Diagnostic Accuracy of Visual Inspection with Acetic Acid for Cervical Neoplasia in Symptomatic Women in a Low-resource Setting: A Prospective Cross-sectional Study
Ananya Kaushik, Ranjana Desai, Swati Gupta, Kiran MirdhaAbstract
Objective:
The objective of this study was to evaluate the diagnostic accuracy of visual inspection with acetic acid (VIA) for the detection of cervical neoplasia in symptomatic women using histopathology as the reference standard.
Design:
The study design was a hospital-based prospective, cross-sectional diagnostic accuracy study.
Setting:
Tertiary care teaching hospital in northern India.
Population:
One hundred and twenty women attending the gynecology outpatient department with complaints suggestive of cervical pathology.
Materials and Methods:
All participants underwent VIA using 3% acetic acid. Cervical biopsy was performed in all of these women. Histopathology served as the reference standard. Diagnostic accuracy parameters were calculated for VIA.
Main Outcome Measures:
Sensitivity, specificity, positive and negative predictive values, likelihood ratios, and diagnostic accuracy.
Results:
The mean age of participants was 35 years (standard deviation: 4.5). VIA was positive in 55% (66/120) of women, while histopathology detected cervical intraepithelial neoplasia or invasive cancer in 48% (58/120). VIA demonstrated a sensitivity of 94.8% (95% confidence interval [CI], 89.1–99.9) and specificity of 82.2% (95% CI, 72.7–91.7).
Conclusions:
VIA demonstrates high sensitivity and acceptable specificity for the detection of cervical neoplasia in symptomatic women and may serve as a pragmatic alternative in low-resource settings where cytology-based screening is unavailable.