Can visual inspection with acetic acid under magnification substitute colposcopy in detecting cervical intraepithelial neoplasia in low-resource settings?
OBJECTIVE
To compare the sensitivity, specificity, positive and negative predictive values and accuracy of visual inspection with acetic acid under magnification (VIAM) and colposcopy for detecting cervical intraepithelial neoplasia (CIN) to determine if VIAM can substitute colposcopy in identifying the biopsy site in screen-positive cases.


METHODS
A prospective cross-sectional study was carried out on 408 symptomatic multiparous women in the reproductive age group (15-49 years) at a tertiary care teaching hospital. VIAM and colposcopy were used to screen for cervical precancerous lesions. Screen-positive women underwent guided biopsy and endocervical curettage. The site of biopsy was recorded as VIAM guided or colposcopy guided. Histopathology was taken as the gold standard.


RESULTS
The mean age was 32.3 ± 6.8 years (range 15-49), whilst the mean parity was 2.9 ± 1.2 (range 1-9). A total of 113 women screened positive. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of VIAM and colposcopy were 95, 78, 19, 99 and 79%, and 86, 79, 18, 99 and 79%, respectively for high-grade lesions.


CONCLUSIONS
VIAM can be a useful alternative to colposcopy when the latter is not available, as it has better sensitivity and equivalent specificity for detecting high-grade CIN.
Aggarwal
Pakhee
P
Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Flat No 1119, Vasto, Mahagun Mansion, 1/4, Vaibhav Khand, Indirapuram, Ghaziabad 201014, Uttar Pradesh, India. pakh_ag@yahoo.com
Batra
Swaraj
S
Gandhi
Gauri
G
Zutshi
Vijay
V
D019342:Acetic Acid; D000293:Adolescent; D000328:Adult; D003127:Colposcopy; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007194:India; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000473:pathology
D019342:Acetic Acid