The study of diagnostic value of pap smear comparing with visual inspection of cervix after acetic acid application in detecting premalignant lesions of cervix

Shubhangi A. Bedekar; Girish B. Karmarkar; Pranali Diwadkar

doi:10.18203/2320-1770.ijrcog20242069

Authors

Shubhangi A. Bedekar Department of Obstetrics and Gynecology, Parkar Hospital, Ratnagiri, Maharashtra, India
Girish B. Karmarkar Department of Obstetrics and Gynecology, Parkar Hospital, Ratnagiri, Maharashtra, India
Pranali Diwadkar Department of Obstetrics and Gynecology, Parkar Hospital, Ratnagiri, Maharashtra, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20242069

Keywords:

VIA, Cervical cancer screening, Pap smear

Abstract

Background: Objective of the study was to compare the effectiveness of VIA and pap smear for screening of premalignant lesions of cervix and to compare the performance of VIA used alone and combined with pap smear for screening of premalignant lesions of cervix.

Methods: VIA and Pap smear were performed in 260 patients attending routine gynaecology OPD. Positive cases of either or both screening tests were subjected to colposcopy and biopsy if indicated. The reports of histopathology were correlated with the pap smear and VIA findings and thereby sensitivity, specificity, positive and negative predictive values of each of the screening methods were calculated and results were analysed.

Results: 260 patients were screened for premalignant lesions of cervix by VIA and pap smear both, 37 of 260 patients, (14.2%) were VIA positive, 30 of 260 patients (11.5%) were pap smear positive, 20 of 260 patients (7.69%) were positive for VIA as well as pap smear, 25 of 260 patients (9.6%) were confirmed of premalignant lesions on histopathology, 24 patients were diagnosed CIN and one patient was diagnosed with CIS.

Conclusions: VIA has lower sensitivity and specificity compared to Pap smear but the results are comparable. Both the tests are fairly accurate. A combination of VIA and Pap smear increased the sensitivity and specificity to 100%.

Metrics

Metrics Loading ...

References

Bruni L, Albero G, Serrano B, Mena M, Collado JJ, Gómez D. ICO/IARC Information Centre on HPV and Cancer (HPV Information Centre). Human Papillomavirus and Related Diseases in the World. Summary Report; 2023.

Krishnamurthy A, Ramshankar V. Current Status and Future Perspectives of Molecular Prevention Strategies for Cervical Cancers. Indian J Surg Oncol. 2020;11(4):752-61.

Ferlay J, Ervik M, Lam F, Laversanne M, Colombet M, Mery L. Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer; 2024.

Mremi A, Mchome B, Mlay J, Schledermann D, Blaakær J, Rasch V. Performance of HPV testing, Pap smear and VIA in women attending cervical cancer screening in Kilimanjaro region, Northern Tanzania: a cross-sectional study nested in a cohort. BMJ Open. 2022;12(10):64321.

Chouhan AS, Prinja S, Srinivasan R, Rai B, Malliga JS, Jyani G et al. Cost effectiveness of strategies for cervical cancer prevention in India. PLoS One. 2020;15(9):23829.

Srivastava AN, Misra JS, Srivastava S, Das BC, Gupta S. Cervical cancer screening in rural India: Status & current concepts. Indian J Med Res. 2018;148(6):687-96.

Sharma J, Yennapu M, Priyanka Y. Screening Guidelines and Programs for Cervical Cancer Control in Countries of Different Economic Groups: A Narrative Review. Cureus. 2023;15(6):41098.

Slavkovsky RC, Bansil P, Sandoval MA, Figueroa J, Rodriguez DM, Lobo JS. Health outcomes at 1 year after thermal ablation for cervical precancer among human papillomavirus- and visual inspection with acetic acid-positive women in honduras. JCO Glob Oncol. 2020;6:1565-73.

Screening and management of preinvasive lesions of the cervix: good clinical practice recommendations from the Federation of Obstetrics and Gynaecologic Societies of India (FOGSI) Bhatla N, Singhal S, Saraiya U, et al. J Obstet Gynaecol Res. 2020;46:201–14.

Hon HJ, Chong PP, Choo HL, Khine PP. A Comprehensive Review of Cervical Cancer Screening Devices: The Pros and the Cons. Asian Pac J Cancer Prev. 2023;24(7):2207-15.

