Community Based Study of Comparison between Pap Smear and Visual Inspection of Cervix with Acetic Acid and Lugols Iodine for Detection of Malignant and Premalignant Lesions of Cervix.

Author(s): Dr. Rekha G. Muricken,

BACKGROUND Visual inspection with acetic acid (VIA) and visual inspection with Lugol’s iodine (VILI) is used as a screening method in low resource setting. Introduction of such simpler and easier screening methods will have a long-term effect on the reduction of incidence of cervical carcinoma. The objective of the study was to compare the sensitivity, specificity, positive predictive value, and negative predictive value of VIA and VILI and Pap smear in screening for premalignant cervical intraepithelial lesion and subclinical early cancer cervix in the community. METHODS A community based prospective study involving 500 patients was done, in and around Alappuzha, and Pap smear followed by VIA and VILI were done for all patients. All positive for visual inspection cases and Pap smear, were posted for biopsy cervix and reports of both were analysed based on histopathology report. Data was analysed for finding a better tool for community screening. RESULTS The study found that sensitivity of visual inspection with acetic acid and Lugol’s iodine was the same and was calculated as 86.7%. Positive predictive value of VIA and VILI was 44.8%. The association between VIA, VILI with Pap smear and HPR was statistically significant i.e. p<0.001 for both. Sensitivity of Pap smear was 73.3%. Positive predictive value of Pap smear 40.7%. CONCLUSIONS Both VIA and VILI had equal sensitivity and positive predictive value, which was more when compared to Pap smear. Hence VIA and VILI can be used as a screening procedure for detecting premalignant lesions of cervix.