Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
권호 표지
DOI QR코드

DOI QR Code

Accuracy of Visual Inspection with Acetic acid in Detecting High-Grade Cervical Intraepithelial Neoplasia in Pre- and Post-Menopausal Thai Women with Minor Cervical Cytological Abnormalities

  • Poomtavorn, Yenrudee (Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University Hospital) ;
  • Suwannarurk, Komsun (Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University Hospital)
  • Published : 2015.04.03
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: To determine the accuracy of visual inspection with acetic acid (VIA) in detecting high-grade cervical intraepithelial neoplasia (CIN) in pre- and post-menopausal women with atypical squamous cells of undetermined significance (ASC-US) and low grade squamous intraepithelial lesion (LSIL) Papanicolaou (Pap) smears. Materials and Methods: Two hundred women (150 pre-menopausal and 50 post-menopausal) with ASC-US and LSIL cytology who attended the colposcopy clinic, Thammasat University Hospital, between March 2013 and August 2014 were included. All women underwent VIA testing and colposcopy by gynecologic oncologists. Diagnostic values of VIA testing including sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for detecting high-grade CIN were determined using the histopathology obtained from colposcopic-directed biopsy as a gold standard. Results: VIA testing was positive in 54/150 (36%) pre-menopausal women and 5/50 (10%) post-menopausal women. Out of 54 pre-menopausal women with positive VIA testing, 15 (27.8%) had high-grade CIN and 39 (72.2%) had either CIN 1 or insignificant pathology. Ten (10.4%), 43 (44.8%) and 43 (44.8%) out of the remaining 96 pre-menopausal women with negative VIA testing had high-grade CIN, CIN 1 and insignificant pathology, respectively. Out of 5 post-menopausal women with positive VIA testing, there were 4 (80%) women with high-grade CIN, and 1 (20%) women with insignificant pathology. Out of 45 VIA-negative post-menopausal women, 42 (93.3%) women had CIN 1 and insignificant pathology, and 3 (6.7%) had high-grade CIN. Sensitivity, specificity, PPV and NPV of the VIA testing were 59.4%, 76.2%, 32.2% and 90.8%, respectively (60%, 68.8%, 27.8% and 89.6% in pre-menopausal women and 57.1%, 97.7%, 80% and 93.3% in post-menopausal women). Conclusions: VIA testing may be used as a screening tool for detecting high-grade CIN in women with minor cervical cytological abnormalities in a low-resource setting in order to lower the rate of colposcopy referral.

