Visual Inspection Using Acetic Acid (VIA) and Pap’s Smear as Methods of Cervical Cancer Screening: An Experience of Dhaka Medical College Hospital, Dhaka, Bangladesh

Background: National screening programme for cervical cancer has been running in Bangladesh since 2004 through visual inspection using acetic acid (VIA). However, Pap’s smear is also used for the same, where it is available.Objectives: To see the effectiveness of VIA and Pap’s Smear as cervical cancer screening methods.Methods: This prospective study was done on 600 women who attended the outpatient gynaecology clinic and cervical cancer screening programme underwent both VIA and Pap’s smear cytology. Histopathology was taken as gold standard to compare the performance of VIA and cytology (Pap’s smear). Hence, positive cases were further subjected to colposcopy directed biopsy. Then the sensitivity and specificity of VIA and Pap’s smear were compared. The study was done in Dhaka Medical College Hospital, Dhaka, between July and December 2012.Results: On VIA, 46 had aceto-white lesions and on Pap’s smear, 28 had atypical squamous cells of undetermined significance (ASCUS) or worse lesions out of 600 women screened. 22 were positive on both VIA and cytology; 24 were positive on VIA only; and 6 were positive on cytology only. Histological diagnosis of CIN/carcinoma cervix was found in 36 positive cases, who underwent biopsy (n=52). Among them, 20 were picked up from Pap’s smear positive cases, whereas, 34 were VIA positive cases. VIA was found more sensitive (94.44%) than Pap’s smear (55.55%), which was statistically significant (p<0.001). However, the specificity of VIA was slightly lower (97.87%) than that of cytology (98.58%). Positive predictive value (PPV) of VIA was 73.91% for VIA and 71.42% for Pap’s smear, while Negative Predictive Value (NPV) were 9.63% and 97.2% respectively.Conclusion: VIA has got much more sensitivity and slightly lower specificity than that of Pap’s smear in cervical cancer screening.International Journal of Human and Health Sciences Vol. 04 No. 03 July’20 Page : 189-193

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Screening of Cervical Cancer by VIA among women in Rajshahi Medical College Hospital

Bangladesh Journal of Obstetrics & Gynaecology ◽

10.3329/bjog.v28i1.29937 ◽

2016 ◽

Vol 28 (1) ◽

pp. 31-37

Author(s):

Nahid Yusuf ◽

Md Ahmed Ali ◽

Md Latifur Rahman ◽

Hasina Akhter ◽

Jahanara Khanam

Keyword(s):

Health Care ◽

Cervical Cancer ◽

Predictive Value ◽

Visual Inspection ◽

Low Cost ◽

Medical College Hospital ◽

Low Grade ◽

College Hospital ◽

Medical College ◽

Cancerous Lesions

Introduction: Visual inspection of cervix after application of 3-5% acetic acid (VIA) is a potential alternative to Pap smear cytology for screening of cervical cancer in resource poor settings. VIA has gained popularity and proven itself in many clinical trials as an adequate screening test. VIA is an attractive alternative to Pap smears for its ease of use, low-cost and fewer physician visits. Currently VIA is done in tertiary level hospitals by trained health care providers to generalize its efficacy.Objective: The main objective of this study was to evaluate the efficacy of visual inspection based screening approach in the detection of precancerous & early cancerous lesions of the cervix.Materials and Methods: This study was done as a part of an ongoing screening program in Rajshahi Medical College Hospital from July 2008 to December 2009. VIA was carried out in 540 eligible women attending Gynae OPD for gynecological problems. The women underwent a complete clinical evaluation. Detection of well-defined, opaque, acetowhite lesion close to squamocolumnar junction (SCJ) or in transitional zone (TZ), well-defined circumferential, acetowhite lesions or dense acetowhitening of ulceroproliferative growth on the cervix constituted a positive VIA. All screened women evaluated by colposcopy and biopsy were taken from colposcopically suspected areas or in cases of VIA negative from different quadrants of the cervix. The final diagnosis was based on histology, which allowed direct estimation of sensitivity, specificity, and predictive values of VIA. Those with CIN I or cancerous lesions diagnosed by histology were considered as true positive.Results: Out of 540 patients screened, 328(61%) were VIA negative and 212(39%) were VIA positive. Out of positive cases 87 (41%)%) seemed to have pathology. Colposcopy yielded normal results in 340 (63%) cases, low grade CIN in 138 (26%) cases, high grade CIN in 44 (8%) cases and cancer in 18 (3%) cases making total 200 cases. Of the 200 (37%) patients with positive colposcopy, 98 (49%) turned out to be negative on histology. There were biopsy proven chronic cervicitis and metaplastic changes in 423 (78%) cases, CIN I in 66 (12%) cases, CIN II in 25 (5%) cases, CIN III/ carcinoma-in-situ in 5 (1%) cases. Eighteen (3%) cases of cervical carcinoma were diagnosed on colposcopy but ultimately 21(21%) cases of invasive cancer were detected on histology. The sensitivity of VIA for biopsy proven CIN I was 74.36%, specificity 75.8%, positive predictive value 41.04%, & negative predictive value 90.85%.Conclusion: VIA can differentiate a normal cervix from a precancerous cervix with reasonable accuracy. Till now a good number of studies had been carried out in different countries of the world and now it is well established that the sensitivity of VIA equaled or exceeded the reported rates for conventional cervical cytology. As it is low cost and simple method, it can be set in any hospital or any health care centre of rural or urban areas of poor resource settings.Bangladesh J Obstet Gynaecol, 2013; Vol. 28(1) : 31-37

