Objective: The aim of this cross-sectional study was to assess the role of visual inspection with acetic acid
VIA as an alternative cost effective tool to Pap smear in screening for cancer cervix in low resource settings.
Material and methods: 3298 women attended the obstetrics and gynecology Department in Benha University
Hospital from May 2012 till August 2015 were screened by Pap smear and VIA. Colposcopy was done for all
women. Positive cases on any screening test were subjected to cervical biopsy. All women with a positive VIA
(200 including 124 Pap +ve), abnormal Cytology (40 were VIA -ve), or those with abnormal colposcopy (70 were
Pap -ve and VIA -ve)) were subjected to cervical biopsy and were included in our study. Thus a total of 310 cases
from whom cervical biopsy were taken were included.
Results: Of the women screened, VIA was positive in 200 (6%) and 164 (5%) were positive on Papanicolaou
smear. Cervical biopsy was done on 310 cases. 191 (62%) biopsies were positive and 119 (38%) were negative.
Of the 191 positive biopsies there were 87 CIN I, 59 CIN II, 29 CIN III and 16 invasive carcinoma. The sensitivity,
specificity, positive predictive value and negative predictive value of VIA were 84%, 67%, 80.5% and 73%
respectively. While the Pap smears had a sensitivity of 72%, specificity of 78%, and positive predictive value of
84% and negative predictive value of 64%.
Conclusion: VIA has the advantage of easy learning, inexpensiveness, high sensitivity in comparison to
Pap smear and immediate availability to assess results. Thus, VIA represents a good method of cervical cancer
screening in many parts of the world especially in poorly resourced locations. |
