title: Is magnification necessary to confirm visual inspection of cervical abnormalities? A randomized trial in Peru.
abstract: OBJECTIVE
  Cervical cancer is the leading cause of cancer death among women in developing countries. This study was designed to evaluate whether visual inspection with acetic acid and magnification (VIAM) improved confirmation of cervical lesions as compared to confirmation with visual inspection with acetic acid (VIA) without magnification when used by physicians.
  
  
  METHODS
  From April-December 2004, women in San Martin, Peru, who were referred as VIA-positive by an "obstetriz" (a professional midwife with 6 years of university training) were randomized into two groups for confirmatory screening by a physician using either VIA or VIAM with an AviScope, a hand-held 4x magnification scope with a green light source. The reference standard for the presence or absence of cervical neoplasia was colposcopy and directed biopsy, as required.
  
  
  RESULTS
  A total of 358 women participated in the study; 161 had a confirmatory examination with VIAM and 159 with VIA. Sensitivity for low- or high-grade lesions was 68% with VIA and 77% with VIAM, and specificity was 62% with VIA and 63% with VIAM; however, these differences were not statistically significant.
  
  
  CONCLUSIONS
  For settings where physician confirmation of cervical abnormalities identified through visual inspection is required and available, this study demonstrates that VIAM had no significant advantage over VIA.
authors.affiliation: PATH, Seattle, Washington 98107, United States of America. jwinkler@path.org
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Winkler
authors.forename: Kristen
authors.initials: K
authors.lastname: Lewis
authors.forename: Roberto
authors.initials: R
authors.lastname: Del Aguila
authors.forename: Miguel
authors.initials: M
authors.lastname: Gonzales
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Delgado
authors.forename: Vivien D
authors.initials: VD
authors.lastname: Tsu
authors.forename: John W
authors.initials: JW
authors.lastname: Sellors
mesh_terms: D019342:Acetic Acid; D000328:Adult; D001706:Biopsy; D002584:Cervix Uteri / Q000473:pathology; D003127:Colposcopy; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007909:Lenses; D008403:Mass Screening / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D010568:Peru; D010808:Physical Examination; D011237:Predictive Value of Tests; D012015:Reference Standards; D012680:Sensitivity and Specificity; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000473:pathology
chemical_list: D019342:Acetic Acid