title: Single visit approach for management of cervical intraepithelial neoplasia by visual inspection & loop electrosurgical excision procedure.
abstract: OBJECTIVE
  Developing a feasible and sustainable model of cervical cancer screening in developing countries continues to be a challenge because of lack of facilities and awareness in the population and poor compliance with screening and treatment. This study was aimed to evaluate a single visit approach (SVA) for the management of cervical intraepithelial neoplasia (CIN) using visual inspection with acetic acid (VIA) and Lugol's iodine (VILI) along with loop electrosurgical excision procedure (LEEP) in women attending Gynaecology OPD in a tertiary care hospital in north India.
  
  
  METHODS
  In this hospital-based study, 450 women receiving opportunistic screening by conventional Pap cytology were also screened by VIA and VILI. VIA/VILI positive cases underwent same-day colposcopy and biopsy of all lesions. If the modified Reid score was >3, the patient underwent LEEP at the same visit.
  
  
  RESULTS
  Of the 450 women screened, 86 (19.1%) and 92 (20.5%) women were VIA and VILI positive, respectively. Detection rates of VIA, VILI and cytology findings at ASCUS threshold were 33.3, 35.5 and 24.4 per 1000, women, respectively to detect a lesion >CIN1. For detection of CIN2+ lesion, detection rates of VIA, VILI and cytology were 20, 22.2 and 22.2 per 1000 women, respectively. Sixteen patients with Reid score >3 underwent the "See-and-treat" protocol. The overtreatment rate was 12.5 per cent and the efficacy of LEEP was 81.3 per cent. There were no major complications.
  
  
  CONCLUSIONS
  The sensitivity of VIA/VILI was comparable to cytology. A single visit approach using visual screening methods at community level by trained paramedical personnel followed by a combination of ablative and excisional therapy can help to decrease the incidence of cervical neoplasia.
authors: Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi, India.
authors: Shilpa
authors: S
authors: Singla
authors: Sandeep
authors: S
authors: Mathur
authors: Alka
authors: A
authors: Kriplani
authors: Nutan
authors: N
authors: Agarwal
authors: Pradeep
authors: P
authors: Garg
authors: Neerja
authors: N
authors: Bhatla
mesh_terms: D019342:Acetic Acid; D000328:Adult; D000368:Aged; D003127:Colposcopy; D004598:Electrosurgery / Q000379:methods; D005260:Female; D006801:Humans; D007454:Iodides; D008403:Mass Screening; D009367:Neoplasm Staging; D014626:Vaginal Smears; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000473:pathology / Q000601:surgery
chemical_list: D007454:Iodides; D019342:Acetic Acid; C010389:Lugol's solution