VIA Positive Cases Research Articles

Colposcopic Findings for Detecting Pre-invasive Lesion of Cervix Among Visually Inspected Acetic Acid Positive Cases

Background: Cervical cancer-a preventable disease, is the second most commonly diagnosed cancer among women of developing countries. Paps smear is the gold standard screening method worldwide. But a low-cost test, visual inspection of cervix with acetic acid (VIA) has been emerged as an alternative for use in lowresource settings. VIA is simple and easy to perform by auxiliary health professionals. Colposcopy is an essential procedure in the evaluation of screen positive cervix though it requires considerable training and experience. Objective: The objective of this study was to evaluate the VIA positive cases by colposcopy, colposcopy guided biopsy and histopathological examination. Methods: This was a cross sectional observational study conducted among 100 VIA positive cases attended at GOPD of Dhaka Medical College Hospital from July 2014 to December 2014. Colposcopy was performed in all VIA positive cases. Subsequent biopsy and histopathological examinations were done for those with colposcopic abnormal findings. Results: The mean age of the study population was 37.9±9.3 years. Among VIA positive cases 66.0% had complaints of whitish vaginal discharge. Among the study population, colposcopically 46.0% had healthy cervix (normal) and 54.0% had abnormal findings. Colposcopy guided biopsy was taken from those with abnormal findings. Histopathological findings were normal in 38.9% cases, chronic cervicitis in 20.37% cases, squamous cell metaplasia in 3.7% cases, CIN I in 16.7%, CIN II in11.11%, CIN III in 5.6% and 3.7% cases were carcinoma cervix. True positive value was 20, false positive value 34 and positive predictive value of colposcopy was 37.03%. Conclusion: This study concluded that VIA is effective in detection of CIN and invasive carcinoma of cervix. It also suggests the role of colposcopy in the evaluation of CIN and other cervical diseases in screen positive cases. VIA can be used as a screening tool in low and middle income countries like Bangladesh, not only in rural areas and small health centres, but also in hospitals, cancer institutes, and other health facilities with better resources. Bangladesh Med Res Counc Bull 2022; 48(1): 27-32

Visual Inspection of Cervix wiih Acetic Acid as A Method of Cervical Cancer Screening in Tertiary Hospital

Background: Cervical cancer belongs to a glorious natural history which favors well implemented secondary prevention. Considering the various constraints in our country, our study aimed to evaluate Visual Inspection of Cervix with Acetic Acid (VIA) as an alternative or adjunct to cervical cytology (Pap smear) in early detection of cervical cancer and also to assess its effectiveness as a screening method in a tertiary center outside of low resource settings.
 Materials and methods: This cross-sectional descriptive study was carried out at Gynae OPD of Chittagong Medical College Hospital (CMCH) from January to December 2012. A total of 1600 sexually active women with 21 to 60 years old were enrolled in this study by purposive sampling technique. The women underwent a complete clinical evaluation, including Pap smear and VIA. Any positive test was referred to colposcopy and directed biopsy. Finally, data were analyzed with the help of SPSS 16 software.
 Results: Out of 1600, VIA was positive in 135(8.4%) and cytology was positive in 74(4.6%) cases of the true positive 48 cases. The sensitivity of VIA (75%) was much higher than that of Pap smear (48%). The sensitivity ratio 1.54 (p<0.001). The positive predictive value for detection of CIN2 and above was 17% for VIA and 16% for pap (p=0.5). Moreover, patients of lost to follow-up before colposcopy and biopsy were only 4.44% with VIA positive cases while 28.38% with positive Pap smear (p<0.0001).
 Conclusions: The high sensitivity of VIA indicates that it may be a feasible alternative test for detection of precancerous lesions of the cervix not only in limited-resource settings but also in a well-equipped tertiary hospital.
 IAHS Medical Journal Vol 4(2), June 2021; 22-26

Visual Inspection of Cervix with Acetic Acid (VIA): An Effective Method of Screening for Cervical Cancer

