Early Detection of Precursors of Cervical Cancer with Cervical Cytology and Visual Inspection of Cervix with Acetic Acid

A hospital-based, prospective study was done in 350 women of 20-50 years to compare VIA withPap smear for early detection of cervical dysplasia at Maternity Hospital, Thapathali, from May2004 to December 2004. Pap smear was taken from each woman followed by VIA. Women withpositive VIA and/or positive Pap smear were referred for colposcopy-directed cervical biopsy. Thevariables studied were age group, presenting complaint, age of marriage, parity, smoking habit andappearance of cervix.The incidence of positive VIA and Pap smear was 2.86 and 0.57 respectively. Pelvic pain was themost common presenting complaint. The majority of the women were married before 20 years ofage. All women with either positive VIA and/or Pap smear were of parity two or above. Therewas no significant association between smoking and positive VIA (P=0.699) or Pap smear (P=0.397).Approximately 36.57% of the women screened had abnormal looking cervix. There were two womenwith high grade intraepithelial lesion (HSIL) and both were VIA positive and this was statisticallysignificant (Fischer exact P=0.0007). Of the ten VIA positive women, on histopathological examinationsix showed chronic cervicitis, one acute cervicitis, one showed cervical intraepithelial neoplasia (CIN)II, one had normal finding and one was lost to follow up.VIA as a screening test for cervical neoplasia did not miss any lesion detected by Pap smear andconfirmed by cervical biopsy.Key words: cervical neoplasia, pap smear, visual inspection

Download Full-text

Correlation of visual inspection with cytological and histopathological findings in cervical neoplasia

Journal of Pathology of Nepal ◽

10.3126/jpn.v7i1.16914 ◽

2017 ◽

Vol 7 (1) ◽

pp. 1070-1073 ◽

Cited By ~ 2

Author(s):

P Sherpa ◽

AD Pant

Keyword(s):

Acetic Acid ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Predictive Value ◽

Visual Inspection ◽

Pap Smear ◽

Invasive Carcinoma ◽

Intraepithelial Neoplasia ◽

Cervical Neoplasia

Background: Cervical cancer is one of the commonest malignancies and a leading cause of morbidity and mortality among women. The aim of this study was to evaluate the diagnostic value of Papanicolaou (PAP) smear and visual inspection with acetic acid as methods of cervical cancer screening.Materials and Methods: This was a observational cross-sectional study conducted from the period of 2068.11.01 to 2069.11.01. The study population consisted of women with histologically confirmed cervical intraepithelial neoplasia or invasive carcinoma who had undergone prior PAP smear.Results: During the study period 160 patients underwent both PAP smear and cervical biopsy. Of these patients, 49 had a histological diagnosis of cervical intraepithelial neoplasia or invasive carcinoma. The histopathological and cytological diagnoses were compared. Visual inspection with acetic acid status was available for 31 of the 49 cases. The sensitivity of PAP smear was 61%, specificity 97%, positive predictive value 91%, negative predictive value 85% and diagnostic accuracy 86% for detection of cervical neoplasia. Visual inspection with acetic acid had a sensitivity of 74%, specificity 48%, Positive predictive value 64%, Negative predictive value 60% and diagnostic accuracy of 63%. Combining the two procedures increased sensitivity by 26%, Negative predictive value by 11% and diagnostic accuracy by 2 per cent.Conclusion: PAP smear has a higher specificity, Positive predictive value, Negative predictive value and diagnostic accuracy but lower sensitivity than visual inspection with acetic acid. Visual inspection with acetic acid by itself is not an effective screening method. A combination of PAP smear and visual inspection with acetic acidcan ensure adequate screening of cervical neoplasia.

Download Full-text

Low Utility in Colposcopy-directed Biopsies for Non-high Grade Cytological Abnormalities on PAP Smear

Current Women s Health Reviews ◽

10.2174/1573404815666190821093421 ◽

2020 ◽

Vol 16 (1) ◽

pp. 18-22

Author(s):

Eronmwon E. Gbinigie ◽

Joshua Fogel ◽

Maggie Tetrokalashvili

Keyword(s):

