Diagnostic Accuracy of Direct Visual Inspection with 5% Acetic Acid in Cervical Cancer Screening in Low Resource Settings

Abstract

Objective: To determine the diagnostic accuracy of Direct visual inspection (DVI) with 5% acetic acid in cervical cancer screening.

Methodology: This Cross-sectional validation study was conducted in the Outpatient clinic of Obstetrics and Gynecology department of Kahuta Research Laboratories (KRL) hospital, Islamabad between 1st December 2017 to 31st May 2018. After fulfilling the inclusion/exclusion criteria, DVI was performed on women in the outpatient clinic and presence of acetowhite changes in the cervix was considered as positive DVI. Women with positive result with DVI, and those with negative DVI but abnormal looking cervix were called for colposcopic directed biopsy which was considered to be gold standard.2*2 table was constructed to analyse the results for sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy. Positive and negative likelihood ratios (PLR and NLR) were also calculated.

Results: Mean age of the study participants were 34.21 ± 6.32 years. 22 DVI +ve women, and 16 DVI –ve women but with abnormal looking cervix were sent for colposcopic directed biopsy. Biopsy confirmed 17 of the 38 cases of cervical intraepithelial neoplasia (CIN) I/II of which 14 were DVI +ve and 3 were DVI –ve. The sensitivity, specificity, PPV, NPV, PLR, NLR and diagnostic accuracy of DVI were 82.35%, 97.77%, 63.64%, 99.15%, 36.96, 0.18 and 97.07% respectively.

Conclusion: In a developing country like Pakistan where Pap smear is not available in low resource settings, DVI is a very helpful tool in picking up preneoplastic lesions due to its good diagnostic accuracy.