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Cervical Cancer Screening Program in Rangpur Medical College Hospital: 11 Years Experience

Bangladesh Journal of Obstetrics & Gynaecology ◽

10.3329/bjog.v33i1.43268 ◽

2019 ◽

Vol 33 (1) ◽

pp. 11-16

Author(s):

Mst Moonmoon Begum ◽

Ferdousi Sultana ◽

Hasina Ferdousy

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Screening Program ◽

Punch Biopsy ◽

Medical College Hospital ◽

College Hospital ◽

Medical College ◽

Cancer Screening Program ◽

Cervical Cancer Screening Program

Background: Prevention of cervical cancer is the easiest with regular screening tests and follow up. CIN is a pre-malignant condition, detection of which is possible by VIA and colposcopy. Objective: To identify the performance of Cervical Cancer Screening Program in Rangpur Medical College Hospital through 11 Years. Methods and materials: Apparently healthy, married or sexually active women (>10 years) and women aged >30 years attending Gynae OPD were included in this study. After counseling and informed consent a speculum examination was performed for direct visualization of cervix to identify the squamo-columner junction. Freshly prepared 5% acetic acid was applied to the cervix for one minute. All the VIA positive women were further evaluated by colposcopy. Women with negative VIA were advised for 3 yearly VIA test. Suspected CIN cases were evaluated by colposcopy guided punch biopsy or LEEP biopsy and histopathology. Results: VIA screening was provided for 11,792 women from August 2005 to August 2016 and 932 (7.9%) were positive VIA. From November 2007 to August 2016, total women underwent colposcopy were 1548. Among them 632 (40.8%) were normal, out of abnormal cases 730 (80.3%) were CIN-1, 147 (16.1%) were CIN-2, 14 (1.5%) were CIN-3, 17 (1.8%) were invasive and 8 (0.5%) were unsatisfactory. From November 2007 to August 2016 punch biopsy was taken in 384 women and total 568 women were treated by LEEP. Conclusion: In a low resource setting like Bangladesh VIA and colposcopy can detect 80% pre-invasive cervical lesion and may be one of the most important tool to prevent cervical cancer and its mortality. Bangladesh J Obstet Gynaecol, 2018; Vol. 33(1) : 11-16

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Evaluation of Visual Inspection of Cervix with Acetic Acid and Liquid Based in Cervical Cancer Screening with Cervical Biopsy

Journal of Nepal Health Research Council ◽

10.33314/jnhrc.v18i3.1674 ◽

2020 ◽

Vol 18 (3) ◽

pp. 426-430

Author(s):

Bigya Shrestha ◽

Karishma Malla Vaidya ◽

Rijuta Joshi

Keyword(s):

Cervical Cancer ◽

Acetic Acid ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Predictive Value ◽

