Magnivisualizer in the early detection of cervical neoplasia

colleagues [1] describe the performance of a simple magnifying device called 'Magnivisualizer' in the early detection of high-grade cervical neoplasia and cervical cancer in a high-risk symptomatic population in a tertiary teaching hospital in New Delhi, India. The Magnivisualizer is a portable, monocular, illuminated magnifying device (×2 to ×5) that can be used for one form of magnified visual inspection of the cervix after application of 3% to 5% acetic acid (VIAM). It has been reported to be of value in the early detection of cervical and oral precancerous lesions in previous cross-sectional studies involving 400 to 1,300 subjects conducted by the authors of the current study [2-4]. In the current study involving 659 symptomatic women, Magnivisualizer based magnified visual inspection with acetic acid (VIAM) was associated with a similar test positivity rate (25% [168/659] vs. 22% [145/659]), higher sensitivity to detect cervical intraepithelial neoplasia grade 2 (CIN 2) or worse lesions including invasive cervical cancer (88% [53/60] vs. 62% [37/60]) compared with naked visual inspection with acetic acid (VIA); if the entire study sample (n=659) is taken into account for analysis and a gold standard consisting of both colposcopy (when no colposcopic abnormalities are visu-alised and consequently no biopsies are directed) and biopsy (when colposcopic abnormalities are detected) as reference standard (as has been the case in most cross-sectional studies assessing any form of visual screening for cervical neoplasia), the specificities of both VIA and VIAM are similar in this study. In my view, this study again proves, as in previous studies [5-7], that the test characteristics of VIA and VIAM (irrespective of whether a simple 2× or 3× lens or Magnivisualizer is used) as primary screening tests are similar, if the definition of true positive disease includes invasive cancer in addition to CIN 2 and CIN 3 lesions. On the other hand, if the definition of true positive lesions includes only CIN 2 and CIN 3 lesions, the sensitivity of VIAM in this study is significantly higher than that of VIA (83% [34/41] vs. 54% [22/41]). Many consider CIN 3 as the true precursor of cervical cancer. If CIN 3 alone is taken as the true positive disease, VIAM detected a higher proportion (79% [26/33]) as compared to VIA (58% [19/33]). Thus VIAM using Magnivisual-izer seems to have a higher performance than naked eye VIA in detecting high-grade precursor lesions in this small cross-sectional study. Much larger cross-sectional …