Published: 2016-12-15

Comparison and correlation of visual inspection with acetic acid, papanicolaou smear and colposcopy in detection of precancerous cervical lesions

Manju Talathi, Girija Wagh


Background: Cervical cancer is a huge emotional and financial burden on society. 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 colposcopy for mass screening of premalignant and malignant lesions of the cervix. The objective of this study was to screen women of 30-45 years of age for precancerous cervical lesions with VIA, Pap smear and colposcopy. And compare and correlate the findings of Pap smear, colposcopy and VIA in detecting precancerous lesions of cervix.

Methods: This was a prospective observational study conducted from 1 January 2015 till 1 June 2016 (36 months) in OPD, department of obstetrics and gynaecology among 500 women of 30-45 years. of age group. Pap smear was performed by the conventional method and then VIA was carried out for all; colposcopy was done in all VIA positive patients.

Results: Out of 500 study group, 364 (72.8%) women were VIA negative and 136 (27.2%) were VIA positive. Pap results in VIA negative women were either NILM or normal, none was with intraepithelial lesions. Out of 136 VIA positive women 42 (34%) pap results were LSIL or HSIL and on colposcopy 59 (44.7%) women had CIN I/II/III.

Conclusions: These results establish VIA as an effective screening test for cancerous and precancerous conditions of the cervix and thus VIA can be implemented as a single primary screening method. Colposcopy can further interpret the VIA positive lesion with almost 100 % sensitivity, specificity, NPV in high grade lesions.



Pap smear, VIA, Colposcopy, Precancerous lesion of cervix, NILM, LSIL, HSIL

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Parkin M. Personal communication, IARC; 2000.

PATH Program for Appropriate Technology in Health. Preventing cervical cancer in low-resource settings. Outlook. 2000;18(1):1-8.

Moss SF, Blaser MJ. Mechanisms of disease: inflammation and origins of cancer. Nat Clin Pract Oncol. 2005;2:907.

Stenkvist B, Bergstrom, Elkland G, Fox CH. Papanicolaou: smear screening and cervical cancer: What can you expect? JAMA. 1984;252:1423.

Day NE. Effect of cervical cancer screening in Scandinavia. Obstet Gynecol. 1984;63:714.

Morrell ND, Taylor JR, Snyder RN, Ziel HK, Saltz A, Willie S. False negative cytology rates in patients in whom invasive cervical cancer subsequently developed. Obstet Gynecol. 1982;60:42.

Berkowitz RS, Ehrmann RL, LaVizo-Mourey R. Invasive cervical cancer in young women. Gynecol Oncol. 1979;8:311.

Richart RM. Screening techniques for cervical neoplasia. Clin Obstet Gynecol. 1979;22:701.

Richart RM. Current concepts in obstetrics and gynaecology. The patient with an abnormal Pap smear screening techniques and management. N Engl J Med. 1980;302(6):332-4.

Richart RM. Evaluation of the true false negative rate in. cytology. Am J Obstet Gynecol. 1964;89:723.

Nayar R, Wilbur DC. The Pap test and bethesda 2014. Acta Cytologica. 2015;59:121-32.

Singh SL, Dastur NA, Nanavati MS. A comparison of colposcopy and papanicolaou smear : sensitivity, specificity and predictive value. BHJ. 2010.

Hegde D, Shetty H, Shetty PK, Rai S. Diagnostic value of acetic acid comparing with conventional Pap smear in the detection of colposcopic biopsy-proved CIN. J of Can Res and Ther. 2011;7(4):454-8.

Consul S, Agrawal A, Sharma H, Bansal A, Gutch M, Jain N. 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. Indian J Med Pediatric Oncol. 2012;33(3):161-5.

Ashmita D, Shakuntala PN, Shubha RR, Sharma SK, Geethanjali S. Comparison and correlation of PAP smear, colposcopy and histopathology in symptomatic women and suspicious looking cervix in a tertiary hospital care centre. IJHSR. 2013;3(5):50-9.