Objective: To assess diagnostic accuracy of visual inspection of cervix with 3-5% acetic acid(VIA) as a screening method for early detection of cervical intraepithelial neoplasia and early cervical cancer.Method: This cross-sectional study was conducted at Gynecology & Obstetrics Department Unit-1, Abbasi Shaheed Hospital, Karachi, from April 2017 to September 2018. Participants were included in the study through non-probability convenience sampling technique. Married, non-pregnant and sexuallyactive women aged between 21-50 years were included in the study. Demographic information and relevant history was taken followed by the procedure for VIA. Acetowhite changes were noted after application of 5% acetic acid on the cervix. The result of the test was documented as positive or negative. Colposcopy was done in all VIA positive cases and suspicious cases with abnormal looking cervix. Biopsy of the cervix was taken for histopathology to assess the results of VIA. SPSS version-20 was used for statistical analysis.Results: There were 323 subjects with a mean age of 35.5 ± 7.6.Out of 323 participants only 6 were found VIA positive (1.86). On histopathology, only two cases were found positive (0.62%), one early invasive cervical cancer and one CIN1. Sensitivity, specificity, positive predictive value and negative predictive value of visual inspection of cervix after acetic acid application was 100%, 57%, 40%, 100%respectively and the diagnostic accuracy was 66.7%.
 Conclusion: Visual inspection of cervix with 3-5% acetic acid is highly sensitive, screening method for cervical cancer. It is quite simple, affordable and better screening modality for detecting cervical cancer at an early stage.

Sensitivity and Specificity of VIA in Diagnosing Cervical Cancer and Precancerous Lesions

Cervical cancer is the leading cause of death in women in India. Cervical Cancer is the most preventable cancer in women as it has a long premalignant phase. Cytological screening is most frequently used method. Visual inspection using acetic acid can be used as an alternative of Pap smear in a low-resource countries. Keeping this in mind this study was done to determine the sensitivity and specificity of VIA in detection of cervical cancer and precancerous lesions. Material and Method: Five hundred and twenty-five women over a period of two years were included in the study. VIA was performed and Pap’s smear, colposcopy, cervix biopsy were performed in women having VIA positive results, and results were analysed. Results: VIA was positive in 29.3% cases. Out of 154 VIA positive cases, precancerous lesions were observed in 111 cases by cytology, 132 cases by colposcopy and 136 cases by histopathology. Sensitivity and specificity of VIA to diagnose precancerous lesions were 88.3% and 95.4% respectively. In 11.7% cases VIA was false positive. Positive predictive value was 88.3% and negative predictive value was 95.4% for VIA. Conclusion: VIA is a safe, acceptable, and effective test that can save lives from cervical cancer even in remote areas with few resources.

Role of molecular biomarker human papilloma virus (HPV) E6 oncoprotein in cervical cancer screening

ObjectiveThe Onco E6™ Cervical Test, based on detection of the E6 oncoprotein of HPV 16 and 18 genotypes is evaluated as a screen for the early detection cervical neoplasia in resource-limited countries. MethodsThis prospective study from June 2018 to June 2019 evaluated 235 women aged 21–65 years, who came to Gynaecological Oncology Outpatient Department by VIA, cytology, E6 oncoprotein test and by colposcopy. Screen-positive women by any of the tests or women with suspicious findings were further evaluated by biopsy at colposcopy. The McNemar test was used to compare the performance of E6 oncoprotein test with other screening tests. ResultsThe E6 oncoprotein positivity rate was 6.8% (n = 16) with 81.25% HPV 16 positive and 18.75% HPV 18 positive. Among VIA positive cases (n = 100), E6 oncoprotein was positive in 9% (p < .001). In histopathology confirmed chronic cervicitis, CIN I, CIN II, CIN III and invasive cervical cancer, E6 test was positive for 2.8%, 4.7%, 25%, 50% and 100% respectively. E6 oncoprotein test had the highest specificity and Positive Predictive Value (PPV; 97% and 75%) compared to VIA (42% and 18%), cytology (95% and 46%) and colposcopy (94% and 59%). Sensitivity of the E6 oncoprotein test for detection of CIN3+ was significantly higher than that of cytology (52% VS 25%) but lower than that of VIA (52% VS 74%). ConclusionsThe HPV E6 oncoprotein test is highly specific and is an effective triage test to reduce colposcopy referrals for the large number of false positive test outcomes seen with VIA.

