Download PDF
CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2012; 33(03): 161-165
DOI: 10.4103/0971-5851.103143
ORIGINAL ARTICLE

Comparative study of effectiveness of Pap smear versus visual inspection with acetic acid and visual inspection with Lugol′s iodine for mass screening of premalignant and malignant lesion of cervix

Shuchi Consul
Casuality Medical Officer, Trauma Centre, KGMU, Lucknow, Uttar Pradesh, India
,
Avinash Agrawal
Department of Medicine, KGMU, Lucknow, Uttar Pradesh, India
,
Hema Sharma
Department of Obstetrics and Gynaecology, NRCH, New Delhi, India
,
Anita Bansal
Department of Obstetrics and Gynaecology, NRCH, New Delhi, India
,
Manish Gutch
Department of Medicine, KGMU, Lucknow, Uttar Pradesh, India
,
Nirdesh Jain
Department of Medicine, KGMU, Lucknow, Uttar Pradesh, India
› Author Affiliations
› Further Information
  PDF Download Permissions and Reprints

Abstract

Background and Objective: Cancer of the cervix is a leading cause of morbidity and mortality among women worldwide. Therefore, to curb the disease, there is a need to develop a screening test that has good sensitivity and specificity. The present study is aimed to compare the effectiveness of the Pap smear, visual inspection with acetic acid (VIA) and visual inspection with Lugol′s iodine (VILI) for mass screening of premalignant and malignant lesions of the cervix; to evaluate the usefulness of VIA and VILI as an adjunct to improve sensitivity of cervical cytology; and to evaluate the role of VILI as a parallel screening method with VIA to enhance its test performance. Design and Setting: This was a prospective, analytical study in which 210 patients of the reproductive age group attending the gynecology OPD were enrolled. Patients and Methods: Patients were first subjected to Pap smear followed by VIA, VILI, colposcopy and biopsy for confirmation of lesion, if needed. Data was obtained and statistically analyzed. Results: Of the 210 patients, 34 (16.27%) had positive Pap test, 29 (13.87%) had positive VIA and 24 (11.43%) had positive VILI and 31 (14.75%) showed features of cervical intraepithelial neoplasia (CIN) on colposcopy. Of the total of 48 patients in whom either of the screening tests was positive and had undergone cervical biopsy, one had CIN-3, three had CIN-2, 12 had CIN-1, three had carcinoma in situ CIS and 29 reported normal. In our study, 40 patients were picked up as positive by combination of these tests, of which 19 (47.50%) had CIN on biopsy. Conclusion: Our study showed that VIA and VILI had sensitivity comparable to Pap smear and can thus be a suitable potential alternative/adjunctive screening test not only in a resource-poor setting but in well-equipped centers also. And, use of a combination of tests (Pap+VIA+VILI) had 100% sensitivity but at cost of low specificity and more false-positive results.

Keywords

Cervical cancer - Pap smear - visual inspection with acetic acid - visual inspection with Lugol′s iodine


Publication History

Article published online:
02 August 2021

© 2012. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Hakama M, Chamberlain J, Day NE, Miller AB, Prorok PC. Evaluation of screening programmes for gynaecological cancer. Br J Cancer 1985;52:669-73.
  • 2 Hakama M, Miller AB, Day NE, editors. Screening for Cancer of the Uterine Cervix (IARC Scientific Publications No. 76), Lyon: International Agency for Research on Cancer; 1986.
  • 3 Lããrã E, Day NE, Hakama M. Trends in mortality from cervical cancer in the Nordic countries: Association with organised screening programmes. Lancet 1987;329:1247-9.
  • 4 Zahid B, Khawaja N, Tayyeb R. Prevalence of abnormal cervical cytology and its relation with age and parity. Ann King Edward Med Coll 2005;11:524-5.
  • 5 Sankaranarayanan R, Wesley R, Thara S, Dhakad N, Chandralekha B, Sebastian P, et al. Test characteristics of visual inspection with 4% acetic acid (VIA) and Lugol′s iodine (VILI) in cervical cancer screening in Kerala, India. Int J Cancer 2003;106(3):404-8.
  • 6 Fahey MT, Irwig L, Macaskill P. Meta-analysis of Pap test accuracy. Am J Epidemiol 1995;141:680-9.
  • 7 Nanda K, McCrory DC, Myers ER, Bastian LA, Hasselblad V, Hickey JD, et al. Accuracy of the Papanicolaou test in screening for and followup of cervical cytologic abnormalities: a systematic review. Ann Intern Med 2000;132:810-9.
  • 8 Sankaranarayanan R, Basu P, Wesley RS, Mahé C, Keita N, Mbalawa CC, et al. Accuracy of visual screening for cervical neoplasia: Results from an IARC multicentre study in India and Africa. Int J Cancer 2004;110:907-13.
  • 9 Panten J, Adami HO, Bergstrom R, Dillner J, Friberg LG, Gustafsson L, et al. Strategies for Global Control of Cervical Cancer. Int J Cancer 1995;60:1-26.
  • 10 University of Zimbabwe/JHPIEGO Cervical Cancer Project Visual inspection with acetic acid for cervical-cancer screening: test qualities in a primary-care setting. Lancet 1999;353:869-73.
  • 11 Denny L, Kuhn L, Pollack A, Wainwright H, Wright TC Jr. Evaluation of alternative methods of cervical cancer screening for resource-poor settings. Cancer 2000;89:826-33.
  • 12 Sankaranarayanan R, Nene BM, Dinshaw K, Rajkumar R, Shastri S, Wesley R, et al. Early detection of cervical cancer with visual inspection methods: a summary of completed and on-going studies in India. Salud Publica Mex 2003;45 Suppl. 3;S399-407.