title: Comparison of Papanicolaou test with visual detection tests in screening for cervical cancer and developing the optimal strategy for low resource settings.
abstract: OBJECTIVE
  To compare the sensitivity, specificity, positive and negative predictive values, and accuracy of Papanicolaou test with visual inspection with acetic acid (VIA)/VIA using magnification devices (VIAM) and develop the best strategy for screening in low resource settings.
  
  
  METHODS
  This is a prospective cross-sectional study on 408 symptomatic multiparous women in the reproductive age group, sequentially using the Papanicolaou test, the VIA, and the VIAM for screening. Women with a positive screening test underwent guided biopsy and endocervical curettage. The site of biopsy was recorded. Histopathological findings were taken as the "gold" standard in comparing the methods.
  
  
  RESULTS
  The mean (SD) age was 32.3 (6.8) years (range, 15-49 years), whereas the mean (SD) parity was 2.9 (1.2) (range, 1-9). Abnormal cytological findings were detected in 2.9% patients, whereas the remaining smears were negative for any intraepithelial lesion or malignancy. A total of 113 cases were screened positive by one/all methods. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the Papanicolaou test, the VIA, and the VIAM were 24, 98, 42, 96, and 94%; 95, 78, 19, 99, and 79%; and 95, 78, 19, 99, and 79%, respectively, for high-grade lesions.
  
  
  CONCLUSIONS
  The Papanicolaou test had low sensitivity but high specificity, whereas visual detection methods had a high sensitivity in addition to being cheaper. Alternative methods of screening such as VIA/VIAM can be a valuable alternative to the Papanicolaou test for cervical cancer screening in low resource settings. Visual inspection using magnification devices may be of benefit over VIA in doubtful cases.
authors.affiliation: Department of Obstetrics and Gynaecology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India. pakh_ag@yahoo.com
authors.forename: Pakhee
authors.initials: P
authors.lastname: Aggarwal
authors.forename: Swaraj
authors.initials: S
authors.lastname: Batra
authors.forename: Gauri
authors.initials: G
authors.lastname: Gandhi
authors.forename: Vijay
authors.initials: V
authors.lastname: Zutshi
mesh_terms: D019342:Acetic Acid; D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D003944:Diagnostic Techniques, Obstetrical and Gynecological / Q000191:economics; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D007202:Indicators and Reagents; D008403:Mass Screening; D008875:Middle Aged; D065006:Papanicolaou Test; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology; D014626:Vaginal Smears / Q000191:economics; D055815:Young Adult
chemical_list: D007202:Indicators and Reagents; D019342:Acetic Acid