title: Comparison of visual inspection of cervix and Pap smear for cervical cancer screening.
abstract: OBJECTIVE
  To evaluate the performance of visual inspection of cervix (VIA) after application of 3% acetic acid in cervical cancer screening in comparison with Pap smear.
  
  
  METHODS
  Comparative study.
  
  
  METHODS
  This study was conducted at Sir Ganga Ram hospital, Lahore, from January 1996-December 1999.
  
  
  METHODS
  Speculum examination was carried out to see the cervix in 501 women. All subjects were screened simultaneously by Pap smear and VIA after application of 3% acetic acid. Positive cases by both screening methods and grossly abnormal cervix even with negative screen were subjected to colposcopy. In case of colposcopic abnormality of atypia or advanced lesions, biopsies were taken. Histology of colposcopically directed biopsy was taken as gold standard to evaluate the performance of the test.
  
  
  RESULTS
  Out of 540 subjects, 356 were negative with both screening techniques. One hundred and fifty-six subjects were positive with VIA(28.9%) while Pap smear was positive in seventy-eight subjects (14.4%). The sensitivity of VIA was 93.9% and of Pap smear was 46.9%. Corresponding specificities were 30.4% and 69.5%. There was no significant difference between the positive predictive value (PPV) of both test (p < 0.05). The accuracy of VIA was 77.5% compared to 52.8% of Pap smear. The difference was highly significant (p < 0.01).
  
  
  CONCLUSIONS
  These results indicate that VIA is more sensitive and has a higher accuracy as compared to Pap smear. It could, therefore, be valuable in detection of precancerous lesions of cervix. Low cost, easy applicability and immediate results make VIA a useful screening test in developing countries like Pakistan as compared to Pap smear.
authors.affiliation: Department of Obstetrics and Gynaecology, Fatima Jinnah Medical College, Lahore.
authors.forename: Rakhshanda
authors.initials: R
authors.lastname: Tayyeb
authors.forename: Nuzhat Parveen
authors.initials: NP
authors.lastname: Khawaja
authors.forename: Nuzhat
authors.initials: N
authors.lastname: Malik
mesh_terms: D019342:Acetic Acid; D000328:Adult; D001706:Biopsy; D002584:Cervix Uteri / Q000473:pathology*; D003127:Colposcopy; D005260:Female; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D010154:Pakistan; D065006:Papanicolaou Test; D010808:Physical Examination; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D014626:Vaginal Smears
chemical_list: D019342:Acetic Acid