Accuracy of visual screening for cervical neoplasia: Results from an IARC multicentre study in India and Africa.
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.
Sankaranarayanan
Rengaswamy
R
Unit of Descriptive Epidemiology, International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon Cedex 08, France. sankar@iarc.fr
Basu
Parthasarathy
P
Wesley
Ramani S
RS
Mahe
Cédric
C
Keita
Namory
N
Mbalawa
Charles C Gombe
CC
Sharma
Rameshwar
R
Dolo
Amadou
A
Shastri
Surendra S
SS
Nacoulma
Marius
M
Nayama
Madi
M
Somanathan
Thara
T
Lucas
Eric
E
Muwonge
Richard
R
Frappart
Lucien
L
Parkin
D Maxwell
DM
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