Accuracy of visual inspection with acetic acid for cervical pathology screening in low cost setup

Aditya Sisodia


Background: Cancer cervix, a preventable disease continues to be a cause of great concern to women’s health, being associated with agonizing morbidity and high mortality. Approximately 493,100 new cases and more than 273,000 deaths occur each year, among women worldwide.IN India the screening is largely based on pap smear, which is cumbersome procedure due to transportation of samples and follow up of patients are not usually feasible. Visual inspection with Acetic acid (VIA) is simple and easy to teach procedure. Follow-up of patients usually doesn’t require.

Methods: This study includes a total of 1000 patients who attended OPD of gynecology. Each patient is subjected to VIA examination. Biopsy is taken from women with abnormal findings on VIA. The objectives of this study were to evaluate the sensitivity and specificity and positive predictive value of inspection of cervix with acetic acid in precancerous lesions of cervix.

Results: When biopsy is taken as reference standard, VIA has sensitivity of 97.7%, specificity of 76.6%, PPV of 62.9% and NPV of 98.5%. The accuracy rate for VIA is 84.8%.

Conclusions: VIA is highly sensitive for diagnosis and treatment of cervical pathology at the same sitting. It can be done cost effectively in low resource set up.


Biopsy, Invasive cancer of cervix, Preinvasive lesion of cervix, Pap Smear, Visual inspection with acetic acid

Full Text:



Sehgal A, Singh V, Bhambhani S, Luthra UK. Screening for cervical cancer by direct inspection. Lancet. 1991;338:282.

JHPIEGO Cervical Cancer Project. Visual inspection with acetic acid for cervical-cancer screening: qualities in a primary care setting. Lancet. 1999;353:869-73.

Belinson JL, Pretorius RG, Zhang WH, Wu LY, Qiao YL, Elson P. Cervical cancer screening by simple visual inspection after acetic acid. Obstet Gynecol. 2001;98(3):441-4.

Sankaranarayanan R, Wesley R, Somanathan T, Dhakad N, Shyamalakumary B, Amma NS, et al. Visual inspection of the uterine cervix after the application of acetic acid in the detection of cervical carcinoma and its precursors. Am Cancer Soc. 1998;83:2150-6.

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

Goel A, Gandhi G, Batra S, Bhambhani S, Zutshi V, Sachdeva P. Visual inspection of the cervix with acetic acid for cervical intraepithelial lesions. Inter J Gynecol Obstet. 2005;88(1):25-30.

Nalliah S, Karikalan B, Kademane K. Multifaceted usage of HPV related tests and products in the management of cervical cancer: a review. Asian Pac J Cancer Prev. 2015;16(6):2145-50.

McCarey C, Pirek D, Tebeu PM, Boulvain M, Doh AS, Petignat P. Awareness of HPV and cervical cancer prevention among Cameroonian healthcare workers. BMC Women's Health. 2011;11(1):45.

Megevand E, Denny L, Dehaeck K, Soeters R, Bloch B. Acetic acid visualization of the cervix: an alternative to cytologic screening. Obstet Gynecol. 1996;88(3):383-6.