Visual inspection techniques versus Pap smear in screening for premalignant and malignant lesions of the cervix in Menoufia governorate, Egypt

Abstract

Objective The aim of this study was to compare the effectiveness of Pap smear, visual inspection with acetic acid (VIA), and visual inspection with Lugol's iodine (VILI) for mass screening of premalignant and malignant lesions of the cervix in Menoufia governorate in Egypt. Patients and methods This cross-sectional study included a total of 820 women between 30 and 60 years of age who underwent Pap smear, followed by VIA, VILI, colposcopy, and biopsy for confirmation of lesion, if needed. Data were obtained and statistically analyzed. Results The Pap smear was abnormal in 30 (3.6%) women, VIA was abnormal in 70 (8.6%) women, and VILI was abnormal in 74 (9.1%) women. Colposcopic findings were abnormal in 38 (4.6%) women. Cytology missed 25 cases of cervical intraepithelial neoplasia (CIN) (16 CIN-1, eight CIN-2, and one CIN-3) and one case of invasive disease; VIA missed three CIN-1 case and one CIN-2 case; and VILI missed only two cases of CIN-1. The sensitivity, specificity, negative and positive predictive values, and accuracy were as follows: 32, 98, 40, 97, and 95% for Pap smear; 89, 95, 49, 99, and 95% for VIA; and 95, 95, 49, 100, and 95% for VILI, respectively. Conclusion Visual inspection techniques (VIA and VILI) can be used as an efficient primary screening tool instead of Pap smear in low-resource settings.