Pap Smear ◽

Multinomial Logistic Regression ◽

Cervical Dysplasia ◽

Outcome Variable ◽

Low Grade ◽

High Grade ◽

Squamous Intraepithelial Lesion ◽

Intraepithelial Lesion ◽

Cytologic Abnormalities ◽

Cytology Screening

Background: Clinicians commonly perform colposcopy directed biopsies on patients with low grade squamous intraepithelial lesion (LSIL) on PAP cytology even when not consistent with clinical guidelines. Objective: We study the association of PAP cytology screening results with cervical intra-epithelia neoplasia (CIN) 2-3 high-grade dysplasia, as confirmed by colposcopy-directed biopsy. Methods: A retrospective study of 263 women with an abnormality on the PAP smear. Multinomial logistic regression was performed with predictors of PAP cytology screening results with the outcome variable of colposcopy-directed biopsy. Results: High grade squamous intraepithelial lesion (HSIL) had significantly increased relative risk for CIN 2-3 (RR: 9.85, 95% CI: 1.84, 52.79, p=0.008). LSIL was not significantly associated with CIN 2-3. In the comparisons of negative with CIN-1, both HSIL and LSIL were not significantly associated with a negative biopsy. Conclusion: HSIL is associated with cervical dysplasia of CIN 2-3 while LSIL is not associated with cervical dysplasia of CIN 2-3. We do not recommend routine biopsies in patients with LSIL cytologic abnormalities unless additional compelling factors exist.

Download Full-text

Efficiency of HPV DNA Test versus Pap Smear in the Screening of Cervical Cancer

Journal of Karnali Academy of Health Sciences ◽

10.3126/jkahs.v1i2.24128 ◽

2018 ◽

Vol 1 (2) ◽

pp. 9-13

Author(s):

Renee Pradhan ◽

U. Pant ◽

B. Aryal

Keyword(s):

Cervical Cancer ◽

Cervical Intraepithelial Neoplasia ◽

Pap Smear ◽

Intraepithelial Neoplasia ◽

Cervical Neoplasia ◽

Hpv Testing ◽

Dna Test ◽

Hpv Dna ◽

Smear Testing ◽

Hpv Dna Test

Introduction: Cancer cervix is a common genital cancer. Human papillomavirus is the main cause of cervical cancer because of the strong association of certain HPV genotypes and the development of cervical cancer and its precursor lesions, cervical intraepithelial neoplasia CIN 2 or CIN3. Methods: The study was conducted on 180 gynecological patients seen at the outpatient department of Manipal Hospital, Bangalore. A comparative study of HPV DNA test with Pap smear in the screening of cervical neoplasia was carried out over the period of 24 months from August 2011 to June 2013. Results: The incidence of cervical cancer and its associated mortality has declined in recent years, largely due to the widespread implementation of screening programs by Pap smear testing. The management and the prevention of cervical cancer should change with HPV DNA testing for high risk HPV, which is more sensitive than pap smear testing. Infection of cervix with HPV is necessary to cause cervical neoplasia and cervical cancer. Persistent infection with HPV is required for the development of cervical dysplasia and invasive cervical cancer. Conclusions: HPV testing alone for primary screening appears promising in women aged 30 years and older as this group is at greatest risk of developing CIN 3. As compared with Pap testing, HPV testing has greater sensitivity for detection of cervical intraepithelial neoplasia.

Download Full-text

Effectiveness of Visual Inspection with Acetic Acid and Pap Smear for Early Detection of Cervical Cancer among Women attending Gynecology O.P.D of Tertiary Level Hospital Gwalior (M.P) India

Nepal Medical Journal ◽

10.37080/nmj.177 ◽

2021 ◽

Vol 4 (1) ◽

pp. 44-50

Author(s):

Nisha Mehta ◽

Saroj Singh

Keyword(s):

Cervical Cancer ◽

Acetic Acid ◽

Early Detection ◽

Visual Inspection ◽

Pap Smear ◽

Sampling Technique ◽

Tertiary Level ◽

Cross Sectional ◽

Screening Programs ◽

Level Hospital

Introduction: Cervical cancer is the fourth most common cause of cancer in women in the world and the second most common cancer among Indian women. About 23% of the global cervical cancer burden is beard by India alone. The screening of cervical cancer is commonly done by a pap smear, visual inspection of acetic acid, human papillomavirus DNA testing etc. These identify precancerous changes which when treated can prevent the development of cancer. The objectives of the study were to screen the patient at Gynecology OPD by visual Inspection with acetic acid (VIA) and Pap smear for early detection of cervical cancer and to evaluate the efficacy of visual inspection with acetic acid and Pap smear in the early detection of cervical cancer. Methods: A descriptive cross-sectional study was conducted among 60 women attending Gynecology O.P.D of a Tertiary Level Hospital, Gwalior (India) by non-probability purposive sampling technique between 1st August to 30th August 2017. Pap smear was taken from each woman followed by VIA. Women with positive VIA and/or positive Pap smear were referred for colposcopy-directed cervical biopsy. Results: After the application of 3% VIA among 60 women, 16 (26.67%) developed acetowhite while 44 (73.33%) didn’t. While the result of Pap smear shows, 22 (36.66%) had an inflammatory smear, 6(10%) shows benign smear, 9(15%) bacterial vaginosis, 1(1.66%) squamous metaplastic cells, 12 (20%) shows adenocarcinoma and 10(16.66%) normal pap smear. Conclusion: The study concludes that VIA and pap smear were effective methods for the early detection of cervical cancer. Visual inspection of the cervix after acetic acid application (VIA) is widely recommended as the method of choice in cervical cancer screening programs in resource-limited settings and developing countries because of its simplicity, cost-effectiveness and ability to link with immediate treatment.

