title: Performance of direct visual inspection of the cervix with acetic acid and magnification in a previously screened population.
abstract: 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.
authors.affiliation: Proyecto Epidemiológico Guanacaste, FUCODOCSA, San José, Costa Rica. project@racsa.co.cr
authors.forename: Ana Cecilia
authors.initials: AC
authors.lastname: Rodríguez
authors.forename: Lidia Ana
authors.initials: LA
authors.lastname: Morera
authors.forename: Concepción
authors.initials: C
authors.lastname: Bratti
authors.forename: Rolando
authors.initials: R
authors.lastname: Herrero
authors.forename: J Thomas
authors.initials: JT
authors.lastname: Cox
authors.forename: Jorge
authors.initials: J
authors.lastname: Morales
authors.forename: Mario
authors.initials: M
authors.lastname: Alfaro
authors.forename: Martha
authors.initials: M
authors.lastname: Hutchinson
authors.forename: Philip E
authors.initials: PE
authors.lastname: Castle
authors.forename: Allan
authors.initials: A
authors.lastname: Hildesheim
authors.forename: Mark
authors.initials: M
authors.lastname: Schiffman