Study of effectiveness of combined test Pap smear, visual inspection with acetic acid and Lugols iodine for mass screening of premalignant and malignant lesions of cervix
Keywords:Pap smear, Visual inspection with acetic acid, Lugols iodine
Background: Cancer cervix is the leading cause of morbidity and mortality in developing nations. This study aims to evaluate the usefulness of visual inspection with acetic acid (VIA) and Lugols iodine (VILI) as adjunct to improve the sensitivity of cervical cytology with Pap smear and to enhance the test performance.
Methods: Study was conducted in Gynaec OPD clinic in SVMCH & RC, Ariyur, Pondicherry during the period of January 2015 to June 2015. 350 patients enrolled in the study, 10 patients (2.8%) had positive Pap smear, 96 patients (27.4%) had inflammatory smears and 244 (69.7%) had normal smear. VIA was positive in 29 patients (8.2%). VILI was positive in 50 patients (14.2%).
Results: Sensitivity of Pap smear = 40% (CI 19.82-64.25%), sensitivity of VIA=40% (CI 19.82-64.25%), sensitivity of VILI = 86.66% (CI 62.12-92.26%), sensitivity of VIA+VILI tests = 86.66% (CI 62.12-96.26), sensitivity of combination tests (Pap + VIA + VILI) = 100% (CI 79.60-100.00). As shown by our study, VILI picked up the maximum premalignant lesions confirmed by cervical biopsy (15 premalignant lesions on cervical biopsy, and VILI is positive in 13 cases) and 6 were picked up by VIA, whereas Pap was positive in 6 patients.Conclusions: This study concludes that the effectiveness of cervical cancer screening can be improved by a combination test of Pap, VILI and VIA, even in tertiary centers in India.
Laara E, Day NE, Hakama M. Trends in mortality from cervical cancer in the Nordic countries: Association with organised screening programmes. Lancet. 1987;329:1247-9.
Sankaranarayanan R, Wesley R, Thara S, Dhakad N, Chandralekha B, Sebastian P. 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.
Yadav K, Patidar M, Bhargava M. A prospective study for evaluating visual inspection after Acetic acid (VIA) and Lugols iodine (VILI) application in screening of premalignant lesions of cervix. Journal of Evolution of Medical and Dental Sciences. 2013;2(4):310-14.
Ghosh P, Gandhi G, Kochhar PK, Zutshi V, Batra S. Visual inspection of cervix with Lugol’s iodine for early detection of pre malignant & malignant lesions of cervix. Indian J Med Res. 2012;136:265-71.
Mehta A, Ladola H, Kotadiya K, Rebecca. Study of high risk cases for early detection of cervical cancer by PAP smear and VILI. NHL Journal of medical sciences. 2013;2(1):65-8.
Sankaranarayanan R, Basu P, Wesley RS, Mahé C, Keita N, Mbalawa CC. Accuracy of visual screening for cervical neoplasia: Results from an IARC multicentre study in India and Africa. Int J Cancer. 2004;110:907-13.
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 Journal of Medical and Paediatric Oncology. 2012;33(3):161-5.
Denny L, Kuhn L, Pollack A, Wainwright H, Wright TC. Evaluation of alternative methods of cervical cancer screening for resource-poor settings. Cancer. 2000;89:826-33.
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. 2012;33(3):161-5.