Download Full-text

Visual Inspection with Acetic Acid (VIA) in cervical cancer screening in low resource settings

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v13i4.15019 ◽

2014 ◽

Vol 13 (4) ◽

pp. 454-459

Author(s):

Shaheen Shaheen ◽

Rajyashri Sharma ◽

Rashi Rashi

Keyword(s):

Acetic Acid ◽

Visual Inspection ◽

Pap Smear ◽

Screening Program ◽

Low Cost ◽

Medical Science ◽

High Sensitivity ◽

Intraepithelial Neoplasia ◽

Screening Methods ◽

Cervical Lesions

Objective: To evaluate the feasibility and validity of visual inspection of the cervix with acetic acid (VIA) for screening cervical intraepithelial neoplasia. Materials and Methods: In this study, 942 women recruited from gynecology outpatient clinic, were screened using the Papanicolaou (PAP) smear, and VIA. The sensitivity and specificity of both the screening methods were analyzed. Results: VIA was positive in 29.3%. The sensitivity of VIA (74.16%) was much higher than that of the Pap smear (47.83%). The specificity of VIA (50.00%) was lower than that of the Pap smear (74.16%), resulting in high false-positive rates for VIA. Conclusion: Visual inspection of the cervix with acetic acid is sensitive for ecto-cervical lesions. The advantage of the VIA method lies in its easy technique, low cost and high sensitivity which are important factors for determining the efficacy of any screening program in developing countries. DOI: http://dx.doi.org/10.3329/bjms.v13i4.15019 Bangladesh Journal of Medical Science Vol.13(4) 2014 p.454-459

Download Full-text

Incidences of Cervical Intraepithelial Neoplasia 2-3 or Cancer Pathologic Diagnoses in Patients with a High Grade Squamous Intraepithelial Lesion Pap Smear Attending a Colposcopy Clinic at Srinagarind Hospital

Asian Pacific Journal of Cancer Prevention ◽

10.7314/apjcp.2012.13.12.6203 ◽

2012 ◽

Vol 13 (12) ◽

pp. 6203-6206 ◽

Cited By ~ 10

Author(s):

Navakorn Ingkapairoj ◽

Sanguanchoke Luanratanakorn ◽

Bandit Chumworathayi ◽

Chumnan Kietpeerakool ◽

Amornrat Supoken

Keyword(s):

Cervical Intraepithelial Neoplasia ◽

Pap Smear ◽

Intraepithelial Neoplasia ◽

High Grade ◽

Squamous Intraepithelial Lesion ◽

Intraepithelial Lesion ◽

Colposcopy Clinic

Download Full-text

To compare the efficacy of pap smear & visual inspection of cervix with acetic acid (VIA) in early diagnosis of cervical intraepithelial neoplasia (CIN) & early cancer cervix

International Journal of Clinical Obstetrics and Gynaecology ◽

10.33545/gynae.2021.v5.i5c.1036 ◽

2021 ◽

Vol 5 (5) ◽

pp. 165-169

Author(s):

Dr. Suman Sharma ◽

Dr. Princy Dudhwala

Keyword(s):

Acetic Acid ◽

Early Diagnosis ◽

Cervical Intraepithelial Neoplasia ◽

Visual Inspection ◽

Pap Smear ◽

Early Cancer ◽

Intraepithelial Neoplasia ◽

Cancer Cervix

Download Full-text

Diagnostic value of VIA comparing with conventional pap smear in the detection of colposcopic biopsy proved CIN

Health Renaissance ◽

10.3126/hren.v9i3.5579 ◽

1970 ◽

Vol 9 (3) ◽

pp. 134-139

Author(s):

D Hegde ◽

H Shetty ◽

PK Shetty ◽

S Rai ◽

L Manjeera ◽

...