Smith SK, Nwosu O, Edwards A, Zerihun M, Chung MH, Suvada K et al. Performance of screening tools for cervical neoplasia among women in low- and middle-income countries: A systematic review and meta-analysis. PLOS Glob Public Health. 2023;3(2):1598.

David J, Joshi V, Jebin Aaron D, Baghel P. A comparative analysis of visual inspection with acetic acid, cervical cytology, and histopathology in the screening and early detection of premalignant and malignant lesions of the cervix. Cureus. 2022;14(9):29762.

Shrestha AD, Andersen JG, Gyawali B, Shrestha A, Shrestha S, Neupane D. Cervical cancer screening utilization, and associated factors, in Nepal: a systematic review and meta-analysis. Public Health. 2022;210:16-25.

Kangethe JM, Monroe-Wise A, Muiruri PN, Komu JG, Mutai KK, Nzivo MM. Utilisation of cervical cancer screening among women living with HIV at Kenya's national referral hospital. South Afr J HIV Med. 2022;23(1):1353.

Nayak PK, Mitra S, Agrawal S, Hussain N, Thakur P, Mishra B. Role of various screening techniques in detecting preinvasive lesions of the cervix among symptomatic women and women having unhealthy cervix. J Cancer Res Ther. 2021;17(1):180-5.

Shrestha B, Malla Vaidya K, Joshi R. Evaluation of Visual Inspection of Cervix with Acetic Acid and Liquid Based in Cervical Cancer Screening with Cervical Biopsy. J Nepal Health Res Counc. 2020;18(3):426-30.

Harsono AB, Susiarno H, Suardi D, Owen L, Fauzi H, Kireina J. Cervical pre-cancerous lesion detection: development of smartphone-based VIA application using artificial intelligence. BMC Res Notes. 2022;15(1):356.

Vahedpoor Z, Behrashi M, Khamehchian T, Abedzadeh-Kalahroudi M, Moravveji A, Mohmadi-Kartalayi M. Comparison of the diagnostic value of the visual inspection with acetic acid (VIA) and Pap smear in cervical cancer screening. Taiwan J Obstet Gynecol. 2019;58(3):345-8.

Screening for cancer in low- and middle-income countries. Sankaranarayanan R. Ann Glob Health. 2014;80:412-7.

Hegde D, Shetty H, Shetty PK, Rai S. Diagnostic value of acetic acid comparing with conventional pap smear in the detection of colposcopic biopsy-proved CIN J Cancer Res Ther. 2011;7:454-8.

Goel A, Gandhi G, Batra S, Bhambhani S, Zutshi V, Sachdeva P. Visual inspection of the cervix with acetic acid for cervical intraepithelial lesions Int J Gynaecol Obstet. 2005;88:25-30.

Fahey MT et al. Meta-analysis of Pap test accuracy. American Journal of Epidemiology. 1995;141:680-9.

Nanda K. Accuracy of the Papanicolaou test in screening for and follow-up of cervical cytologic abnormalities: a systematic review. Annals of Internal Medicine. 2000;132:810-9.

Srinivas V, Nishimura HM, Jayakrishna P, Krupp K, Madhivanan P, Madhunapantula SV. Evaluating the feasibility of utilizing Gynocular-triage-to-diagnose application with VIA (Visual inspection with Acetic acid) in community cervical cancer screening programs in rural Mysore, India. Indian J Cancer. 2021;58(3):409-16.

Consul S, Agrawal A, Sharma H, Bansal A, Gutch M, Jain N. Comparative study of effectiveness of pap smear versus visual inspection with acetic acid and visual inspection with lugol's iodine for mass screening of premalignant and malignant lesion of cervix Indian J Med Paediatr Oncol. 2012;33:161-5.

Lagos-Castillo M, Guevara-Vizcarra M, Paredes-Campos F, Kosuri S, Vilchez G. The effectiveness of pap and visual inspection with acetic acid (via) tests in cervical dysplasia screenings during the COVID-19 pandemic. Cureus. 2022;14(7):27364.

Sankaranarayanan R, Basu P, Wesley RS, Mahe C, Keita N, Mbalawa CC. IARC multicentre study group on cervical cancer early detection. accuracy of visual screening for cervical neoplasia: Results from an IARC multicentre study in India and Africa. Int J Cancer. 2004;110(6):907-13.