Visual Inspection of Cervix With Acetic Acid as a Screening Modality for Cervical Cancer.

OBJECTIVE: To assess feasibility and suitability of visual inspection of cervix with acetic acid (VIA) in detecting cervical intraepithelial neoplasia (CIN), and compare it with Papanicolaou test. METHODS: This was a diagnostic accuracy cross-sectional study conducted at an Egyptian teaching hospital, where 784 women were offered Papanicolaou test, VIA, colposcopy, and cervical biopsy. RESULTS: Histopathologically confirmed CIN 2/3 was noted in 26 cases (3.3%) and cervical cancer in 3 cases (0.4%). Twenty-seven (93.1%) of these 29 cases of CIN 2+, including one invasive cancer, were suggested by VIA. The test sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) to detect CIN 2+ were 93.1%, 90.6%, 26.6%, and 99.7%, respectively. Positive likelihood ratio (LR +) and negative likelihood ratio (LR-) for VIA were 9.90 (95% confidence interval [CI], 7.77-12.62) and 0.08 (95% CI, 0.02-0.29), respectively. Twenty-six cases (89.7%) of CIN 2+ were suggested by Papanicolaou test, whereas all 3 cancers were missed by this test. Papanicolaou test sensitivity, specificity, PPV, and NPV to detect CIN 2+ were 89.7%, 99.1%, 78.8%, and 99.6%, respectively. Positive likelihood ratio and LR- for the Papanicolaou test were 96.7 (95% CI, 45.78-204.23) and 0.10 (95% CI, 0.04-0.3), respectively. Colposcopy suggested 28 cases (96.6%) of CIN 2+, including 2 cancers. Colposcopy sensitivity, specificity, PPV, and NPV to detect CIN 2+ were 96.6%, 99.2%, 82.4%, and 99.9%, respectively. CONCLUSION: Visual inspection of the cervix with acetic acid is a feasible and suitable screening test for cervical cancer in under-resourced settings in developing countries. Its performance is comparable to the Papanicolaou test.

Levonorgestrel-releasing intrauterine device versus dydrogesterone for management of endometrial hyperplasia without atypia.

OBJECTIVE: To compare the efficacy and safety of the levonorgestrel-releasing intrauterine device (LNG-IUD) with dydrogesterone applied for the same duration in patients having endometrial hyperplasia (EH) without atypia. MATERIALS AND METHODS: One hundred thirty eight women aged between 30 and 50 years with abnormal uterine bleeding and diagnosed as EH by transvaginal ultrasound were randomized to receive either LNG-IUD or dydrogesterone for 6 months. Primary outcome measures were regression of hyperplasia after 6 months of therapy. Secondary outcome measures were occurrence of side effects during treatment or recurrence of hyperplasia during follow-up period. RESULTS: After 6 months of treatment, regression of EH occurs in 96% of women in the levonorgestrel-releasing intrauterine system (LNG-IUS) group versus 80% of women in the oral group (P < .001). Adverse effects were relatively common with minimal differences between the 2 groups. Intermenstrual vaginal spotting and amenorrhea were more common in the LNG-IUD group (P value .01 and .0001). Patient satisfaction was significantly higher in the LNG-IUS group (P value .0001). Hysterectomy rates were lower in the LNG-IUS group than in the oral group (P = .001). Recurrence rate was 0% in the LNG-IUD group compared to 12.5% in the oral group. CONCLUSION: In management of EH without atypia, LNG-IUS achieves a higher regression and a lower hysterectomy rate than oral progesterone and could be used as a first-line therapy.