title: Assessment of 2 cervical screening methods in Mongolia: cervical cytology and visual inspection with acetic acid.
abstract: OBJECTIVE
  The aim of the study was to evaluate the test parameters of visual inspection with acetic acid (VIA) and cervical cytology in 3 Mongolian aimags.
  
  
  METHODS
  From February 18, 2002, to December 12, 2004, sexually active women, 30 years or older who had never been screened, underwent cervical cytology and VIA in the aimags' central hospital. Women with abnormal test results and 5% of women with normal results were recommended to have colposcopy with or without biopsy.
  
  
  RESULTS
  Two thousand nine women underwent both tests. Visual inspection with acetic acid was abnormal in 254 (12.6%); Pap smear showed atypical squamous cells of undetermined significance or worse in 3%. Using cervical intraepithelial neoplasia 2 or higher disease on biopsy as the end point, the test parameters for VIA are sensitivity of 82.9% (95% CI = 81.3%-84.5%), specificity of 88.6% (95% CI = 87.2%-90.0%), positive predictive value of 12.2% (95% CI = 10.8%-13.6%), and negative predicative value of 99.7% (95% CI = 99.5%-99.9%). The test parameters for Pap smear are sensitivity of 88.6% (95% CI = 87.2%-90.0%), specificity of 98.5% (95% CI = 98.0%-99.0%), positive predictive value of 51.7% (95% CI = 49.5%-53.9%), and negative predicative value of 99.8% (95% CI = 99.6%-100%).
  
  
  CONCLUSIONS
  Visual inspection with acetic acid has an acceptable test parameter for population-based cervical screening in Mongolia.
authors.affiliation: Division of Gynecologic Oncology, McMaster University, Hamilton, Ontario, Canada. laurie.elit@hrcc.on.ca
authors.forename: L
authors.initials: L
authors.lastname: Elit
authors.forename: G
authors.initials: G
authors.lastname: Baigal
authors.forename: J
authors.initials: J
authors.lastname: Tan
authors.forename: A
authors.initials: A
authors.lastname: Munkhtaivan
mesh_terms: D019342:Acetic Acid; D000328:Adult; D000368:Aged; D001706:Biopsy; D002584:Cervix Uteri / Q000473:pathology; D003127:Colposcopy; D005260:Female; D006801:Humans; D007202:Indicators and Reagents; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D008986:Mongolia; D065006:Papanicolaou Test; D010808:Physical Examination / Q000379:methods*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis
chemical_list: D007202:Indicators and Reagents; D019342:Acetic Acid