Histopathological Diagnosis of Colposcopically Negative Cases for CIN

Background: Colposcopy is a good diagnostic tools for the detection of abnormalities cervix of the uterus.&#x0D; Objective: The purpose of the present study was to see the histological diagnosis of colposcopically negative cases for CIN among VIA positive women.&#x0D; Methodology: This cross sectional study was conducted in the Department Of Pathology at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh during the period of July 2007 to June 2008 for one (01) year. Patients who are colposcopically negative but clinically suspicious for cervical neoplasia were included in this study. The cervix was examined on naked eye by Cusco’s speculum to see whether it was healthy or not. Then it was examined by the colposcope after applying 3 to 5% acetic acid and colposcopic findings were collected. VIA positive cases were underwent colposcopy guided LEEP biopsy.&#x0D; Result: A total of 63 patients of different age group were recruited for this study. The age of 63 patients ranged from 20 years to 65 years with an average age of 34.6±9.59 years. Among 63 VIA positive patients, 54 cases were colposcopically positive for cervical intraepithelial neoplasia and carcinoma in situ, remaining 9 patients were colposcopically negative. Histological examination was also performed in nine patients who were colposcopically negative but clinically suspicious for malignancy or precancerous lesion. Of these nine cases, eight cases (89%) were diagnosed as chronic cervicitis, one case (11.0%) as CIN-I and none as CIN-II and CIN- III.&#x0D; Conclusion: In conclusion majority of the colposcopically negative VIA positive cases are the patients of chronic cervicitis.&#x0D; Journal of National Institute of Neurosciences Bangladesh, 2020;6(1): 29-32

Value of PAP’s Smear with Regard to DNA Testing for Identification of Cervical Precancerous Lesions in VIA Positive Cases

Background: Carcinoma cervix is one of the cause of female death in developing country like Bangladesh. Prevention can be done by several screening procedure like VIA, Pap's smear, HPV DNA testing, Colposcopy and colposcopy directed biopsy. We can markedly reduce the mortality and morbidity by these procedures and can be detected carcinoma in precancerous and very early carcinoma stage. This study was conducted to compare HPV DNA testing and pap’s smear for identification of cervical precancerous lesions in VIA positive cases.&#x0D; Materials and methods: It was an analytical type of cross sectional study. Data were obtained in outpatient Department of Gynecology and Obstetrics, Chattogram Medical College Hospital, Chattogram from July 2014 to December 2014. Total 90 subjects were included in the study consecutively after considering inclusion and exclusion criteria and taking written informed consent. Data analysis was done by SPSS (Version 17).&#x0D; Results: Histopathology findings of biopsy materials of colposcopy positive cases where 8(28.6%) were chronic cervicitis, 10(35.7%) were CIN I, 7(25.0%) were CIN II, 3(10.7%) were CIN III. Total 20(71.4%) cases were found positive or precancerous. Regarding validity analysis of different tests that were performed for cervical precancerous conditions taking histopathology results as a gold standard, sensitivity of Pap’s smear was found lower (75.0%) than the HPV DNA whereas specificity of Pap’s Smear was higher (87.5%) then the specificity of HPV DNA (75.0%).&#x0D; Conclusion: HPV DNA testing was both more sensitive and specific near to Pap cytology. So the use of a less invasive and more user friendly primary screening strategy like HPV-DNA testing may be required to achieve the coverage necessary for effective reduction in cervical cancer mortality.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.18 (2); July 2019; Page 27-32

