Comparison of efficacy of visual inspection with 4% acetic acid, visual inspection with Lugol's iodine, Pap smear and colposcopy in screening cervical precancerous lesions

Apurba K. Bhattacharya, Hem K. Sarma, Antara Das


Background: Cervical malignancy is the fourth most common cancer in women worldwide. Screening of high-grade cervical intraepithelial neoplasia aids in early detection and their effective treatment which constitutes the most effective and widely used strategy to prevent cervical carcinoma throughout the world. Objectives of the study were to: screen women with visual inspection with 4% acetic acid (VIA), visual inspection with Lugol's iodine (VILI), Pap smear and colposcopy who have abnormal symptoms for unhealthy cervix; and to evaluate the sensitivity and specificity of VIA, VILI, Pap smear and colposcopy.

Methods: This was a hospital based cross sectional study conducted at Jorhat Medical College, Assam at the department of obstetrics and gynaecology from June 2020 to May 2021, carried out on 60 women. This study was done on 60 women who fulfilled the inclusion and exclusion criteria, were first subjected to Pap smear followed by VIA, VILI, colposcopy and biopsy for confirmation of lesion, if needed. Data was obtained and statistically analyzed.

Results: VIA showed sensitivity 96.15%, specificity 62.50% and diagnostic accuracy 88.23%. VILI showed sensitivity 89.65%, specificity 40% and diagnostic accuracy 82.35%. Colposcopy showed sensitivity 96.66%, specificity 25% and diagnostic accuracy 88.23%. Pap smear showed sensitivity of 86.66%, specificity 75% and diagnostic accuracy of 85.29%.

Conclusions: Our study shows that VIA, VILI, Pap smear and colposcopy has comparable sensitivity. Pap smear shows better specificity. Therefore, use of combination of these tests gives better sensitivity and specificity for early detection of cervical carcinoma.



Cervical cancer, Pap smear, visual inspection with acetic acid, visual inspection with Lugol’s iodine, Colposcopy.

Full Text:



Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-49.

Global Cancer Data: GLOBOCAN 2018 | UICC. Available at: Accessed on 05 September 2021.

Sankaranarayanan R, Budukh AM, Rajkumar R. Effective screening programmes for cervical cancer in low- and middle-income developing countries. Bull World Health Organ. 2001;79(10):954-62.

World Health Organization. IARC Handbooks of Cancer Prevention on Cervix Cancer Screening. Volume 10. Lyon. IARC press. 2005.

Ferlay J, Shin H-R, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127(12):2893-917.

Denny L, Kuhn L, Hu C-C, Tsai W-Y, Wright TC. Human papillomavirus-based cervical cancer prevention: long-term results of a randomized screening trial. J Natl Cancer Inst. 2010;102(20):1557-67.

Sankaranarayanan R, Wesley R, Thara S, Dhakad N, Chandralekha B, Sebastian P, et al. Test characteristics of visual inspection with 4% acetic acid (VIA) and Lugol’s iodine (VILI) in cervical cancer screening in Kerala, India. Int J Cancer. 2003;106(3):404-8.

Schiffman M. Solomon D. Findings to date from the ASCUS-LSIL Triage Study (ALTS). Arch Pathol Lab Med. 2003;127:946-9.

Sheshadri V, O’Connor DM. The agreement of colposcopic grading as compared to directed biopsy results. J Low Genit Tract Dis. 1999;3:150-4.

Manisha S, Bagde N, Shrivastava D. Visual inspection of cervix with acetic acid: An alternative to cytology and colposcopy in early screening of cervical cancer in low-resource setup. J Datta Meghe Inst Med Sci Univ. 2017;12:32-4.

Goyal S, Tandon P, Bhutani N, Gill BK. To study the role of visual inspection of cervix with acetic acid (VIA) in cervical cancer screening. Int J Reprod Contracept Obstet Gynecol. 2017;3(3):684-7.

Ardahan M, Temel AB. Visual inspection with acetic acid in cervical cancer screening. Cancer Nurs. 2011 Apr;34(2):158-63.

Savitha TS, Sapna W. A comparison of PAP smear, colposcopy and colposcopy directed biopsy in evaluation of unhealthy cervix. J Evolution Med Dent Sci. 2015;4(21):3639-47.

Olaniyan OB. Validity of colposcopy in the diagnosis of early cervical neoplasia--a review. Afr J Reprod Health. 2002;6(3):59-69.

Massad LS, Jeronimo J, Katki HA, Schiffman M, National Institutes of Health/American Society for Colposcopy and Cervical Pathology Research Group. The accuracy of colposcopic grading for detection of high-grade cervical intraepithelial neoplasia. J Low Genit Tract Dis. 2009;13(3):137-44.

Shalini R, Amita S, Neera MA. How alarming is post-coital bleeding--a cytologic, colposcopic and histopathologic evaluation. Gynecol Obstet Invest. 1998;45(3):205-8.

Ashmita D, Shakuntala PN, Rao SR, Sharma SK, Geethanjali S. Comparison and Correlation of PAP smear, Colposcopy and Histopathology in Symptomatic Women and Suspicious Looking Cervix in a Tertiary Hospital Care Centre. Int J Health Sci Res. 2013;3(5):50-9.