Archives of Gynecology and Obstetrics

, Volume 284, Issue 2, pp 397–403 | Cite as

Can visual inspection with acetic acid under magnification substitute colposcopy in detecting cervical intraepithelial neoplasia in low-resource settings?

  • Pakhee AggarwalEmail author
  • Swaraj Batra
  • Gauri Gandhi
  • Vijay Zutshi
General Gynecology



To compare the sensitivity, specificity, positive and negative predictive values and accuracy of visual inspection with acetic acid under magnification (VIAM) and colposcopy for detecting cervical intraepithelial neoplasia (CIN) to determine if VIAM can substitute colposcopy in identifying the biopsy site in screen-positive cases.


A prospective cross-sectional study was carried out on 408 symptomatic multiparous women in the reproductive age group (15–49 years) at a tertiary care teaching hospital. VIAM and colposcopy were used to screen for cervical precancerous lesions. Screen-positive women underwent guided biopsy and endocervical curettage. The site of biopsy was recorded as VIAM guided or colposcopy guided. Histopathology was taken as the gold standard.


The mean age was 32.3 ± 6.8 years (range 15–49), whilst the mean parity was 2.9 ± 1.2 (range 1–9). A total of 113 women screened positive. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of VIAM and colposcopy were 95, 78, 19, 99 and 79%, and 86, 79, 18, 99 and 79%, respectively for high-grade lesions.


VIAM can be a useful alternative to colposcopy when the latter is not available, as it has better sensitivity and equivalent specificity for detecting high-grade CIN.


CIN Visual inspection with acetic acid Magnavisualizer VIAM Low-resource settings Colposcopy Screening 



The instrument for this study (Magnavisualizer) was provided by Dr Aditya Parashari and the Indian Council of Medical Research. Statistical analysis was done by Prof RM Pandey at the Department of Biostatistics at All India Institute of Medical Sciences.

Conflict of interest



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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Pakhee Aggarwal
    • 2
    Email author
  • Swaraj Batra
    • 1
  • Gauri Gandhi
    • 1
  • Vijay Zutshi
    • 1
  1. 1.Department of Obstetrics and GynaecologyMaulana Azad Medical College and Lok Nayak HospitalNew DelhiIndia
  2. 2.Department of Obstetrics and Gynaecology, All India Institute of Medical SciencesIndirapuram, GhaziabadIndia

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