Socio-demographic Characteristics and Incidence of CIN of Uterine Cervix among VIA Positive Women attended at a Tertiary Care Hospital in Dhaka City

Background: Women in different socio-demographic are presented with VIA positivity.&#x0D; Objective: The purpose of the present study was to see the socio-demographic characteristics and incidence of CIN of uterine cervix among of VIA positive women.&#x0D; Methodology: This cross sectional study was conducted in the Department Of Pathology at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh during the period of July 2007 to June 2008 for one (01) year. Patients who were colposcopically positive for cervical intraepithelial neoplasia and early invasive carcinoma or patients who are colposcopically negative but clinically suspicious for cervical neoplasia were included in this study. The clinical history was obtained by taking history with particular attention to age, age at marriage, parity, history of contraceptives, abnormal per vaginal discharge and post coital bleeding. The cervix was examined on naked eye by Cusco’s speculum to see whether it was healthy or not. Then it was examined by the colposcope after applying 3.0 to 5.0% acetic acid and colposcopic findings were collected. VIA positive cases were underwent colposcopy guided LEEP biopsy.&#x0D; Result: A total of 63 patients of different age group were recruited for this study. The mean with SD of age of this study population was 34.6±9.59 years. In this study, 41(65%) cases were diagnosed as cervical intraepithelial neoplasia (CIN). Incidence of CIN-I was 10 cases in age group 20 to 29 years. Most of the cases were in 30 to 39 (18 cases) years age group. Among 20 cases of high grade lesion (CIN-II/III) 9(45%) cases were in lower class, 8(40%) cases were in middle class and 3(15%) cases in upper class. Conclusion: In conclusion majority of the women were middle aged reproductive age group who are mostly in the lower class of socioeconomic class.&#x0D; Journal of Current and Advance Medical Research 2020;7(1): 7-11

Feasibility of implementing cervical cancer screening program using smartphone imaging as a training aid for nurses in rural India.

The Indian national program stresses implementation of cervical cancer screening by health workers/nurses using VIA (Visual Inspection under Acetic acid). We demonstrate its feasibility and reliability in rural setting, assessing the role of smartphone-imaging for continuous training of nurses. A cross-sectional design to assess the reliability of the nurse-led VIA test. To assess feasibility, VIA positive patients were observed till confirmative diagnosis was made. Hospital-based purposive sampling was used to recruit participants. A structured questionnaire for recording participants' details, VIA findings and follow-up information; and an observational checklist to record implementation parameters during each clinic. An expert assessed the nurse's judgment using smartphone-images of cervix. During October 2016-June 2017, 2758 patients attended the weekly clinic; 238 (8.6%) met the criteria, of those 180 (75.6%) tested after consent. Nurse reported 25 (13.8%) VIA-positive cases, but only 19 accessed the referral service. Kappa statistic: 0.45 (CI: 0.26-0.63) suggested moderate nurse-expert agreement. Image retrieval and quality affected expert's evaluation. Implementation challenges include low awareness among the population and referral link-up. Appropriately trained nurses can reliably conduct screening. Real-time expert feedback might improve reporting. Rigorous awareness activities and on-site treatment can reduce drop-outs. The medical institute's involvement and administrative will were instrumental.

Cervical Cancer Screening On 1000 Healthy Asymptomatic Women Residing In Slum of Rajshahi City of Bangladesh

Background: Cervical carcinoma is an important cause of mortality among adult women.Objective: The purpose of the present study was to detect the pre-cancerous condition of cervix in women.Methodology: This cross sectional study was carried out in the OPD of a tertiary care hospital of Rajshahi City in Bangladesh during the year June 2010 to August 2011. Healthy asymptomatic women residing in slum of Rajshahi city with a marital age of 8 years and above were included as study population. VIA test was performed in all women. The VIA positive cases were invited for colposcopy and directed biopsies were obtained from women who were colposcopically positive.Result: A total number of 1000 women were studied. Among them 80(8%) women were VIA positive. These positive cases were also referred for colposcopy. Out of the 80 cases, 26 (32%) were colposcopically normal and 50(63%) were CIN-1 and 4(5%) women were CIN II. Directed biopsy was done among colposcopically positive group. Histopathological examination shows 44 (82%) were CIN-1 and 4(7%) were CIN- II and 6(11%) were chronic cervicities.Conclusion: Cervical screening of the slum area women shows an important number of women suffering from precancerous condition of which CIN-l is the most common.J Shaheed Suhrawardy Med Coll, 2015; 7(1):14-17

