Cervical Cancer Screening: Comparing PAPs Smear with VIA/VILI in Semiurban Women of Delhi

Abstract

Introduction Screening with PAPs smear for screening of cervical cancer has been the gold standard for many years in high-income countries but has still not been successful in low- and middle-income country like India due to unavailability at public ground level. Thus, a simple, effective, and low-cost alternative to cervical cytology for cervical cancer prevention is urgently needed for high-risk, low-resource settings.

Objectives The aim was to compare the efficacy of visual inspection with acetic acid (VIA) and visual inspection with Lugol's iodine (VILI) with the PAP smear for screening precursor intraepithelial lesions and early signs of cervical cancer, and to evaluate their potential as alternative screening methods to the PAP smear in a semiurban population in Delhi.

Materials and Methods A total of 127 married, nonpregnant patients between 18 and 65 years were randomly selected from gynecology outpatient department. Then, PAP smear samples were taken from all patients followed by VIA and VILI. Biopsies were then taken from those who showed positive findings in either of the screening methods. Out of these, 50 PAP and VIA-negative women were included as a control group. The diagnostic accuracy of VIA and VILI was compared with PAP smear, for diagnosis of precancerous lesions.

Results VIA and VILI results were positive in 22 patients out of 127 (17.3%). PAP cytology report showed epithelial cell abnormality in 13 cases (10.2%) with atypical squamous cells of undetermined significance in 1 case, atypical glandular cells of undetermined significance in 4 cases, low-grade squamous intraepithelial lesion in 3 cases, and high-grade squamous intraepithelial lesions in 5 cases. PAP smear had showed better specificity (90.79%) and less sensitivity (85.71%) as compared with VIA and VILI method. Sensitivity of VIA was 100% and specificity was 80.26%. Similar parameters were seen with the VILI method also. The overall p-value for all the parameters of either screening method was > 0.05; hence, both methods are comparable for screening.

Conclusion VIA and VILI can be employed as initial screening tools in place of PAP smear, particularly in countries with limited resources or developing regions.

Keywords

visual inspection by acetic acid (VIA) - visual inspection by Lugol's iodine (VILI) - PAP smear - cancer cervix - screening - low- and middle-income countries (LMIC)

Recommendations

The advantages of affordability, straightforward implementation, and a point-of-care diagnosis and treatment protocol should serve as compelling reasons for developing countries like India to adopt visual inspection as a screening method for cervical cancer.

Patient Consent

Informed patient consent was obtained for this study.

Ethics Statement

This article does not contain any studies with human participants or animals performed by any of the authors. The procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional or regional) and with the Helsinki Declaration of 1975, as revised in 2000. The resources used in the research were totally provided by the hospital and the Municipal Corporation of Delhi. Informed consent was obtained from all individual participants included in the study.

Publication History

Article published online:
11 December 2024

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