Abstract

---

Objective: To study and compare efficacy of visual inspection with Acetic acid (VIA) /Visual inspection with Lugol's Iodine (VILI) and Pap smear as screening test in terms of "Sensitivity" and "Specificity" for Cervical cancer and pre–cancerous lesions.
Method : Seven Hundred and sixty sexually active women between 25–60 years of age underwent pelvic examination by both pap smear and VIA/ VILI. Colposcopic/ Histodiagnosis was considered as gold standard against which the sensitivity & specificity of cytology, acetic acid and Lugol's iodine application as screening tool were evaluated.
Result: Sensitivity of VIA/VILI was 94.3 % versus 74.3 % for cytology. VIA/VILI specificity was 82.6 % versus 93.7 % for cytology.
Conclusion: Visual inspection with acetic acid (VIA) & Lugol's iodine (VILI) is more sensitive but less specific than cytology in detection of cervical cancer and its pre–cancerous lesions. VIA/ VILI has acceptable test qualities and may in low resource settings be implemented as a large scale screening method.

Introduction

---

Cervical cancer is the leading malignancy amongst Indian women. It is estimated that every year about 90,000 new cases arise in India. India bears 18% of the brunt of invasive cancer cervix in the world. The initiating event in cervical dysplasia and carcinogenesis is infection with Human Papilloma virus (HPV). Invasive cervical cancer is preceded by a long pre–malignant phase known as cervical intraepithelial Neoplasia (CIN). The goal of cervical cancer screening is detection and treatment of precancer before cancer develops.
In developed countries cervical cytologic screening of every women is part of National Health policy. In India, due to other more rampant problems of reproductive health including population control, cytologic screening for cervical cancer and its precancerous lesions is not being focussed. Thus, we need alternative tests which can be offered to every women for detecting cervical precancerous lesions before invasive cancer develops. These problems have stimulated research on VIA/VILI as screening method for cervical precancerous lesions.
VIA is based on acetowhitening, with the CIN tissue turning white when exposed to 5% acetic acid (vinegar) due to high nuclear protein content and in VILI, the dysplastic tissue does not take up iodine due to poor glycogen content. The present study aims to compare efficacy of VIA/VILI and Pap smear as a screening tool for cervical cancer and precancerous lesions.

Methods and Materials

---

The present study was conducted on 760 sexually active women attending Gynae O.P.D. of S.V.B.P. Hospital, L.L.R.M. Medical College, Meerut from August 2006 to July 2007. Each case was subjected to thorough history taking, complete physical and pelvic examination. Then, all women were subjected to Pap smear and to VIA/VILI tests after explaining the procedure.
VIA involved gentle application of freshly prepared 5% acetic acid to ectocervix and endocervix (to include TZ). VIA was considered positive when an acetowhite area either consistent with low grade or high grade lesion was observed within the TZ.
VILI was considered positive if there was any area which took light yellow or orangish stain (saffron) in comparison to deep mahogany brown stained area of normal cervix and vagina.
Those who had abnormal results in one or both of the screening tests were referred for colposcopic examination and directed biopsy, if needed. Colposcopic/ Histodiagnosis was considered as gold standard against which sensitivity and specificity of cytology, VIA and VILI application as screening tests were evaluated. If colposcopy remained unsatisfactory, ECC was performed. Thirty patients were randomly selected from Pap smear and VIA/VILI negative group and subjected for colposcopic examination as control. Study protocol used for follow up of cases (Illustration-1).

Discussion

---

VIA/VILI is more sensitive but less specific than cytology in detecting precancerous lesions of cervix. Likewise, University of Zimbabwe/JHPIEGO cervical cancer project (1999)¹ concluded that the high sensitivity of VIA shows that the test could be valuable in detection of precancerous lesions of cervix. Singh et al (2001)² concluded that screening for cervical precancerous and cancerous lesions using visual inspection aided by acetic acid may be a suitable low cost and a feasible alternative modality for control of cervical cancer in a resource poor setting. Sankaranaryanan et al (2003)³ concluded that VIA/VILI are suitable alternate screening tests to cytology for detecting cervical neoplasia. Doh et al (2005)⁴ stated that VIA has acceptable test qualities and may in low resource settings be implemented as a large scale screening method. Abdel-Hady et al (2006)⁵ concluded that VIA/VILI, although associated with a relatively high rate of false positive results, is a valuable test for the screening of cervical carcinoma.

References

---

1.University of Zimbabwe /JGPIEGO Cervical cancer project (1999). Visual Inspection with acetic acid for cervical cancer screening: test qualities in a primary care setting. Lancet; 353(9156): 869-73.
2.Singh V, Sehgal A, Parashari A, Sondhani P, Satyanarayana L. (2001) Early detection of cervical cancer through acetic acid application an aided visual inspection. Singapore Med J.; 42: 351-54.
3.Sankaranarayanan R, Wesley R, Thara S, Dhakad N, Chandralekha B, Seastian P, Chithrathara K, Parkin DM, Nair MK. (2003) Test characteristics of visual inspection with 4% acetic acid (VIA) and Lugol's iodine (VILI) in cervical cancer screening in Kerala, India. Int J. Cancer 106(3): 404-8.
4.Doh AS, Nikele NN, Achu P, Essimbi F, Essame O, Nkegoum B. (2005) Visual Inspection with Acetic acid and cytology as screening methods for cervical lesions in Cameron. Int J Gyanecol Obstet; 89(2): 167-73.
5.Abedl-Hady ES, Emam M, Al-Gohary A, Hassan M, Farag MK, Abo Elkheir M. (2006) Screening for cervical carcinoma using visual inspection with acetic acid. Int J Gynaecol Obstet; 93(2): 118-22.

Source(s) of Funding

---

none

Competing Interests

---

none

Disclaimer

---

This article has been downloaded from WebmedCentral. With our unique author driven post publication peer review, contents posted on this web portal do not undergo any prepublication peer or editorial review. It is completely the responsibility of the authors to ensure not only scientific and ethical standards of the manuscript but also its grammatical accuracy. Authors must ensure that they obtain all the necessary permissions before submitting any information that requires obtaining a consent or approval from a third party. Authors should also ensure not to submit any information which they do not have the copyright of or of which they have transferred the copyrights to a third party.
Contents on WebmedCentral are purely for biomedical researchers and scientists. They are not meant to cater to the needs of an individual patient. The web portal or any content(s) therein is neither designed to support, nor replace, the relationship that exists between a patient/site visitor and his/her physician. Your use of the WebmedCentral site and its contents is entirely at your own risk. We do not take any responsibility for any harm that you may suffer or inflict on a third person by following the contents of this website.