Comparing the efficacy of visual inspection of cervix with acetic acid and Lugol's iodine with Pap smear cytology in screening for cancer cervix

Abstract

Background: Cervical cancer, despite being a preventable disease endangers the lives of significant number of women every year and also its incidence is growing with time. Cervical cytology which is a well-accepted standard screening tool in developed countries but in developing countries like India it fails not only due to the lack of awareness but also due to financial and technical constraints. Visual inspection with acetic acid (VIA) and visual inspection with Lugol's iodine (VILI) have been evaluated in a number of large clinical trials and is considered to be a possible alternative to cervical cytology for primary cervical cancer screening in low-resource settings. Aim of the Study: (1) The aim of the present study was to compare the efficacy of VIA and Lugol's iodine with Pap smear cytology in screening for cancer cervix and evaluate their usefulness as tools for screening of premalignant and malignant lesions of cervix so that VIA can be used in peripheral areas where cytology is not available. (2) Early detection of pre-cancerous conditions and treating them before they progress to invasive cancer. Methodology: This clinical study was conducted on 200 gynecological patients who were nonpregnant or who had no history suggestive of cervical intraepithelial neoplasia or carcinoma cervix. After taking informed and written consent each woman who fulfilled the inclusion criteria were subjected to Pap smear examination, VIA and VILI. A biopsy was taken in patients with abnormal findings or suspicious findings on VIA/VILI. Results: In the present study, the sensitivity of VIA and VILI was 88.23%, specificity 78.68%, positive predictive value was 53.57%, and negative predictive value was 96% with biopsy as the reference standard. The sensitivity and specificity of cytology in our study were 88% and 52.63%, respectively. Conclusion: VIA and VILI are simple, inexpensive, and low-technology test. Both when combined have high sensitivity as well as specificity. This can be practiced by clinicians and paramedics on a wide scale. Another advantage is immediate availability of results and hence that treatment can be started during the same visit.