Evaluation of coloscopic and Pap’s smear findings among visual inspection with acetic acid cases in detection of precancerous lesion of cervix against histopathology

Abstract

Background: Cervical cancer is the commonest cancer in women in developing countries. Visual inspection with acetic acid (VIA) is much popular method as primary screening modalities in low resource setting.Whereas Pap smear is well recognized and popular in developed countries. Colposcopy is recognized as the best method for detection of cervical cancer and cervical intraepithelial neoplasia (CIN) as secondary screening. The present study was intended to compare the accuracy of Pap smear and colposcopy in the detection of pre-invasive cervical lesion in VIA positive cases.
 Methods: This cross sectional study was carried out in the Colposcopic Clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka over a period of 1 year from August 2015. All consecutive VIA positive cases were included the study.
 Results: Mean age of the VIA positive women was 36.9 years with peak age group being 31-40 years (44.0%). Nearly three-quarters of the women (74.0%) were in their 3" and 4 decades of life. Among VIA positive women, 35.0% were Pap positive and 55.0% were colposcopically positive and 41.0% were histopathologically positive. Pap smear had low sensitivity (53.7%) and high specificity (78.0%). Using Pap smear nearly half (46.3%) of the precancerous lesion were escaped. Whereas colposcopy findings, revealed high sensitivity (90.2%) and specificity (69.5%). Both Pap and colposcopy was judged against histopathological diagnosis. Over 40.0% of the VIA positive women were diagnosed as CIN confirmed by histopathology. Strength of agreement test using Kappa statistics revealed a moderate agreement between Pap smear test and colposcopy (49.5%).
 Conclusion: The study concluded that colposcopy has a high sensitivity, optimum specificity and moderate agreement against histopathology in relation to Pap smear. Pap smear has very little role whereas colposcopy has significant role for diagnosis of CIN. So, it would be adopted and encouraged to do the colposcopy where it is possible.
 Bangladesh Med Res Counc Bull 2019; 45: 103-107