Can visual inspection with acetic acid be used as an alternative to Pap smear in screening cervical cancer?

ObjectiveTo evaluate the value of visual inspection with acetic acid (VIA) in screening cervical cancer in comparison to Pap smear.Material and methods200 women attending the obstetric and gynecology Department in Zagazig University hospital from December 2011 to November 2012 were included. They were screened using Pap smear and VIA. Colposcopy was done for all women. Positive cases on any screening test were subjected to cervical biopsy.ResultsAcetic acid (VIA) was positive in 24/200 (12%) patients and Pap smear was abnormal in 8 (4%). There were 5 LSIL, 2 HSIL and one with cells suspicious of malignancy. Colposcopy was recorded abnormal in 35 cases (17.5) .18 cases (51.4%) had a Reid score of 0–2 and considered negative .17 cases (48.6%) had a positive colposcopy (Reid 3–8). Cervical biopsy was done on all 35 cases. 44% biopsies were positive and 56% were negative .15 positive biopsies incorporated 11 mild dysplasia, 2 moderate dysplasia, 1 sever dysplasia and one carcinoma in situ. The Pap smear had a sensitivity of 50.1%, specificity of 93.1%, and positive predictive value of 89.3% and negative predictive value of 65.6%. VIA had a sensitivity of 90%, specificity of 37%, and positive predictive value of 52% and negative predictive value of 81%.ConclusionVIA a good screening, simple test, has low cost and high sensitivity in comparison to Pap smear. So, it can be used as alternative screening modality for cervical cancer in low resource locations.