The role of low-level magnification in visual inspection with acetic acid for the early detection of cervical neoplasia.
Several studies have investigated the accuracy of naked eye visual inspection with acetic acid (VIA) in the early detection of cervical neoplasia. It is not clear whether low-level (2-4x) magnification (VIAM) can improve the sensitivity and specificity of VIA. The accuracy of both VIA and VIAM, provided by independent health workers, were evaluated in three cross-sectional studies involving 18,675 women aged 25-65 years in Kolkata and Mumbai in India. All screened women were investigated with colposcopy and biopsies were obtained based on colposcopy findings. The final disease status was based on the reference standard of histology (if biopsies had been taken) or colposcopy. Data from the studies were pooled to calculate the test characteristics for the detection of high-grade squamous intraepithelial lesions (HSIL). 14.1% and 14.2% were positive on testing with VIA and VIAM respectively. Two hundred twenty-nine were diagnosed with HSIL and 68 with invasive cancer. The pooled sensitivity, specificity, positive and negative predictive values for VIA in detecting high-grade squamous intraepithelial lesions (HSIL) were 60.3% (95% CI: 53.6-66.7), 86.8% (95% CI: 86.3-87.3), 5.9% (95% CI: 5.0-7.0), and 99.4% (95% CI: 99.2-99.5), respectively. The values were 64.2% (95% CI: 57.6-70.4), 86.8% (95% CI: 86.2-87.3), 6.3% (95% CI: 5.3-7.3) and 99.4% (95% CI: 99.3-99.6), respectively, for VIAM. Low-level magnification did not improve the test performance of naked eye visualization of acetic acid impregnated uterine cervix.
Sankaranarayanan
Rengaswamy
R
Unit of Descriptive Epidemiology, International Agency for Research on Cancer, 150 cours Albert Thomas, Lyon 69008, France. sankar@iarc.fr
Shastri
Surendra S
SS
Basu
Parthasarathi
P
Mahé
Cédric
C
Mandal
Ranajit
R
Amin
Geethanjali
G
Roy
Chinmayi
C
Muwonge
Richard
R
Goswami
Smriti
S
Das
Pradip
P
Chinoy
Roshini
R
Frappart
Lucien
L
Patil
Sharmila
S
Choudhury
Devjani
D
Mukherjee
Titha
T
Dinshaw
Ketayun
K
D019342:Acetic Acid; D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D002584:Cervix Uteri / Q000473:pathology; D019411:Clinical Laboratory Techniques / Q000592:standards; D020681:Colposcopes / Q000592:standards; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007202:Indicators and Reagents / Q000592:standards; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology
D007202:Indicators and Reagents; D019342:Acetic Acid