Visual inspection with acetic acid a screening method for cervical lesions

Abstract

BackgroundCarcinoma cervix accounts for 12% of all malignancies worldwide. Pap smear is the most popular screening tool to detect cervical lesion since 1960s. However, this screening method requires an established laboratory a trained cytologist and a repeat visit for its report and further evaluation. In 1982 visual inspection after application of acetic acid on the cervix was reported as an alternative method for screening of cervical cancer. Application of 3–5% acetic acid causes dehydration of cells and surface coagulation of proteins in active cells, giving its white appearance called acetowhite areas. MethodWe conducted a cross sectional study in the outpatient Department of Obstetrics and Gynaecology, Sir Ganga Ram Hospital from November 2008 to November 2010. The objectives of this study were to evaluate the utility of visual inspection with acetic acid (VIA) for screening of precancerous or cancerous lesion of cervix and to compare it with papanicolaou smear. ResultsThe prevalence of abnormal smear (more than CIN II) amongst women screened with Pap smear in our study was 5.8%. The sensitivity of VIA and Pap smear in our study to diagnose precancerous and invasive disease was comparable 93.1% vs 86.2%. Both screening tests had low specificity VIA 32.2% and Pap smear 60%. ConclusionWe suggest that VIA with high sensitivity is comparable to Pap smear can be used as an alternative screening test, especially in low resource settings where the expertise for definite tests is not available. The screen and refer approach for further tests can be used, although there are limitations of this method in terms of low specificity and lack of standardization.