Performance of direct visual inspection of the cervix with acetic acid and magnification in a previously screened population.
OBJECTIVE
To assess the screening performance of direct visual inspection with acetic acid and x2 magnification (VIAM) in a previously screened population, as performed by experienced gynecologic nurses with minimal training in VIAM.


METHODS
Performance of VIAM was evaluated in 2,080 women from a population-based cohort in Guanacaste, Costa Rica, 5 years after they had negative enrollment results of conventional and liquid-based cytologic analysis, cervigram, and human papillomavirus DNA by Hybrid Capture Tube Test (Digene Corporation, Gaithersburg, MD). The VIAM results were compared with repeat conventional Pap smears, liquid-based cytologic examinations, and cervicography, with adjudication of differences by reference to MY09/MY11 L1 consensus primer polymerase chain reaction detection of oncogenic human papillomavirus DNA.


RESULTS
Less than 5% of women were classified as having positive results using VIAM. The VIAM positivity was also very low among women with high-grade squamous intraepithelial lesion conventional Pap smear results (8.3%), high-grade squamous intraepithelial lesion liquid-based cytologic results (6.3%), or cervigrams suggesting cervical intraepithelial neoplasia 2,3 or cancer (30%). The VIAM positivity was not associated with human papillomavirus DNA positivity.


CONCLUSIONS
As we practiced it, VIAM was not sensitive for detection of possibly serious incident cervical lesions in this previously screened population where cytologic screening is in place.
Rodríguez
Ana Cecilia
AC
Proyecto Epidemiológico Guanacaste, FUCODOCSA, San José, Costa Rica. project@racsa.co.cr
Morera
Lidia Ana
LA
Bratti
Concepción
C
Herrero
Rolando
R
Cox
J Thomas
JT
Morales
Jorge
J
Alfaro
Mario
M
Hutchinson
Martha
M
Castle
Philip E
PE
Hildesheim
Allan
A
Schiffman
Mark
M