Elsevier

Obstetrics & Gynecology

Volume 98, Issue 3, September 2001, Pages 441-444
Obstetrics & Gynecology

Original research
Cervical cancer screening by simple visual inspection after acetic acid

https://doi.org/10.1016/S0029-7844(01)01454-5Get rights and content

Abstract

OBJECTIVE:

To estimate the sensitivity and specificity of visual inspection using acetic acid as a primary screen for cervical intraepithelial neoplasia (CIN).

METHODS:

Visual inspection was done on 1997 women aged 35–45 years in a screening trial in rural China. Each women had colposcopy and at least five cervical biopsies (directed biopsy of lesions, one biopsy at 2, 4, 8, or 10 o’clock at the squamocolumnar junction in each normal quadrant, and an endocervical curettage).

RESULTS:

Forty-three women had biopsy-proven CIN II, 31 had CIN III, and 12 had invasive cancer. In two women only the endocervix was positive (one with CIN II and one with CIN III). Visual inspection yielded normal results in 1445 women (72%), low-grade intraepithelial neoplasia in 525 (26%), high-grade in 21 (1%), and cancer in six (0.3%). With abnormal visual inspection defined as low-grade intraepithelial neoplasia or worse, the sensitivity for detecting biopsy proven CIN II or worse was 71% (61 of 86, 95% confidence interval [CI] 60%, 80%); the specificity was 74% (1420 of 1911, 95% CI 72%, 76%); the sensitivity was 65% for smaller lesions (37 of 57, 95% CI 51%, 77%), and 89% for larger lesions (24 of 27, 95% CI 71%, 98%) (P = .03).

CONCLUSION:

The sensitivity of visual inspection equaled or exceeded reported rates for conventional cervical cytology. Visual inspection and colposcopy have similar specificity profiles for CIN II and greater. The benefit of an inexpensive point-of-care diagnosis and treatment algorithm will be a powerful incentive to pursue visual inspection for cervical cancer screening in developing countries.

Section snippets

Materials and methods

The human subject review boards of both the Cleveland Clinic Foundation and the Cancer Institute/Hospital of the Chinese Academy of Medical Sciences approved the study. Acetic acid (5%) was applied to the cervix and, after waiting 1 minute, the cervix was inspected using a single 100-watt tungsten bulb in a goose-neck style light. A normal cervix had no white lesions. A diagnosis of low-grade cervical intraepithelial neoplasia (CIN) showed pale white lesions that might or might not abut the

Results

Among 1997 women screened, 43 had biopsy-proven CIN II, 31 had CIN III, and 12 had invasive cancer. Thirty-nine women had biopsies with at least CIN II in one quadrant, 18 had at least CIN II in two quadrants, 10 had at least CIN II in three, and 17 had at least CIN II in four quadrants, and two had no ectocervical lesion (they had only ECC positive for CIN II and CIN III). Visual inspection was done on all 1997 women in the study. The visual inspection results were normal in 1445 women (72%),

Discussion

Early efforts at nonmagnified visual diagnosis of cervical cancer did not use acetic acid. The technique was not specific enough to be practical, especially if a see-and-treat algorithm were to be considered. In addition, the focus was on downstaging cancers at detection rather than the detection of preinvasive disease.6, 7, 15 The practical aspect of dealing with the complexities of treating cancers as opposed to preinvasive disease led to efforts that would be more sensitive to detect

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  • Cited by (0)

    Supported by Taussig Cancer Center Cleveland Clinic Foundation, Cleveland, Ohio; Cancer Institute/Hospital, Chinese Academy of Medical Sciences, Beijing, China; Terry Fox Foundation, Burnaby, British Columbia; Transamerica Corporation, San Francisco, California; Digene Corporation, Gaithersburg, Maryland; Cytyc Corporation, Boxborough, Massachusetts; Optical Biopsy Tech, LLC., Knoxville, Tennessee; and Carl Zeiss Inc., Thornwood, New York.

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