Comparison of Visual Inspection using Acetic Acid and Liquid Based Cytology for Cervical Cancer Screening in Rural Area: A Cross-Sectional Study

Abstract

Introduction: Cervical cancer is the primary malignancy in Indian women. The most significant method for untimely diagnosis of cancer cervix is cytology screening, but it is not possible to launch nationwide cytology screening programme of cervical cancer. So, this has lead to the development of low cost technology e.g., visual inspection of the cervix after application of acetic acid. Aim: To compare Visual Inspection using Acetic Acid (VIA) and Liquid Based Cytology (LBC) in evaluation of abnormal cervical lesions. Materials and Methods: This was a cross-sectional study conducted on 1600 women who fulfill selection criteria. Patients attending Gynaecology Outpatient Department (OPD) with the following signs and symptoms like vaginal discharge, abnormal uterine bleeding, lowback pain, contact bleeding, and lower abdominal pain were included. After taking informed consent, the participant was subjected to detailed history, physical examination, LBC, VIA and Colposcopy followed by biopsy (if required). The sensitivity and specificity of each test are determined and compared. Data entry and analysis were done using SPSS Inc., version 11.0. Results: In present study, VIA was more sensitive (92.06%) than the LBC (68.25%) for the detection of dysplasia. However, the specificities of VIA (56.76%) and LBC (54.05%) had not much difference. Positive Pedictive Value (PPV) of VIA was 78.38% and Negative Predictive Value (NPV) of VIA was 80.77% while PPV of LBC was 71.67% and NPV of LBC was 50%. The accuracy of VIA (79%) is higher than LBC (63%). Conclusion: The VIA is more sensitive screening modality than LBC. The accuracy of VIA is higher than LBC in detecting premalignant lesion which makes it a suitable and valuable alternative screening method to cytology in poor resource setting.