title: The role of low-level magnification in visual inspection with acetic acid for the early detection of cervical neoplasia.
abstract: 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.
authors.affiliation: Unit of Descriptive Epidemiology, International Agency for Research on Cancer, 150 cours Albert Thomas, Lyon 69008, France. sankar@iarc.fr
authors.forename: Rengaswamy
authors.initials: R
authors.lastname: Sankaranarayanan
authors.forename: Surendra S
authors.initials: SS
authors.lastname: Shastri
authors.forename: Parthasarathi
authors.initials: P
authors.lastname: Basu
authors.forename: Cédric
authors.initials: C
authors.lastname: Mahé
authors.forename: Ranajit
authors.initials: R
authors.lastname: Mandal
authors.forename: Geethanjali
authors.initials: G
authors.lastname: Amin
authors.forename: Chinmayi
authors.initials: C
authors.lastname: Roy
authors.forename: Richard
authors.initials: R
authors.lastname: Muwonge
authors.forename: Smriti
authors.initials: S
authors.lastname: Goswami
authors.forename: Pradip
authors.initials: P
authors.lastname: Das
authors.forename: Roshini
authors.initials: R
authors.lastname: Chinoy
authors.forename: Lucien
authors.initials: L
authors.lastname: Frappart
authors.forename: Sharmila
authors.initials: S
authors.lastname: Patil
authors.forename: Devjani
authors.initials: D
authors.lastname: Choudhury
authors.forename: Titha
authors.initials: T
authors.lastname: Mukherjee
authors.forename: Ketayun
authors.initials: K
authors.lastname: Dinshaw
mesh_terms: 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
chemical_list: D007202:Indicators and Reagents; D019342:Acetic Acid