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Naked eye visual inspection with acetic acid versus cervical smear as a screening test for cervical intraepithelial neoplasia.

Ali Nakash, Ali Falih Al-Assadi Zina Abdul Hussein AL-Safi Jasim M AL-Diab

Background: Worldwide, cervical cancer is the second commonest cancer among women. Cervical cancer generally develops slowly over a period of 10-15 years. It is preceded by detectable and treatable precursor conditions. The presence of effective screening programs makes the cervical cancer a preventable condition. Because of the lack of trained cytopathologists and cytology labs, an alternative method of screening is needed for countries with very limited resources and infrastructure. However, simple visual inspection of the cervix after application of acetic acid has been effectively used in resource-poor settings for cervical cancer screening.

Aim of the study: To evaluate the use of naked eye visual inspection with acetic acid (VIA) as an alternative to cervical cytology as a screening test for diagnosis of cervical intraepithelial neoplasia. This study is a prospective comparative study carried out in Basra maternity and children hospital included 156 women between the ages of (25-65) years old, who were attending the outpatient department for deferent gynaecological problems. Both screening tests Pap smear sampling and VIA was performed, and compared the results to histopathology as a diagnostic test and results were analysed statistically. The study included 156 women, Pap smear and VIA was done for all patients respectively and the results were 31 women with positive pap smear and 85 women with positive VIA. All the positive acetowhite (85) and 20 negative acetowhite randomly selected and underwent cervical biopsy and histopathology. The total number included in biopsy sampling was 105 patients.

Results: The results were positive for CIN and cancer in 52 cases. After comparing the results of Pap smear and histopathology the true positive Pap smear results were 24 cases out of 52 and the true positive VIA was 44 cases from 52. The sensitivity of VIA was higher than Pap smear. After dividing the result of VIA to low threshold and high threshold the specificity will increase without loss of sensitivity, and this increment was statistically significant.