Visual Inspection ◽

Screening Programs ◽

Cervical Biopsy ◽

Liquid Based Cytology ◽

Acid Test

Background: Cervical cancer is the second most common cancer among women in developing countries. Cervical cancer generally develops slowly over a period of 10-15 years. Incidence and mortality related to cervical cancer both have declining in developed countries because of effective screening programs through Papanicolaou smear. Therefore, cervical cancer can be prevented through implementation of different methods of screening programs like visual inspection of cervix with application of acetic acid visual inspection with acetic acid, liquid based cytology and human papilloma virus deoxyribonucleic acid. The purpose of this study is to compare the efficacy of visual inspection with Acetic Acid with liquid based cytology in cervical cancer screening taking cervical biopsy as a gold standard. Methods: The study was conducted at Paropakar Maternity and Women’s Hospital, Kathmandu. One hundred forty four patients underwent visual inspection with acetic acid and liquid based cytology test followed by biopsy for confirmation of the lesion, when required. Data were obtained and statistically analyzed. Results: Out of 144 screened patients, 62 (43.05%) were positive in visual inspection with acetic acid test. Eighteen (12.5%) cases were positive in liquid based cytology. Thirteen women were positive with both tests. Thirty-nine cases underwent histopathological examination including 13 cases who were positive in both tests. The sensitivity, specificity, positive predictive value and negative predictive value for visual inspection with acetic acid was 81.25%, 65.22%, 61.90% and 83.33%, whereas for liquid based cytology it was 100%, 91.30%, 88.89% and 94.87% respectively. Conclusions: Liquid based cytology was more efficacious to diagnose atypical cells with higher sensitivity and specificity in comparison to that of visual Inspection with Acetic Acid test. Keywords: Cervical cancer; liquid based cytology; visual inspection with acetic acid

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Implementation and feasibility of an adapted two-stage visual inspection with acetic acid/cryotherapy-based cervical cancer screening programme for HIV-infected women in Addis Ababa, Ethiopia

European Journal of Cancer Care ◽

10.1111/ecc.12480 ◽

2016 ◽

Vol 25 (3) ◽

pp. 526-527

Author(s):

J.T. Price ◽

R. Asgary

Keyword(s):

Cervical Cancer ◽

Acetic Acid ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Visual Inspection ◽

Screening Programme ◽

Addis Ababa ◽

Two Stage ◽

Cancer Screening Programme ◽

Cervical Cancer Screening Programme

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The Utility of Visual Inspection with Acetic Acid in Cervical Cancer Screening

Edelweiss: Cancer Open Access ◽

10.33805/2689-6737.103 ◽

2017 ◽

pp. 7-14

Author(s):

Chidi Okorie Onwuka ◽

Ima-Obong A. Ekanem

Keyword(s):

Cervical Cancer ◽

Acetic Acid ◽

Cancer Screening ◽

Negative Predictive Value ◽

Cervical Cancer Screening ◽

Predictive Value ◽

Visual Inspection ◽

Pap Smear ◽

Screening Methods ◽

Cancer Management

Objective: Cervical cancer is potentially preventable but still remains a leading cause of cancer mortality in in developing countries like Nigeria. Cytology-based screening programmes are difficult to maintain in these countries. Developing a cheap and reliable alternative is an important public health measure in these regions. This study was carried out to compare the utility of VIA and Pap smear as Cervical cancer screening methods in HIV-infected and non HIV-infected women. Methodology: Between March, 2013 and March, 2014, 461 consenting women, comprising 231 HIV positive women (HPW) and 230 HIV negative women (HNW) were recruited and screened for cervical cancer using conventional Pap smear and VIA simultaneously in University of Uyo Teaching Hospital. The Pap smear findings were classified using the 2001 Bethesda system. Patients with a positive Pap smear or abnormal VIA findings were recalled for biopsy. The results of the two tests were compared using biopsy as the gold standard. Results: The overall sensitivity, specificity, positive predictive value and negative predictive value for VIA were 100%,80%,76.9%, and 100%, respectively compared to 80%, 100%, 100%, and 88.2% for conventional Pap smear. Visual inspection of the cervix with acetic acid for cervical cancer screening is not specific but has a high negative predictive value. Conclusion: This study does not support a “see-and-treat” approach in cervical cancer management using VIA only. In resource-challenged areas, VIA can be applied on a large scale basis in primary screening for cervical cancer so as to triage, women who will benefit from further evaluation before applying the appropriate treatment.

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