Comparative study of visual inspection of the cervix using acetic acid (VIA) and Papanicolaou (Pap) smears for cervical cancer screening

This article is a comparative study of two screening methods for pre-invasive lesions of the cervix. The Papanicolaou (Pap) smear, an old and tested screening method, is compared with the findings from visual inspection of the cervix following acetic acid (VIA) wash. VIA is a new screening method being advocated by the World Health Organization as an alternative to Pap smear in low-resource settings. OBJECTIVE: The objective of this article is to compare the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of VIA and Pap smear. METHODS: This was a comparative study carried out in the postnatal clinic of Ahmadu Bello University Teaching Hospital, Zaria. Pap smear samples were taken by the researcher. Samples were fixed in 95% ethyl alcohol and taken to the Pathology Department for interpretation. The cervix was then painted with 3–5% VIA and observed for aceto-white lesions. Suspected areas were biopsied and transported to the Pathology Department for interpretation. Patients with positive Pap smear results were also called back for biopsy. Biopsy served as the reference standard. RESULTS: There were 351 samples that were suitable for statistical analysis. The sensitivity of VIA was 60%, specificity 94.4%, positive predictive value 50%, negative predictive value 99.4%, and accuracy was 98.6%. Pap smear had a sensitivity of 60%, specificity of 100%, positive predictive value of 100%, negative predictive value of 99.4%, and accuracy of 99.4%. CONCLUSIONS: VIA had a comparable result with Pap smear. It should be incorporated into our national screening programme to complementthe cervical cytology in low-resource settings similar to ours.