Keyword(s):

Cervical Cancer ◽

Acetic Acid ◽

Predictive Value ◽

Visual Inspection ◽

Pap Smear ◽

High Grade ◽

Squamous Intraepithelial Lesion ◽

Low Resource Settings ◽

Low Resource ◽

Intraepithelial Lesion

Introduction: Cervical cancer, the leading malignancy among Indian women is preventable and curable if detected at an early stage using proper screening tools. We conducted a study to assess the role of visual inspection with acetic acid as an alternative to pap smear and in screening program for cervical cancer in low resource settings. Methods: Two hundred and twenty five women in reproductive age group attending the Gynecology department at K.S Hegde Charitable Hospital were enrolled in the study. A Papanicolaou smear and visual inspection of the cervix with acetic acid was done. All women then underwent colposcopy using the videocolposcope. All patients who tested positive on screening then underwent colposcopy guided biopsy. Pap smear of low grade squamous intraepithelial lesion (LSIL) and above was taken as abnormal. The statistical test used was chi square test and results were computed using SPSS version 12.0. Results: Out of 225 patients, VIA was positive in 27(12%) patients and pap smear was abnormal in 26(11.7%). There were 15 LSIL, 6 high grade squamous intraepithelial lesion (HSIL) and 5 were squamous cell carcinoma. On biopsy, there were 15 mild dysplasia, 2 moderate dysplasia, 4 severe dysplasia and 3 squamous cancers. Pap smear had a sensitivity of 83%, specificity of 98%, positive predictive value of 80 % and negative predictive value of 97.9%. VIA had a sensitivity of 70.8%, specificity of 95%, and positive predictive value of 62.9 % and negative predictive value of 96.5%. Conclusion : Since diagnostic values of VIA is comparable to pap smear, and it performs well in detecting high grade lesion we conclude that VIA can be used as a screening modality for cervical cancer in low resource settings. Keywords: visual inspection with acetic acid; pap smear- colposcopy; cervical cancer; low resource settings DOI: http://dx.doi.org/10.3126/hren.v9i3.5579 HR 2011; 9(3): 134-139

Download Full-text

Outcomes of loop electrosurgical excision procedure for cervical neoplasia in human immunodeficiency virus–infected women

International Journal of Gynecological Cancer ◽

10.1136/ijgc-00009577-200605000-00021 ◽

2006 ◽

Vol 16 (3) ◽

pp. 1082-1088

Author(s):

C. Kietpeerakool ◽

J. Srisomboon ◽

P. Suprasert ◽

C. Phongnarisorn ◽

K. Charoenkwan ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Antiretroviral Therapy ◽

Pap Smear ◽

Cervical Neoplasia ◽

Low Grade ◽

Squamous Intraepithelial Lesion ◽

Immunodeficiency Virus ◽

Intraepithelial Lesion ◽

Loop Electrosurgical Excision ◽

Loop Electrosurgical Excision Procedure

The objective of this study was to evaluate the treatment outcomes and complications in human immunodeficiency virus (HIV)–infected women undergoing loop electrosurgical excision procedure (LEEP) for cervical neoplasia. The medical record of 60 evaluable HIV-infected women who had abnormal Papanicolaou (Pap) smear and underwent LEEP following colposcopy at Chiang Mai University Hospital between May 1998 and June 2004 was reviewed. Thirty-one (51.7%) had associated genital infection at screening. Twenty-five (41.7%) had opportunistic infection, but only 18 (30.0%) were treated with antiretroviral therapy. The most common abnormal Pap smear was high-grade squamous intraepithelial lesion (46.7%), followed by low-grade squamous intraepithelial lesion (40.0%). Forty (66.7%) women had clear surgical margins after LEEP. Only one (1.7%) woman had severe intraoperative hemorrhage. Early and late postoperative hemorrhage were noted in three (5%) women of each period. Localized infection of the cervix was detected in seven (11.7%) women. Two (3.3%) women developed cervical stenosis at 6 months after LEEP. There was no significant difference in overall complications between HIV-infected women and the control group (P = 0.24). Among 60 HIV-infected women, no statistical difference in the rate of margins involvement (P = 1.00) and complications (P = 0.85) could be demonstrated between HIV-infected women who received antiretroviral therapy and those who did not. Disease-free rate at 6 and 12 months were 97.1% and 88%, respectively. These data demonstrated that LEEP appears to be safe and effective in HIV-infected women.

Download Full-text