Abstract
Context (Background): Visual-based
screening techniques are low cost and have good
sensitivity. Hence, they appear promising for
primary screening in low-resource settings.
However, to reduce referrals for diagnostic
colposcopy, there is need to triage these
screen-positive women with test with good
specificity. Aims: The study aims to evaluate the
performance of cytology as triage for visual
inspection after application of 4% acetic acid
(VIA) screen-positive women. Settings and Design:
Community-based cervical cancer screening using
VIA was implemented among socioeconomically
disadvantaged women in Mumbai, India. Methods:
Cytology was performed on screen-positive women.
All primarily screen-positive women underwent
colposcopy. Directed biopsies were obtained among
women with positive findings on colposcopy. The
gold standard used for final disease status was
histopathology or negative colposcopy. Statistical
Analysis Used: Test characteristics of cytology as
triage test. Results: Among the 138,383
population, 16,424 eligible women were screened
with VIA. 785 (4.78%) women were VIA positive and
580 women participated in triage with cytology.
The sensitivity and specificity of cytology at
threshold of atypical squamous cells of
undetermined significance in detecting ≥cervical
intraepithelial neoplasia (CIN) 2 were 75.0 and
94.7, respectively. The positive and negative
predictive values of cytology as triage test were
23.1 and 99.4, respectively, and the false
positivity and false negativity rates were 5.34
and 25.0, respectively. Conclusion: Cytology
triage with VIA can reduce referrals for
colposcopy to 4.97% of original referrals but may
miss around 25%, of high-grade CIN. The
substantial reduction in referrals has special
implication for low-resource settings, wherein
compliance to referral and availability of
diagnostic facilities are poor.
Visual inspection with acetic acid for cervical cancer screening outside of low-resource settings
