using cervical biopsy findings as gold standard. Methods: Cervical cytology specimens were collected from 200 women. LP sample was taken with the help of a Rover Cervex brush, the tip of which was broken and dropped into the alcohol based LP preservative fluid which was further processed to prepare the slide. They were later screened by VIA and VILI through colposcopy. Cytologic interpretations were classified into following categories: 1)Negative for SIL 2) Cervicitis (3) Atypical cells of undetermined significance 4) Atypical cells cannot exclude HSIL 5) LSIL 6) HSIL 7) Invasive carcinoma. VIA/VILI findings were recorded as positive or negative. Results: The sensitivity was similar for both VIA/VILI and LiquiPrep TM (94.55%). However the specificity was higher for LiquiPrep TM (86.36%). LiquiPrep TM (94.55%) had a higher positive predictive value and negative predictive value (86.36%) than VIA/VILI. The percentage of false positives was higher with VIA/VILI (36.36%) compared with (13.63%). The percentage of false negatives was similar for both LiquiPrep TM and VIA/VILI (5.45%). Conclusions: In conclusion, VIA/VILI can be used as an initial screening test for cervical cancer in a low resource country like India. LiquiPrep TM has a high sensitivity equal to that of VIA/VILI and a comparatively higher specificity and therefore can be used for screening in conditions when there are no financial constrains.