A Study of Sensitivity of Visual Inspection of the Cervix with Acetic Acid in Cervical Cancer Screening
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.
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.
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.
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.
KeywordsVIA Cancer cervix CIN
Compliance with Ethical Standards
Conflict of interest
Authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. All procedures included are approved by ethical committee of faculty of medicine, university of Alexandria.
Informed consent was obtained from all individual participants included in the study.
- 2.Bruni L, Barrionuevo-Rosas L, Albero G, Aldea M, Serrano B, Valencia S, et al. ICO Information Centre on HPV and Cancer (HPV Information Centre). Human Papillomavirus and Related Diseases Reports. Accessed 2017. p. March 20. Available from: 2 http://www.hpvcentre.net/statistics/reports/XWX.pdf.
- 5.Stuver S, Adami HO. Cervical cancer. In: Adami HO, Hunter D, Trichopoulos D, editors. Textbook of cancer epidemiology. New York: Oxford University Press; 2002. p. 340–58.Google Scholar
- 6.Visual inspection with acetic acid for cervical-cancer screening: test qualities in a primary-care setting. University of Zimbabwe/JHPIEGO Cervical Cancer Project. Lancet. 1999;353(9156):869–73.Google Scholar
- 12.Blumenthal PD, Gaffikin L, Deganus S, Lewis R, Emerson M, Adadevoh S. Cervical cancer prevention: safety, acceptability, and feasibility of a single-visit approach in Accra, Ghana. Am J Obstet Gynecol. 2007;196(407):e1–8.Google Scholar