title: Cervical cancer screening in north east Thailand using the visual inspection with acetic acid (VIA) test and its relationship to high-risk human papillomavirus (HR-HPV) status.
abstract: OBJECTIVE
  This study investigated the utility of visual inspection with acetic acid (VIA) as a method for cervical cancer screening in Thailand and examined the relationship of VIA to high-risk human papillomavirus (HR-HPV) status.
  
  
  METHODS
  Cervical cells were collected from 160 patients receiving a Pap smear. VIA was performed on the cervix of the patients by application of 5% acetic acid. HPV screening of DNA extracted from cytology samples was performed by PCR using the GP5+/6+ primer system followed by reverse line blot hybridization genotyping.
  
  
  RESULTS
  The majority (96.9%) of the patients were diagnosed with normal or inflammatory cytologic changes. 32.8% of normal cytology and 42.0% of inflammation cases showed positive acetowhite staining. 3.1%, 38.1% and 42.5% of subjects were positive for an abnormal Pap test, VIA test, and HPV DNA, respectively. VIA demonstrated 50% sensitivity and 66.7% specificity for abnormal histology with PPV and NPV values of 50% and 66.7%, respectively, whereas HPV DNA test showed 100% sensitivity. HPV16 was the most common (54.4%) and HR-HPV was detected in 36.3% of all cases. 48.5% of HR-HPV positive and 36.8% of HR-HPV negative cervices stained with acetowhite following the VIA test.
  
  
  CONCLUSIONS
  The VIA test is a simple method for cervical cancer screening; however, a significant proportion of patients with normal or inflammatory cytology were positive by this test. Further, HR-HPV in women without acetowhite staining was demonstrated. Therefore, some form of HR-HPV detection test may be required for combination with cervical cell screening even in low-resource nations.
authors.affiliation: Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
authors.forename: Tipaya
authors.initials: T
authors.lastname: Ekalaksananan
authors.forename: Chamsai
authors.initials: C
authors.lastname: Pientong
authors.forename: Jedsada
authors.initials: J
authors.lastname: Thinkhamrop
authors.forename: Bunkerd
authors.initials: B
authors.lastname: Kongyingyoes
authors.forename: Mark F
authors.initials: MF
authors.lastname: Evans
authors.forename: Arkom
authors.initials: A
authors.lastname: Chaiwongkot
mesh_terms: D019342:Acetic Acid; D000293:Adolescent; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008875:Middle Aged; D016017:Odds Ratio; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000235:genetics*; D012680:Sensitivity and Specificity; D013785:Thailand; D020798:Two-Hybrid System Techniques; D002583:Uterine Cervical Neoplasms / Q000235:genetics / Q000473:pathology* / Q000821:virology; D014626:Vaginal Smears / Q000379:methods*; D002578:Uterine Cervical Dysplasia / Q000235:genetics / Q000473:pathology / Q000821:virology
chemical_list: D019342:Acetic Acid