Test characteristics of visual inspection with 4% acetic acid (VIA) and Lugol's iodine (VILI) in cervical cancer screening in Kerala, India

Abstract

Simple and inexpensive methods based on visual examination of the cervix are currently being investigated as alternative methods of cervical screening. The test characteristics of visual inspection with 4% acetic acid (VIA), and Lugol's iodine (VILI) and conventional cytology were investigated in a crosssectional study involving 4,444 women aged 25 to 65 years in Kerala, India. While detection of any acetowhite area constituted a low-threshold positive VIA, detection of well-defined, opaque acetowhite lesions close to or touching the squamocolumnar junction constituted a high-threshold positive VIA test. Detection of definite yellow iodine nonuptake areas in the transformation zone close to or touching the squamocolumnar junction constituted a positive VILI test. Cytology was considered positive if reported as atypia or worse lesions. All screened women were evaluated by colposcopy and biopsies were directed in 1,644 women (37.0%), which allowed the direct estimation of sensitivity, specificity and predictive values. The reference diagnosis was based on a combination of histology and/or colposcopy. Cytology-based screening is not feasible in many developing countries at high risk for cervical cancer in view of the considerable financial, technical and manpower resources required for organizing such a program. Visual inspection-based screening is currently being evaluated as a potential alternative to conventional cytology in the early detection of cervical neoplasia. 1 We investigated the test characteristics of visual inspection of the cervix after application of 4% acetic acid (VIA) and visual inspection after the application of Lugol's iodine (VILI) in detecting high-grade cervical intraepithelial neoplasia (CIN 2-3) and invasive cervical cancer and compared these with that of cervical cytology, in a cross-sectional study, the results of which are reported in this article. MATERIAL AND METHODSA cross-sectional study was carried out during the years 1998 -2000 in Kerala, a southern state on the west coast of India. The study protocol was reviewed and approved by institutional review and ethics committees at the Regional Cancer Centre (RCC), Thiruvananthapuram, Kerala, and the International Agency for Research on Cancer (IARC), Lyon, France. Health education campaigns were conducted in different districts of Kerala to motivate women to seek cervical cancer prevention services in the early cancer detection clinics conducted by the community oncology division of the RCC. Apparently healthy women aged 25 to 65 years, who voluntarily attended these clinics, were invited to participate in the study. Pregnant women, and those who had already undergone hysterectomy or treatment for cervical precancer or cancer, were excluded from the study.The objectives and the methodology of the study were explained by a social worker and leaflets on cervical cancer prevention and early detection in the local language were distributed to the eligible women. A written informed consent was obtained from each woman willing to participa...

Prevalensi Dan Faktor Yang Mempengaruhi Lesi Pra Kanker Serviks Pada Wanita

“…Selanjutnya kegiatan ini akan dikembangkan di daerah lain di Indonesia (Depkes RI, 2008). Berdasarkan penelitian yang dilakukan oleh Sankaranarayan (2007) tentang perbandingan pasien kanker serviks yang meninggal dunia pada kelompok yang dilakukan deteksi dini dengan IVA dan pada kelompok yang tidak dilakukan deteksi dini pada negara berkembang (India) didapatkan hasil bahwa mereka yang melakukan skrining IVA, 35% lebih sedikit yang meninggal dunia dibandingkan mereka yang tidak melakukan skrining IVA (Sankaranarayan, 2007).…”

Colposcopy - A Novel Diagnostic Technique for Oral Mucosal Lesions

“…The sensitivity and specificity of 4% acetic acid in detection of cervical cancer in cervical cancer in India was proved to be 88% and 78% respectively as reported by Sankaranarayanan and colleagues [11]. Since the anatomy of and the types of cancer found in the oral cavity and cervix are comparable, acetic acid seems to be an appropriate clinical marker for the detection of oral cancer as well.…”

Accuracy of visual inspection with acetic acid in cervical ectopy evaluation

“…It was also in agreement with the findings of Cronje et al 2003 who reported in their study about comparison of four screening methods for cervical neoplasia in a developing country that the specificity of VIA was 48.5%. [19] However this result was in disagreement with the findings of Sankaranarayanan et al [8,20] who reported a much higher VIA specificity of 65% & 81.9%, respectively.…”

“…(1999) [8] who reported in their study about visual inspection with acetic acid in the early detection of cervical cancer and precursors that VIA test had a sensitivity of 96%. Within the same line, Goel et al (2005) [17] in their study about "visual inspection of the cervix with acetic acid for cervical intraepithelial lesions" reported that VIA sensitivity was 96.7%.…”

“…Positive lesions are often treated immediately. [8] 1.2 Aim of the study The aim of this study was to evaluate the accuracy of visual inspection with acetic acid for cervical ectopy evaluation.…”