Evaluation of Visual Inspection after Acetic Acid/ Cervicography as an Alternative to Colposcopy for Detection of Cervical Intraepithelial Neoplasia

Abstract

Objective: The study was conducted to (1) find out if visual inspection after acetic acid (VIA)/cervicogram can be used as an alternative to colposcopy and (2) compare the sensitivity and specificity of VIA/cervicogram with conventional Pap smear. Methods: A total of 540 sexually active women aged between 20 and 60 years attending gynecology outpatient (OPD) treatment were included in the study. After the complete evaluation and informed consent, the patients were subjected to the following tests: Pap smear, visual inspection after acetic acid (VIA) application, cervicography, and finally colposcopy. Cervical biopsy was done (a) in women with any of these three tests positive and (b) in patients with unsatisfactory colposcopy. Cervical tissue was obtained with the help of loop electrosurgical excision procedure (LEEP). Biopsies revealing mild dysplasia or worse lesions on histopathology were considered as true positive cases. Biopsies showing chronic cervicitis were considered negative. All results were compiled and subjected to statistical analysis. Results: Our study revealed sensitivity, specificity, positive predictive value, negative predictive value of Pap smear for LSIL or above as 28, 99.7, 25, and 97.9. Sensitivity, specificity, positive predictive value, negative, predictive value of VIA was 71.4, 92, 20, and 99.1. The sensitivity, specificity, positive predictive value, negative predictive value of cervicography in our study was 71.4, 93.9, 23, and 99%. The sensitivity of colposcopy was 78 and specificity 56.66%. Conclusion: Results of VIA and cervicography are quite promising and can be considered as primary screening in low-resource settings.