Aided visual inspection with acetic acid (VIA) and HPV detection as optional screening tools for cervical cancer and its precursor lesions.
OBJECTIVE
To assess the contribution of visual inspection with acetic acid (VIA) and Hybrid Capture II (HCII) as adjunct methods to the Pap test in detecting cervical neoplasia.


METHODS
This was a cross-sectional study with 809 women who consecutively attended gynecological consultations at Campinas University, Brazil, from January 2002 to July 2003. Pap test, HCII, VIA, and colposcopy were offered to all patients. Performance of tests (alone or in combination) in detecting histologically confirmed lesions was evaluated.


RESULTS
Of the 40 patients with CIN, 69% had CIN1, 26% CIN2 or CIN3 and one patient had invasive carcinoma. VIA had the best performance in detecting CIN, yielding 72% sensitivity and 91% specificity. Considering only CIN2 or worse as significant lesions, HCII had the best sensitivity (73%), while the Pap test was the most specific (93%). Combining the three exams, 92% of the CIN1 or worse were detected. When CIN1 was excluded from the analysis, Pap smear plus HCII delivered 82% sensitivity and 79% specificity. However, this combination yielded a very low (5%) PPV.


CONCLUSIONS
VIA and HCII contributed to the screening of cervical neoplasia in a group of Brazilian women, but the cost-effectiveness of conjoint screening modalities is still debatable.
Bragança
J F
JF
Obstetrics and Gynecology Department, Universidade Estadual de Campinas State University, Campinas, Brazil.
Derchain
S F
SF
Sarian
L O
LO
Messias da Silva
S M
SM
Labatte
S
S
Zeferino
L C
LC
D019342:Acetic Acid; D000293:Adolescent; D000328:Adult; D001706:Biopsy; D002584:Cervix Uteri / Q000473:pathology / Q000821:virology; D003127:Colposcopy; D003430:Cross-Sectional Studies; D015344:DNA Probes, HPV; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D065006:Papanicolaou Test; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000175:diagnosis*; D010808:Physical Examination / Q000379:methods*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis*
D015344:DNA Probes, HPV; D019342:Acetic Acid