A STUDY OF AGREEMENT BETWEEN VISUAL INSPECTION WITH ACETIC ACID OF CERVIX AND PAP SMEAR FOR CERVICAL CANCER SCREENING
AbstractBackground: One of the common causes of mortality and morbidity among young women is cervical cancer. Following a wash of cervix through acetic acid, the Papanicolaou (PAP) smears and the visual inspection with acetic acid (VIA), are compared. Objective of the study was to check the level of agreement between the PAP smear for cancer of cervix and VIA. Methods: It is a cross-sectional study and was carried out in Obstetrics and Gynaecology department, Sheikh Zaid Hospital, Lahore, Pakistan. All patients were put in lithotomy position and vaginal speculum was applied and pap smear taken followed by 5% acetic acid application to cervix and changes in the cervix noted down. Results: Patients with mean age 48±7.795 years were included. In 30 (12%) and 61 (24.4%) patients diagnosis of cervical cancer was positive on PAP smear and VIA respectively. The agreement between two test was significant with Kappa value = 0.322 and p-value ≤ 0.00. Conclusion: Our study revealed that agreement of PAP smear is almost 80%. VIA on the other hand can be used when there is no access to PAP smear. Keywords: Cervical cancer screening; Visual Inspection with acetic acid (VIA); Pap smear
Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN, 2008. Int J Cancer 2010;127(12):2893–917.
Shastri SS, Dinshaw K, Amin G, Goswami S, Patil S, Chinoy R, et al. Concurrent evaluation of visual, cytological and HPV testing as screening methods for the early detection of cervical neoplasia in Mumbai, India. Bull World Health Organ 2005;83(3):186–94.
Shapiro K, Ottolenghi E, Claeys P, Petitpierre J. Comprehensive cervical cancer control: a guide to essential practice. Geneva: World Health Organization, 2006; p.272.
Sherigar B, Dalal A, Durdi G, Pujar Y, Dhumale H. Cervical Cancer Screening by Visual Inspection with Acetic Acid- Interobserver Variability between Nurse and Physician. Asian Pac J Cancer Prev 2010;11(3):619–22.
Gaffikin L, McGrath JA, Arbyn M, Blumenthal PD. Visual inspection with acetic acid as a cervical cancer test: accuracy validated using latent class analysis. BMC Med Res Methodol 2007;7:36.
Denny L, Quinn M, Sankaranarayanan R. Chapter 8: Screening for cervical cancer in developing countries. Vaccine 2006;24(Suppl 3):S3/71–7.
Vedantham H, Silver MI, Kalpana B, Rekha C, Karuna B, Vidyadhari K, et al. Determinants of VIA (Visual Inspection of the Cervix after Acetic Acid Application) positivity in Cervical Cancer Screening of Women in a peri-urban area in Andhra Pradesh, India, Cancer Epidemiol Biomarkers Prev 2010;19(5):1373–80.
Eftekhar Z, Yarandi F, Moosavi A, Yarandi F, Brojerdi R. Accuracy of acetic acid 5% in early detection of cervical dysplasia. Iran J Obstet Gynecol Infertil 2000;1(4):9–13.
Denny L, Kuhn L, Pollack A, Wright TC Jr. Direct visual inspection for cervical cancer screening: an analysis of factors influencing test performance. Cancer 2002;94(6):1699–707.
Murillo R, Luna J, Gamboa O, Osorio E, Bonilla J, Cendales R. Cervical cancer screening with naked-eye visual inspection in Colombia. Int J Gynaecol Obstet 2010;109(3):230–4.
Keshavarzi F, Nankali A, Fakheri T, Rezaei M, Khoshay A, Eslamizadeh N, et al. Cervical visual inspection with acetic acid as an alternative screening test for cervical cancer detection. Int J Collab Res Intern Med Public Health 2013;5(1):60.
Kumar Y, Mishra G, Gupta S, Shastri S. Cancer screening for women living in urban slums -acceptance and satisfaction. Asian Pac J Cancer Prev 2011;12(7):1681–5.
Luciani S, Munoz S, Gonzales M, Delgado JM, Valcarcel M. Effectiveness of cervical cancer screening using visual inspection with acetic acid in Peru. Int J Gynaecol Obstet 2011;115(1):53–6.
Hasanzadeh M, Esmaeili H, Tabaee S, Samadi F. Evaluation of visual inspection with acetic acid as a feasible screening test for cervical neoplasia. J Obstet Gynaecol Res 2011;37(12):1802–6.
Sankaranarayanan R, Esmy PO, Rajkumar R, Muwonge R, Swaminathan R, Shanthakumari S, et al. Effect of visual screening on cervical cancer incidence and mortality in Tamil Nadu, India: a cluster-randomised trial. Lancet 2007;370(9585):398–406.
Sherigar B, Dalal A, Durdi G, Pujar Y, Dhumale H. Cervical cancer screening by visual inspection with acetic acid - interobserver variability between nurse and physician. Asian Pac J Cancer Prev 2010;11(2):323–6.
Albert S, Oguntayo O, Samaila M. Comparative study of visual inspection of the cervix using acetic acid (VIA) and Papanicolaou (Pap) smears for cervical cancer screening. Ecancermedicalscience 2012;6:262.
Goyal S, Tandon P, Bhutani N, Gill BK. To study the role of visual inspection of cervix with acetic acid (VIA) in cervical cancer screening. Int J Reprod Contracept Obstet Gynecol 2017;3(3):684–7.
Ajenifuja KO, Gage JC, Adepiti AC, Wentzensen N, Eklund C, Reilly M, et al. A population-based study of visual inspection with acetic acid (VIA) for cervical screening in rural Nigeria. Int J Gynecol Cancer 2013;23(3):507–12.
Arbyn M, Sankaranarayanan R, Muwonge R, Keita N, Dolo A, Mbalawa CG, et al. Pooled analysis of the accuracy of five cervical cancer screening tests assessed in eleven studies in Africa and India. Int J Cancer 2008;123(1):153–60.
Rana T, Zia A, Sher S, Tariq S, Asghar F. Comparative evaluation of PAP smear and visual inspection of acetic acid (VIA) in cervical cancer screening program in Lady Willingdon Hospital, Lahore. Ann King Edw Med Univ 2010;16(1 SI).