title: Cytology versus visual inspection with acetic acid among women treated previously with cryotherapy in a low-resource setting.
abstract: OBJECTIVE
  To compare visual inspection with acetic acid (VIA) with conventional cervical cytology as a follow-up cervical cancer screening method in women who had been treated previously with cryotherapy.
  
  
  METHODS
  Salvadoran women screened with VIA and treated with cryotherapy within 3 years were eligible to participate. Study participants were rescreened with VIA, Pap smear, colposcopy, 4-quandrant biopsy, and endocervical curettage.
  
  
  RESULTS
  Of 147 women enrolled in the study, post-cryotherapy VIA was positive in 39 women (26.5%; 95% CI, 19.6%-34.4%). Of these 39, 1 woman had CIN 1 or higher on biopsy. Post-cryotherapy Pap smear was positive (ASCUS or higher) in 6 women (4.1%; 95% CI, 1.5%-8.7%). Of these 6, 2 women had CIN 1 or higher on biopsy. Post-cryotherapy specificity was significantly higher for Pap compared with VIA (95.8% [138/144]; 95% CI, 91.2%-98.5% vs 73.6% [106/144]; 95% CI, 65.6%-80.6%; P<0.001).
  
  
  CONCLUSIONS
  As the single-visit approach for cervical cancer screening gains popularity, more women will have been treated with cryotherapy. Appropriate follow-up screening is therefore vital. Cytology may be a more suitable screening method than VIA in low-resource settings for women treated previously with cryotherapy.
authors.affiliation: Department of Obstetrics and Gynecology, Mount Sinai School of Medicine, New York, NY 10029-6574, USA. miriam.cremer@mssm.edu
authors.forename: Miriam
authors.initials: M
authors.lastname: Cremer
authors.forename: Kimberley
authors.initials: K
authors.lastname: Bullard
authors.forename: Mauricio
authors.initials: M
authors.lastname: Maza
authors.forename: Ethel
authors.initials: E
authors.lastname: Peralta
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Moore
authors.forename: Lydia
authors.initials: L
authors.lastname: Garcia
authors.forename: Rachel
authors.initials: R
authors.lastname: Masch
authors.forename: Veronica
authors.initials: V
authors.lastname: Lerner
authors.forename: Todd A
authors.initials: TA
authors.lastname: Alonzo
authors.forename: Juan
authors.initials: J
authors.lastname: Felix
mesh_terms: D019342:Acetic Acid / Q000032:analysis*; D000328:Adult; D000368:Aged; D002584:Cervix Uteri / Q000473:pathology; D003127:Colposcopy; D017679:Cryotherapy; D055088:Early Detection of Cancer / Q000379:methods*; D004544:El Salvador; D005260:Female; D006801:Humans; D008875:Middle Aged; D065006:Papanicolaou Test; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000628:therapy*; D014626:Vaginal Smears; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000473:pathology* / Q000628:therapy*
chemical_list: D019342:Acetic Acid