A Study of Sensitivity of Visual Inspection of the Cervix with Acetic Acid in Cervical Cancer Screening

Background

Visual inspection tests with 3–5% acetic acid (VIA) and/or Lugol's iodine (VILI) appear to be a satisfactory alternative screening approach to cytology. These tests have been used since the 1990s, mainly in poor-resource settings. They are simple and cost-effective with relative ease of use and may be performed by different health care workers (physicians, nurse, midwives and technicians). Moreover, this approach does not require high technology or infrastructure and has been shown to reduce mortality in developing countries.

Methods

The study was conducted on 1000 women recruited for gynaecology outpatient clinic at El Shatby Maternity University Hospital after giving of written consent. VIA was done by applying 3–5% acetic acid to the cervix using a cotton swab, checking the transformation zone carefully for any dense, non-movable aceto-white areas in the epithelium or any raised and thickened white plaques.

Results

The summary sensitivity and specificity of VIA were 84.1% and 53.8%, respectively; VIA was sensitive in detecting more severe outcome, although there was a slight loss in specificity. Apparent heterogeneity existed in sensitivity and specificity for VIA.

Conclusions

High sensitivity of VIA was found when a combination of colposcopy and histology was used as disease confirmation, so it could be a good option for cervical screening in low-resource settings.