Screening of Cervical Cancer: Visual Inspection with Acetic Acid (VIA) and Site of Lesion Verified by Multiple Punch Biopsies

Abstract

BACKGROUND: Cervical cancer is the tenth most frequent cancer in Egyptian women. The Papanicolaou screening test is not suitable for rural area as most follow-up consultations never take place. AIM: To evaluate visual inspection of the cervix with acetic acid as a screening test. MATERIALS AND METHODS: According to the inclusion criteria, women aged 25-60 years commuting to a gynecological out-patient clinic at the University Hospital went through a visual inspection of the cervix with acetic acid (VIA). Exclusion criteria were women below 25 years, unmarried, pregnant, menstruating, known to have cancer, having a precancerous lesion or a cervical operation. Multiple punch biopsies were done for all VIA positive cases and a subsample of the VIA negative cases underwent the same. Cervical intraepithelial neoplasia (CIN) was evaluated. In addition, the site of the lesion was assessed. SPSS was used for the statistical analysis. RESULTS: Of the 379 screened women, 17.1% were found to be VIA positive. The sensitivity was found to be 91.3% (79.6%-96.5%) and the specificity 68.5% (57.1%-77.9%). Significantly more women with positive punch biopsies complained of contact bleeding than those with negative punch biopsies. CIN2 and CIN3 were mostly found (77.8%) in the right quadrant, while 74% of CIN1 was found in the lower right and left quadrant. CONCLUSION: VIA is weak as a test to stand alone but may need a combination with other indicators such as the location of the lesion on the right side of the cervix or contact bleeding. A combined indicator may detect precancerous cervix.