title: Accuracy of visual screening for cervical neoplasia: Results from an IARC multicentre study in India and Africa.
abstract: Visual inspection-based screening tests, such as visual inspection with 4% acetic acid (VIA) and with Lugol's iodine (VILI), have been proposed as alternatives to cytology in mass screening programs. To date, there is only limited information on the accuracy of these tests in detecting High-grade Squamous Intraepithelial Lesions (HSIL). Eleven cross-sectional studies involving 56,939 women aged 25-65 years were conducted in Burkina Faso, Congo, Guinea, India, Mali and Niger to evaluate the accuracy of VIA and VILI performed by health workers. A common protocol and questionnaire was used. For final diagnosis, all women were investigated with colposcopy and biopsies were taken when necessary. Data from the studies were pooled to calculate sensitivity, specificity and predictive values of the tests for the detection of HSIL. Of the screened women, 16.1% and 16.4% were positive on examination using, respectively, VIA and VILI; 1,063 were diagnosed with HSIL. The pooled sensitivity, specificity, positive and negative predictive values for VIA were 76.8% (95% CI: 74.2-79.4%), 85.5% (95% CI: 85.2-85.8%), 9.4% (95% CI:8.8-10.8%) and 99.5% (95% CI:99.4-99.6%), respectively. The values were 91.7% (95% CI: 89.7-93.4%), 85.4% (95% CI: 85.1-85.7%), 10.9% (95% CI: 10.2-11.6%) and 99.8% (95% CI:99.7-99.9%), respectively for VILI. The range of sensitivity and specificity for VIA was 56.1-93.9% and 74.2-93.8%, respectively, between studies and were 76.0-97.0 % and 73.0-91.3% for VILI. VILI had a significantly higher sensitivity than VIA in detecting HSIL, but specificity was similar. VILI appears to be a more accurate visual test for use in screening and treatment programs in low-resource settings.
authors.affiliation: Unit of Descriptive Epidemiology, International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon Cedex 08, France. sankar@iarc.fr
authors.forename: Rengaswamy
authors.initials: R
authors.lastname: Sankaranarayanan
authors.forename: Parthasarathy
authors.initials: P
authors.lastname: Basu
authors.forename: Ramani S
authors.initials: RS
authors.lastname: Wesley
authors.forename: Cédric
authors.initials: C
authors.lastname: Mahe
authors.forename: Namory
authors.initials: N
authors.lastname: Keita
authors.forename: Charles C Gombe
authors.initials: CC
authors.lastname: Mbalawa
authors.forename: Rameshwar
authors.initials: R
authors.lastname: Sharma
authors.forename: Amadou
authors.initials: A
authors.lastname: Dolo
authors.forename: Surendra S
authors.initials: SS
authors.lastname: Shastri
authors.forename: Marius
authors.initials: M
authors.lastname: Nacoulma
authors.forename: Madi
authors.initials: M
authors.lastname: Nayama
authors.forename: Thara
authors.initials: T
authors.lastname: Somanathan
authors.forename: Eric
authors.initials: E
authors.lastname: Lucas
authors.forename: Richard
authors.initials: R
authors.lastname: Muwonge
authors.forename: Lucien
authors.initials: L
authors.lastname: Frappart
authors.forename: D Maxwell
authors.initials: DM
authors.lastname: Parkin
mesh_terms: D000328:Adult; D000349:Africa / Q000453:epidemiology; D017677:Age Distribution; D000368:Aged; D001706:Biopsy; D003127:Colposcopy; D003710:Demography; D005260:Female; D005843:Geography; D006801:Humans; D007194:India / Q000453:epidemiology; D008403:Mass Screening / Q000379:methods; D008593:Menopause; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology