Evaluation of visual inspection with acetic acid and Lugol's iodine as cervical cancer screening tools in a low-resource setting

Qureshi, Sabuhi; Das, Vinta; Zahra, Fatima

doi:10.1258/td.2009.090085

Cited by 23 publications

(19 citation statements)

References 8 publications

(10 reference statements)

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“…Using sequential UNEE and VIA as an alternative method of cervical cancer screening to Pap test is characterized by being fast, simple, and easily learned with appropriate training by non-physician providers such as nurses. Other international researchers have demonstrated similar findings indicative of nurses safely expanding their scope of practice to include MNEE and VIA screening as demonstrated in the initial pioneering studies (19,20). It seems logical to consider colposcopically-guided cervical biopsy positive results the gold standard for this study.…”

Section: Discussionsupporting

confidence: 55%

Double Test: A Simplified Alternative for Cervical Cancer Screening in Low Resource Countries

2015

American Research Journal of Nursing

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Abstract:Objectives: To test if combining positive results of sequential magnified naked-eye examination (MNEE) and visual inspection of cervix after application of acetic acid (VIA) would increase diagnostic indices for precancerous and cancerous cervical lesions in comparison to the gold standard positive Pap test in a developing country set up. A secondary objective was to evaluate the effectiveness of nurse training and patient acceptance of this screening approach. Design: An analytic cross-sectional research designSetting: Gynecology and infertility out-patient clinics of the departments of Obstetrics and Gynecology, Woman's Health University hospital, Assiut University, Egypt. Materials and methods:A total of 445 non-pregnant women aged between 17 and 44 years were counseled and entered this study. They were subjected to MNEE after cleaning of the cervix with 0.9% saline, exfoliative cytology and lastly VIA. Positive results were evaluated and managed accordingly. Colposcopy with or without subsequent cervical biopsy were done in all positive cases of MNEE, VIA and Pap smear. Main outcome measures included diagnostic accuracy of VIA alone versus VIA and MNEE as compared to cytology.Results: This study comprised 445 non pregnant women in the reproductive age. The main complaint was abnormal vaginal discharge in 403 cases (89.6%) . MNEE of the cervix indicated that 338 women (75.1%) and 112 women (24.9%) had healthy and unhealthy-looking cervices respectively. Pap smear sampling was negative for premalignant or malignancy in 377 cases (83.8%).VIA test findings were positive in 77 cases ( 17.3% ) and negative in 368 cases (82.6% ) All diagnostic indices increased significantly after combing MNEE and VIA positive results except negative predicative value if compared to VIA positive results alone as an alternative to the standard Pap smear. Nurses proved high level of skill in performing cervical cytology, MNEE and VIA as proved by lower rate of unsatisfactory results. Patient acceptability was very high after proper counseling.Conclusions: Sequential MNEE and VIA would improve most of diagnostic indices as an alternative diagnostic tool to the gold standard Pap smearing for detection of abnormal precancerous and cancerous cervical lesions. This simplified cheap approach with high percentage of patient acceptability would help expanding screening programs in countries were Pap smear is poorly available. Being performed by doctors as well as trained nurses on one-stop base is a clear advantage. More large sample sized studies on the cost-effectiveness of this approach versus colposcopically-guided positive histopathology are recommended before its universal spread.

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Section: Discussionsupporting

confidence: 55%

Double Test: A Simplified Alternative for Cervical Cancer Screening in Low Resource Countries

2015

American Research Journal of Nursing

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“…The sensitivity to detect HGL ranged from 61 to 100% [20-25] while the specificity, positive predictive value (PPV), and negative predictive value (NPV) were 36-98% [20-25], 9-44% [19,22,23,26], and 88-100% [19,22,23,26], respectively. Another obvious benefit is its immediate results from the clinical impression leading to a proper counselling and a possibility of the "see and treat" approach.…”

