Assessing alternate technique Visual inspection with acetic acid (VIA) for screening of Carcinoma of cervix in Situ for low resource countries like India

Background and Objective: A Clinic initiated community oriented cross sectional study to assess efficacy of VIA Technique in Screening of Carcinoma of cervix in Situ was conducted by department of Tahaffuzi-wa-Samaji Tib (Preventive and Social Medicine), Jamia Hamdard, New Delhi. The General Objective of the study was to evaluate accuracy of VIA technique (visual inspection with acetic acid) as a screening tool for carcinoma in situ. Methods: After informed consent had been obtained from the subjects, the eligible subjects were first laid in lithotmy position and Pap smear was taken by scraping cervix with Ayer’s spatula. Then 5% acetic acid was applied on cervix and findings were noted after one minute. Definite acetowhite lesions near the transformation zone were regarded as positive. Relative sensitiv ity, specificity, Positive predictive value and negative predictive value of VIA relative to Pap smear was calculated. McNemar’s test was applied for test of significance of effectiveness of VIA by group comparison of paired samples. Results: Relative sensitivity of VIA was 62.5%.Relative Specificity of VIA was 85.5%.Relative Positive predictive value of VIA was 27.7%.Relative negative predictive value of VIA was 96.25%. Conclusion: VIA was found to be more effective in detecting Cervical Intraepithelial Lesion (CIN) than Pap smear and the difference was statistically significant (Mc Nemar’s χ 2 =6.25; Mc Nemar’s with Yates’s Correction χ2=5.06, both statistically significant at d.f 1 and C.I 95%).Relative negative predictive value being high ,it can be used in low resource settings like India at primary care level and will play important role in prevention of Carcinoma of cervix in situ.