ABSTRACT
Background: In developing and resource-limited countries alternative screening methods like VIA, VILI, and Pap smear are used in detection of premalignant and malignant lesions of cervix. The aim of our study was to compare the efficacies of VIA, VILI, and Pap smear in detection of premalignant and malignant lesions of cervix.Methods: The study was conducted for a period of one year in the department of obstetrics and gynaecology, Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, Himachal Pradesh. Women who attended the outdoor patient department of obstetrics and gynecology were subjected to collection of Pap Smear, VIA followed by VILI and a thorough pelvic examination.Results: Among the 350 women studied, 59 women (16.9%) had abnormal VIA, 64 women (18.2%) had abnormal VILI. On pap smear, 10 women were reported as ASCUS, 11 as L-SIL and 1 as H-SIL. Cervical biopsy was done in 98 women, out of which 70 had one or more abnormality on VIA, VILI, or Pap, and 28 women who had normal results. Sixteen women (16.3%) reported as CIN-1 and 2 women (2.07%) as CIN-3. VIA and VILI had a higher sensitivity as compared to pap. However, pap was more specific. The PPV of pap was also much higher as compared to VIA and VILI, whereas there was no difference in NPV of the three.Conclusions: Authors observed that VIA presented the best sensitivity (88.8%), followed by VILI (83.3%), and Pap (72.2%). Pap smear had the highest specificity of 97.2%. The positive predictive value of Pap was higher as compared to VIA and VILI, whereas there was no difference in NPV of the three. VIA and VILI have good sensitivity, with reasonable specificity and because of their cost effectiveness and ease of availability, these can be an alternative screening modality for cervical cancer screening.
ABSTRACT
Background: There are multiple screening methods available for screening cervical cancer with their advantages and disadvantages, researches that compare the sensitivity, specificity, positive and negative predictive values of these tests in a low-cost setting specific to a geographical area is lacking and has to be enhanced. The objective of this study was to determine and compare the agreement, sensitivity, specificity and predictive values of conventional Pap smear cytology, liquid-based cytology and VIA/VILI with cervix biopsy.Methods: This cross sectional study was conducted on women of >35 years of age. Pap smear specimen was collected followed by Liquid Base Cytology (LBC) using cytobrush specimen after which visual inspection with 5% acetic acid (VIA) and visual inspection with Lugol’s Iodine (VILI) procedure was carried out and followed by cervix biopsy. All methods were analyzed for accuracy.Results: Sensitivity was lowest for PAP smear (39.1%, 95% CI 19.18% to 59.1%), followed by VIA VILI (95.7%, 95% CI 87.32% to 100%), and highest for LBC (100.0%). The negative predictive value was lowest for PAP smear (87.4%, 95% CI 81.21% to 93.6%), followed by VIA VILI (99.0%, 95% CI 96.99% to 100.0%) and highest for LBC (100%). The overall diagnostic accuracy was lowest for PAP smear (88.3%) followed by VIA/VILLI (99.2%) and highest for LBC (100%).Conclusions: Treatment decisions based on findings of the PAP smear have to be taken with caution, considering the lower sensitivity. Wherever resources are available more accurate screening methods like liquid-based cytology must be used.