Section: Introductionmentioning

confidence: 99%

Visual inspection with acetic acid for detection of high grade lesion in atypical squamous cells and low grade squamous intraepithelial lesions from cervical Pap smear

et al. 2011

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ObjectiveTo evaluate the value of visual inspection with acetic acid (VIA) test to detect high grade lesion in women with atypical squamous cells or low grade squamous intraepithelial lesions cervical cytology.MethodsWomen with atypical squamous cells or low grade squamous intraepithelial lesions who were scheduled to undergo colposcopy at Vajira Hospital and met inclusion criteria were included. All participants underwent VIA test prior to usual steps of colposcopy. The VIA results were interpreted as positive or negative using the criteria by the International Agency for Cancer Research. The standard colposcopic examination and appropriate investigations for cervical pathology were then continued. The diagnostic values of VIA test including sensitivity, specificity, positive predictive value, and negative predictive value were determined using high grade lesion including cervical intraepithelial neoplasia 2-3 and squamous cell carcinoma as a threshold.ResultsTotal of 106 women was included. The VIA test was positive in 33 women (31.1%) and negative in 73 women (68.9%). Among the women with VIA test positive, 14 had high grade lesion (42.4%) while 19 had no significant lesions. Only 2/73 (2.7%) cases with negative VIA test had high grade lesion (both had cervical intraepithelial neoplasia 2). The sensitivity, specificity, positive predictive value and negative predictive value with 95% confidence interval were 87.5% (81.2 to 93.8%), 78.8% (71.1 to 86.7%), 42.4% (33.0 to 51.8%), and 97.2% (94.2 to 1.0%) respectively.ConclusionVIA as the intermediate test in atypical squamous cells and low grade squamous intraepithelial lesions cytology may reduce the necessity to refer some women for colposcopy.

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“…VIA/VILI is a cheap, simple, and rapid screen-and-treat method that does not require equipment or extensive training [8]. Moreover, recent studies show the sensitivity and specificity of VIA varies from 55.55 to 96% and 44 to 94.6%, respectively, and the sensitivity and specificity of VILI varies from 36.3 to 87.2% and 48.93 to 96.2%, respectively [9–13], indicating that VIA/VILI is a relatively effective screening tool for CIN and cervical cancer.…”

Section: Discussionmentioning

confidence: 99%

Analysis of the effectiveness of visual inspection with acetic acid/Lugol’s iodine in one-time and annual follow-up screening in rural China

Lewkowitz

Zhao

et al. 2012

Arch Gynecol Obstet

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Purpose Via a large population-based survey conducted in rural, southwestern China, we aim to evaluate the effect of visual inspection with acetic acid/Lugol’s iodine (VIA/VILI) on diagnosing cases of cervical cancer and of precancerous lesions while exploring the mode of cervical prevention and control in low-resource settings in China. Methods Women aged 30–59 years from Chongqing, China were recruited from 2006 to 2009. Participants underwent VIA/VILI, and, if positive, received colposcopy-directed or random biopsies. Women with negative VIA/VILI or biopsy-confirmed cervical intraepithelial neoplasia (CIN) 1 lesions diagnosed in the first round of screening were re-screened in the following year with the same procedure. Results In total, 10,269 women received VIA/VILI. The average age of participants was 40.9 ± 7.6 years. Overall, 0.85% (87/10,269) of women were diagnosed via pathology-confirmed biopsy with CIN1, 0.25% (26/10,269) with CIN2, 0.27% (28/10,269) with CIN3, and 0.02% (2/10,269) with cervical cancer. Over half (57.7%) of CIN2 lesions, the majority of CIN3 lesions (89.3%), and all cancer cases (100%) were detected in the first round of screening. Conclusion In a rural, low-resource setting in China, onetime VIA/VILI screening detected more than a half of CIN2 cases, most CIN3 cases and all the cervical cancer cases. Detection rates of CIN2 lesions significantly increased with a 1-year follow-up VIA/VILI screen. Therefore, if multiple cervical cancer screenings are not feasible logistically or financially, a one-time VIA/VILI may be the most efficient strategy to detect cervical cancer and most CIN3 lesions in women in low-resource settings.

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Evaluation of visual inspection with acetic acid and Lugol's iodine as cervical cancer screening tools in a low-resource setting

Cited by 23 publications

References 8 publications

Double Test: A Simplified Alternative for Cervical Cancer Screening in Low Resource Countries

Double Test: A Simplified Alternative for Cervical Cancer Screening in Low Resource Countries

Visual inspection with acetic acid for detection of high grade lesion in atypical squamous cells and low grade squamous intraepithelial lesions from cervical Pap smear

Analysis of the effectiveness of visual inspection with acetic acid/Lugol’s iodine in one-time and annual follow-up screening in rural China

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