Visual inspection with acetic acid and Lugol's iodine in cervical cancer screening at the general referral hospital Kayembe in Mbuji-Mayi, Democratic Republic of Congo.

IntroductionCervical cancer is the leading cause of morbidity and mortality of women from cancer in the developing World. It is the primary cause of reduced life expectancy in Sub-Saharan countries such as Democratic Republic of Congo. The aim of this work was to determinate the socio-demographic profile of women with precancerous and cancerous lesions of the cervix, to determinate the frequency of VIA and VILI positive cases and to show the challenges that can be faced in managing patients with abnormalities in the city of Mbuji-Mayi in the Democratic Republic of Congo.MethodsAs part of its activities, the “Association de Lutte contre le Cancer du Col utérin” (ALCC) organized a community outreach followed by free voluntary testing for cervical cancer for two weeks (26thMarch to 10th April 2011) at the General Referral Hospital Kayembe in Mbuji-Mayi (Democratic Republic of Congo).ResultsA total of 229 women were examined. 38% of tests (VIA + VILI) were positive with 6 clinically suspected cases of invasive cancer at stage 1 (7% of cases). Nearly 70% of patients were still of childbearing age and had started their first sexual intercourse before 18 years of age and 86% of cases were multiparous. Given the material, financial and technical constraints, 75% of patients were placed in a monitoring program of 9 months to 1 year (= expectation and another test) while 11% of them were selected for a biopsy to be locally practiced and sent to the pathologist. Nearly 8% of the cases were candidates for hysterectomy.ConclusionGiven the difficulties encountered and the frequency of positive tests, we recommend another study with a larger sample, improved working conditions (mainly equipment) and the association of another test such as the Human Papilloma Virus (HPV) test.

Comparative Study of Cytology and Histopathology of Cervical Lesion in VIA Positive Patients in Mymensingh

Cervical cancer is the second most frequent type of cancer and leading cause of mortality among women worldwide. More than eighty eight percent deaths from cervical cancer occur in developing countries and by 2030, it will be at least ninety eight percent. In developed countries, the cases and deaths have declined markedly due to their extensive screening programs. The present study was undertaken to assess precancerous and cancerous cervical lesion by cytology and their comparison with histopathology in VIA positive cases. This descriptive, cross-sectional type of observational study was carried out in the Department of Pathology, Mymensingh Medical College in collaboration with the Department of Gynecology and Obstetrics, Mymensingh Medical College Hospital, during the period of July 2012 to June 2013. Study was carried out among 160 VIA positive patients and selected by non-random judgment sampling from the colposcopy clinic. Histological findings revealed that the most common age group affected by different types of cervical lesions is 30 – 39 years. It also revealed that squamous cell carcinoma (SCC) was very much common in age group 40-49 years. The statistical value of accuracy, sensitivity and specificity of Pap smear cytology test and histopathology yielded some important directives. The sensitivity values of Pap smear cytology was found 87.50%. The accuracy of the Pap smears in this study was 88.13%. The present study show significant relationship between cytological test with histopathological diagnosis. However cytology testing is not suitable as a single test. In conclusion, it can be stated that combination of cytology (Pap smear) and histopathology would ultimately be more useful.&#x0D; CBMJ 2015 July: Vol. 04 No. 02 P: 35-40

Role of Visual Inspection of Cervix with Acetic Acid (VIA) in Detecting Precancerous Lesions of Cervix