Keywords

References

  1. Aggarwal P, Batra S, Gandhi G, Zutshi V (2011). Can visual inspection with acetic acid under magnification substitute colposcopy in detecting cervical intraepithelial neoplasia in low-resource settings? Arch Gynecol Obstet, 284, 397-403. https://doi.org/10.1007/s00404-010-1673-0
  2. Bradford L, Goodman A (2013). Cervical cancer screening and prevention in low-resource settings. Clin Obstet Gynecol, 56, 76-87. https://doi.org/10.1097/GRF.0b013e31828237ac
  3. Castle PE, Qiao YL, Zhao FH, et al (2014). Clinical determinants of a positive visual inspection after treatment with acetic acid for cervical cancer screening. BJOG, 121, 739-46. https://doi.org/10.1111/1471-0528.12646
  4. Chute DJ, Covell J, Pambuccian SE, Stelow EB (2006). Cytologic-histologic correlation of screening and diagnostic papanicolaou tests. Diagn Cytopathol, 34, 503-6. https://doi.org/10.1002/dc.20462
  5. Cremer M, Conlisk E, Maza M, et al (2011). Adequacy of visual inspection with acetic acid in women of advancing age. Int J Gynaecol Obstet, 113, 68-71. https://doi.org/10.1016/j.ijgo.2010.10.018
  6. Cronje HS, Parham GP, Cooreman BF, et al (2003). A comparison of four screening methods for cervical neoplasia in a developing country. Am J Obstet Gynecol, 188, 395-400. https://doi.org/10.1067/mob.2003.153
  7. Dasgupta S, Bhattacharya S (2012). Is visual inspection with acetic acid better than cervical cytology to screen women >40 years of age for carcinoma cervix? A cross-sectional study on proportion of screen-positive women (by VIA and cervical cytology) having CIN II/III lesion on cervical biopsy: difference between two age groups and among screening methods. Arch Gynecol Obstet, 285, 1731-6. https://doi.org/10.1007/s00404-012-2228-3
  8. Denny L, Kuhn L, Pollack A, Wright TC Jr (2002). Direct visual inspection for cervical cancer screening: an analysis of factors influencing test performance. Cancer, 94, 1699-707. https://doi.org/10.1002/cncr.10381
  9. Evans MF, Adamson CS, Papillo JL, et al (2006). Distribution of human papillomavirus types in thinprep papanicolaou tests classified according to the bethesda 2001 terminology and correlations with patient age and biopsy outcomes. Cancer, 106, 1054-64. https://doi.org/10.1002/cncr.21664
  10. Goksedef BP, Akbayir O, Baran SY, et al (2011). Atypical squamous cells of undetermined significance in postmenopausal women: a comparative retrospective analysis. Eur J Obstet Gynecol Reprod Biol, 159, 418-21. https://doi.org/10.1016/j.ejogrb.2011.07.027
  11. Hasanzadeh M, Esmaeili H, Tabaee S, Samadi F (2011). Evaluation of visual inspection with acetic acid as a feasible screening test for cervical neoplasia. J Obstet Gynaecol Res, 37, 1802-6. https://doi.org/10.1111/j.1447-0756.2011.01614.x
  12. Kantathavorn N, Kietpeerakool C, Suprasert P, et al (2008). Clinical relevance of atypical squamous cells of undetermined significance by the 2001 bethesda system: experience from a cervical cancer high incidence region. Asian Pac J Cancer Prev, 9, 785-8.
  13. Khuakoonratt N, Tangjitgamol S, Manusirivithaya S, et al (2008). Prevalence of high grade squamous intraepithelial lesion (HSIL) and invasive cervical cancer in patients with low grade squamous intraepithelial lesion (LSIL) at cervical pap smear. Asian Pac J Cancer Prev, 9, 253-7.
  14. Limpvanuspong B, Tangjitkamol S, Manusirivithaya S, et al (2008). Prevalence of high grade squamous intraepithelial lesions (HSIL) and invasive cervical cancer in patients with atypical squamous cells of undetermined significance (ASC-US) from cervical pap smears. Southeast Asian J Trop Med Public Health, 39, 737-44.
  15. Massad LS, Einstein MH, Huh WK, et al (2013). 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis, 17, 1-27.
  16. Murillo R, Luna J, Gamboa O, et al (2010). Cervical cancer screening with naked-eye visual inspection in Colombia. Int J Gynaecol Obstet, 109, 230-4. https://doi.org/10.1016/j.ijgo.2010.01.019
  17. Nessa A, Nahar KN, Begum SA, et al (2013). Comparison between visual inspection of cervix and cytology based screening procedures in Bangladesh. Asian Pac J Cancer Prev, 14, 7607-11. https://doi.org/10.7314/APJCP.2013.14.12.7607
  18. Parashari A, Singh V (2013). Reasons for variation in sensitivity and specificity of visual inspection with acetic acid (VIA) for the detection of pre- cancer and cancer lesions of uterine cervix. Asian Pac J Cancer Prev, 14, 7761-2. https://doi.org/10.7314/APJCP.2013.14.12.7761
  19. Phongsavan K, Phengsavanh A, Wahlstrom R, Marions L (2011). Safety, feasibility, and acceptability of visual inspection with acetic acid and immediate treatment with cryotherapy in rural Laos. Int J Gynaecol Obstet, 114, 268-72. https://doi.org/10.1016/j.ijgo.2011.03.009
  20. Rochelson B, Krumholz BA (1983). The “unsatisfactory” colposcopic examination. J Reprod Med, 28, 131-6.
  21. Sankaranarayanan R, Wesley RS (2003). A practical manual on visual screening for cervical neoplasia. Lyon: International Agency for Research on Cancer.
  22. Sankaranarayanan R, Basu P, Wesley RS, et al (2004). Accuracy of visual screening for cervical neoplasia: results from an IARC multicentre study in India and Africa. Int J Cancer, 110, 907-13. https://doi.org/10.1002/ijc.20190
  23. Sankaranarayanan R, Gaffikin L, Jacob M, Sellors J, Robles S (2005). A critical assessment of screening methods for cervical neoplasia. Int J Gynaecol Obstet, 89, 4-12. https://doi.org/10.1016/j.ijgo.2005.01.009
  24. Sankaranarayanan R, Nene BM, Dinshaw KA, et al (2005). A cluster randomized controlled trial of visual, cytology and human papillomavirus screening for cancer of the cervix in rural India. Int J Cancer, 116, 617-23. https://doi.org/10.1002/ijc.21050
  25. Sauvaget C, Fayette JM, Muwonge R, Wesley R, Sankaranarayanan R (2011). Accuracy of visual inspection with acetic acid for cervical cancer screening. Int J Gynaecol Obstet, 113, 14-24. https://doi.org/10.1016/j.ijgo.2010.10.012
  26. Solomon D, Davey D, Kurman R, et al (2002). The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA, 287, 2114-9. https://doi.org/10.1001/jama.287.16.2114
  27. Vedantham H, Silver MI, Kalpana B, et al (2010). Determinants of VIA (visual inspection of the cervix after acetic acid application) positivity in cervical cancer screening of woman in a peri-urban area in Andhra Pradesh, India. Cancer Epidemiol Biomarkers Prev, 19, 1373-80. https://doi.org/10.1158/1055-9965.EPI-09-1282