Visual Inspection with Acetic Acid Versus Papanicolaou Test in Cervical Cancer Screening
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ORIGINAL ARTICLE
Visual Inspection with Acetic Acid Versus Papanicolaou Test in Cervical Cancer Screening Arunima Srivastava1
•
Parul Sinha1
•
Priti Vatsal1 • Fareha Khatoon1
•
Nirupma Lal2
Received: 20 June 2020 / Revised: 20 July 2020 / Accepted: 25 July 2020 Ó Association of Gynecologic Oncologists of India 2020
Abstract Purpose To compare the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of visual inspection with acetic acid with Papanicolaou test. Methods This was cross-sectional study conducted over a period of 18 months. A total of 800 patients attending the gynecology outpatient department of Era’s Lucknow Medical College and Hospital and fulfilling the inclusion criteria and giving their informed consent were included. Results Out of 800 women from whom Pap smear was obtained, 716 (89.5%) were negative. There were 84 (10.5%) positive cases. Among 800 women screened using VIA, 171 (21.38%) were found to be positive, while 629 (78.62%) were negative. Histopathological evaluation could be done in 155 screened cases. Among these 155 cases, 41 (26.45%) were positive for pre-malignancy and 114 (73.55%) were negative. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of PAP against histopathology were 80.5%, 62.3%, 43.4%, 89.9% and 67.1%, respectively, whereas the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of VIA against histopathology were 87.8%, 5.3%, 25.0%, 54.5% and 27.1%, respectively. Conclusion The sensitivity of VIA and Pap was nearly equal, i.e., 87.8% and 80.5%, respectively. Pap was found to be more specific than VIA, i.e., 62.3 vs. 5.3%. The findings of the study thus showed that although PAP was more specific than VIA, VIA had a higher sensitivity. Despite a high false positivity rate, it could be recommended as a preliminary screening tool in primary care low-resource settings. Keywords Cancer screening Visual inspection with acetic acid Pap smear Bethesda system Sensitivity Specificity Low-resource settings
Introduction Cervical cancer is one of the most prevalent malignant neoplasms among women in developing countries, affecting them mainly in the fifth and sixth decades of life [1]. Every year in India, 122,844 women are diagnosed with cervical cancer and 67,477 die from the disease. India has a
& Parul Sinha [email protected] Arunima Srivastava [email protected] 1
Department of Obstetrics and Gynecology, ELMCH, Lucknow, India
2
Department of Pathology, ELMC & H, Lucknow, India
population of 432.2 million women aged 15 years and older who are at risk of developing cancer. It is the second most common cancer in women aged 15–44 years. India also has the highest age standardized incidence of cervical cancer in South Asia at 22, compared to 19.2 in Bangladesh, 13 in Sri Lanka, and 2.8 in Iran [2]. In the Indian subcontinent, it has an overall incidence of 132,000 new cases per year and 74,000 deaths take place due to this dis
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