Background: Carcinoma of cervix is the most common malignancy in female and a major public health problem worldwide. It is the leading cause of death from cancer among women in low resource settings. In Bangladesh, mortality rate is high as most of the cases with cervical cancer are diagnosed in advanced stage. World Health Organization considers cervical cancer as a preventable disease as it can be identified in preinvasive stage. Considerable efforts have been given in detection and treatment of the condition all over the world. A number of cervical cancer screening tests are available. Among them, visual inspection of cervix with acetic acid is rational and can be competently performed by physicians with proper training. Objective: To find out the feasibility of the visual inspection of cervix with acetic acid for the detection of the precancerous lesions of the cervix in our country. Materials and Methods: This cross sectional, analytical study was carried out among the patients attending the outpatient department of Bangabandhu Sheikh Mujib Medical University (BSMMU) who were VIA positive and sent for colposcopy in the colposcopy clinic in the department of Obstetrics and Gynecology in BSMMU from June to December 2004. Two hundred samples were considered for this study. Results: Out of 200 cases, colposcopically 85% had CIN and invasive lesions, 4% had inflammatory lesions while 11% had normal findings. Colposcopy directed punch biopsy revealed positive lesions in 81%, 4% had inflammatory lesions while 15% had normal findings. Conclusion: The study concluded that VIA and colposcopy are the important methods in the evaluation of cervical premalignancy. VIA may be an important tool for screening of cervical cancer in low resource settings as it is simple, easy to perform and cost-effective. After screening, VIA positive cases must be referred for colposcopic evaluation. We can screen cervical cancer by VIA all over the country and thus reduce morbidity and mortality rate. DOI: http://dx.doi.org/10.3329/jemc.v4i1.18068 J Enam Med Col 2014; 4(1): 39-44

Result of Colposcopy among VIA positive cases attending in Colposcopy Clinic of BSMMU

This study was carried out among women attending Gynae out door of BSMMU with different clinical complaints like per vaginal discharge, post coital bleeding, dyspareunia, irregular per vaginal bleeding, backache, abnormal cervix on examination, age between 18-60 years and was advice for VIA test. This test was carried at VIA center. The aim of this study was to evaluate the role of colposcopy for detecting pre cancerous and early cancerous lesion of cervix. Women with positive result were referred for Colposcopy. Colposcopic examination was carried at colposcopic clinic of BSMMU. Women with VIA positive result found in Colposcopic examination underwent colposcopic directed biopsy. Then both sensitivity and specificity of colposcopy was determined and result was compared with other studies of home &amp; abroad. This prospective study was conducted from July 2011 to December 2011 on 164 women attending in "Colposcopy Clinic" of BSMMU. Only VIA positive cases were consideration of the study. Colposcopy evaluated 106 cases as CIN(CIN1- 35.9%,CIN II -25.47%,CIN III -15%) and 3.7% as invasive carcinoma. Biopsy evaluated 36.5% as (CIN I -17%, CIN II-10%,CIN III-9.1%) and 1.2% as invasive lesions. The sensitivity and specificity of Colposcopy were 85.48% and 48.03% respectively.

1454P - Evaluation of Colposcopy and Loop Electrosurgical Excision Procedure (LEEP) in A Rural Mobile Cervical Cancer Screening Unit in West Bengal, India

