Early Detection of Precursors of Cervical Cancer with Cervical Cytology and Visual Inspection of Cervix with Acetic Acid

Abstract

A hospital-based, prospective study was done in 350 women of 20-50 years to compare VIA with
Pap smear for early detection of cervical dysplasia at Maternity Hospital, Thapathali, from May
2004 to December 2004. Pap smear was taken from each woman followed by VIA. Women with
positive VIA and/or positive Pap smear were referred for colposcopy-directed cervical biopsy. The
variables studied were age group, presenting complaint, age of marriage, parity, smoking habit and
appearance of cervix.
The incidence of positive VIA and Pap smear was 2.86 and 0.57 respectively. Pelvic pain was the
most common presenting complaint. The majority of the women were married before 20 years of
age. All women with either positive VIA and/or Pap smear were of parity two or above. There
was no significant association between smoking and positive VIA (P=0.699) or Pap smear (P=0.397).
Approximately 36.57% of the women screened had abnormal looking cervix. There were two women
with high grade intraepithelial lesion (HSIL) and both were VIA positive and this was statistically
significant (Fischer exact P=0.0007). Of the ten VIA positive women, on histopathological examination
six showed chronic cervicitis, one acute cervicitis, one showed cervical intraepithelial neoplasia (CIN)
II, one had normal finding and one was lost to follow up.
VIA as a screening test for cervical neoplasia did not miss any lesion detected by Pap smear and
confirmed by cervical biopsy.
Key words: cervical neoplasia, pap smear, visual inspection