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Background: Cervical cancer is an important reproductive health problem in women and a leading cause of morbidity and mortality of women from cancer in the developing world. Invasive cervical cancers are preceded by a long phase of precancerous lesion which can be detected by screening and treated effectively by simple curative methods, thus preventing invasive cancer.
Aim: The present study is aimed to compare the effectiveness of the Papanicolaou's smear with visual inspection of cervix with acetic acid (VIA) and Lugol's iodine (VILI) for screening of premalignant and malignant lesions of the cervix.
Materials and Methods: The study was a hospital based cross- sectional observational study done on 400 sexually active women above the age of 21 years attending the Gynaecology OPD of Hindu Rao Hospital in close association with the Department of Pathology. Papanicolaou's smear was performed on patients included in the study and the cervix was visually inspected under 3- 5% acetic acid and Lugol's iodine. Biopsy was performed on patients with suspicious lesion on visual inspection. Statistical testing was conducted with the statistical package for the social science system version SPSS 17.0. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy was calculated to analyze the diagnostic value of visual inspection methods and Pap test.
Results: The mean age of the women was 39.16 ± 6.30 years and the mean age at marriage or first sexual contact was 18.94± 3.02 years in our study. Most common presenting complaint among the patients in the present study was white discharge per vaginum (62.3%). The sensitivity, specificity, PPV, NPV and accuracy of VIAwas 81.8%, 88.1%, 52.9%, 96.7% and 82.9% respectively, and 90.9%, 83.6%, 47.6%, 98.2% and 80.5% respectively for VILI. VIA and VILI are more sensitive than conventional cytology in detecting premalignant and malignant lesions of cervix, though they have lower specificity and higher false positive rates. The negative predictive value and diagnostic accuracy of all three tests were comparable.The correlation between VIA/VILI and Pap's test was statistically significant (p value < 0.001 and 0.001).
Conclusion: Cytology based screening programmes are difficult to establish and maintain in developing nations due to lack of resources, trained man power, infrastructure and requirement of multiple visits. Considering the low cost, easy to perform and immediate availability of results, VIA/ VILI can be used as an alternative to Pap test for mass screening of cancer cervix in low resource settings.
Keywords: Visual inspection of cervix; Cytology of cervix; Cervical screening; Visual Inspection with Lugol's Iodine