ABSTRACT Background In recent years there are many attempts to see accuracy of colposcopy in poor resource setting where ‘see and treat’ approach is used. Sensitivity and specificity for colposcopy in India is not determined accurately so far because of poormethodology of experiments. Objectives Hence, in a cervical cancer screening and management project for rural poor women in West Bengal province of India we tried to calculate specificity and sensitivity of colposcopy based on management by LEEP. Methods VIA combined with colposcopy and LEEP using mobile van is planned in a biotechnology based programme for women under Department of Biotechnology, Govt. of India where efficacy of colposcopy was assessed by camp approach in rural area of a remote district. We used video colposcopy as triage and managed positive cases by LEEP. We randomly selected 50 cases that wereColposcopy negative & 50 cases with CIN I and did biopsy cervix on all of them. We thus evaluated our early screeningand management to detect sensitivity & specificity of Colposcopy in this rural setting. Results A total of 2836 women participated in our rural camp for screening during this period. We could detect 415 VIA positive cases. In this gold standard test we saw 12 cases of false positive. Only 14 cases of false negative that then underwent LEEP. Thus colposcopy in our series had 60% sensitivity and 63% positive predictive value while 87.7% specificity and 86% negative predictive value. Complication Rate was 3 percent (14 cases). Conclusion In our series sensitivity of colposcopy was comparatively low. Main confounding variable producing false positive result was inflammation of cervix which seems to be a cause of concern in our country. However, obustness of VIA needs to be calculated in a bigger study to find out efficacy of such screening. Disclosure All authors have declared no conflicts of interest.

Visual inspection using acetic acid and pap smear as a method of cervical cancer screening

Introduction: The objective of this study was to study the of comparison of visual inspection using acetic acid and pap smear as a method of cervical cancer screening. The specific objectives were to determine the proportion of women screened positive with VIA and proportion of women screened positive with pap smear. Another specific objective was to determine total number of cervical intraepithelial neoplasia and carcinoma cervix in the study population. Method: This was a comparative study. A total of 500 women presenting to the outpatient gynecologic clinic, T.U. Teaching Hospital from23rd February 2004 to 22nd February 2005, who met the inclusion criteria were examined by both conventional cytology and visual inspection using 5% acetic acid. Distinct acetowhite areas touching the transformation zone were categorized as VIA positive cases. ASCUS or worse lesions by cytology were considered as positive smears. Those women who showed positive test result with either VIA or pap smear or both tests were further subjected to colposcopy directed biopsy and histology was taken as gold standard to compare the performance of VIA and cytology. Those for whom histology revealed no pathology or reactive/reparative change or inflammation were considered as false positives. Results: On VIA, 37 out of 500 women screened had acetowhite lesions. On pap smear, 27 out of the 500 women had ASCUS or worse lesions. The proportion of women screened positive with VIA was 7.4%and the proportion of women screened positive with pap smear was 5.4 %. Of the 500 enrolled women, 20 were positive on both VIA and cytology; 17 were positive on VIA only; and 7 were positive on cytology only. So 44 patients had cervical biopsies performed on them. Histological diagnosis of CIN/cancer was made in 28 out of the total 44 patients who underwent biopsy. Incidence of CIN/ cancer cervix in the study population was found to be 5.6 %. Pap smear picked up 20 out of the 28 biopsy-proven cases. The 8 lesions missed by cytology included 5 low grade, 2 high grade and 1 cancer. VIA could identify 27 out of the 28 CIN/carcinoma cervices; the only lesion being missed was LSIL. But VIA had higher number of false positives as compared to cytology. VIA was more sensitive (96.4%) than pap smear (71.4%), which was statistically significant. However, the specificity of VIA was lower (37.5 %) than that of cytology (56.3%). The PPV of VIA was 73% versus 71.4 % for pap smear. The NPV of VIA was 85.7 % versus 52.9 % for cytology. Overall, VIA demonstrated an accuracy of 75 % as compared to 65.9 % for cytology. Conclusion: In women undergoing screening for pre-invasive and cancer cervix, visual inspection using 5 % acetic acid was found to be more sensitive and has a higher accuracy as compared to pap smear. VIA is less specific than cytology, resulting in high false-positive and hence unnecessary referral for colposcopy/biopsy. Although the present study is small, other larger comparative studies have evaluated the validity of VIA as a method of cervical cancer screening and concluded the same. Another important feature of VIA is its high Negative Predictive Value, which means that when the test result is negative, the woman can go home assured that she is not likely to have a neoplastic cervical lesion. Visual inspection is a simple, accurate, cost effective method of rapidly differentiating between a potentially diseased cervix and a healthy one and therefore its use can be recommended as primary screening method. Journal of Institute of Medicine Vol.28(1) 2006