Abstract
Objectives| To evaluate the accuracy of Visual Inspection with Acetic Acid (VIA) and Papanicolaou (Pap) smear as screening tests for cervical carcinoma and compare it with cervical biopsy as a gold standard. Methods| This was a cross-sectional study conducted at Gynae Unit 3 Services Institute of Medical Sciences from Jan 2016 to December 2016. All the married patients between 18 to 64 years of age were included in the study. Every patient underwent VIA, Pap smear and colposcopic directed biopsy from aceto white area as well as from 2:00 clock and 5:00 clock position. We determined the sensitivity, specificity, positive and negative predictive values of VIA, Pap smear and both tests and compared them with histopathology of biopsy specimen. Results| 476 women were screened in the study. Out of these, 110 (23.10%) patients were VIA positive and 40 (8.40%) patients were positive with Pap smear. Thirty seven (7.77%) patients were positive on both VIA and Pap smear. A total of 43 (9.03%) patients had cervical pre-malignancy on biopsy. The sensitivity of VIA and pap was 97.67%, 94.87% while specificity was 84.29% and 99.31%respectively (p=0.001). The PPV of VIA and pap was 38.18% and 92.5 %( p=0.00) while NPV was 99.7% and 99.5% respectively. The sensitivity and specificity of both tests combined was 94.59% and 99.54% while the PPV and NPV was 94.59% and 99.54% respectively. Diagnostic accuracy of VIA was 85.5%. Conclusion| VIA has high sensitivity and NPV which makes it an effective screening test for cervical carcinoma in developing countries like Pakistan. Pap smear can be combined to VIA positive cases to improve its specificity.
Highlights
Cancer cervix is the fourth most common female cancer in developed countries and is second commonest cancer and a major cause of death from cancer in females in under-privileged countries. 525,000 new cases of cervical cancer are reported each year and most of these i.e. around 85% occur in developing countries.[1]
The incidence of cervical carcinoma has reduced by 50% in last 40 years in developed countries due to a well-established screening program
All married and sexually active women between 18 – 64 years presenting to Gynae OPD with any complaint were recruited in the study. Those with bleeding PV or active infection at the time of examination, with frank invasive cervical cancer, bleeding disorder, previous abnormal cytology and pregnancy were excluded from the study
Summary
Cancer cervix is the fourth most common female cancer in developed countries and is second commonest cancer and a major cause of death from cancer in females in under-privileged countries. 525,000 new cases of cervical cancer are reported each year and most of these i.e. around 85% occur in developing countries.[1]. Cancer cervix is the fourth most common female cancer in developed countries and is second commonest cancer and a major cause of death from cancer in females in under-privileged countries. 525,000 new cases of cervical cancer are reported each year and most of these i.e. around 85% occur in developing countries.[1] Cervical cancer has a long preinvasive state and if managed in pre-invasive stage, it is preventable. The incidence of cervical carcinoma has reduced by 50% in last 40 years in developed countries due to a well-established screening program. It is expensive and patients need to make a second visit to collect report which often leads to loss of follow up
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