TY - JOUR
T1 - Accuracy of visual screening for cervical neoplasia
T2 - Results from an IARC multicentre study in India and Africa
AU - Sankaranarayanan, Rengaswamy
AU - Basu, Parthasarathy
AU - Wesley, Ramani S.
AU - Mahe, Cédric
AU - Keita, Namory
AU - Mbalawa, Charles C.Gombe
AU - Sharma, Rameshwar
AU - Dolo, Amadou
AU - Shastri, Surendra S.
AU - Nacoulma, Marius
AU - Nayama, Madi
AU - Somanathan, Thara
AU - Lucas, Eric
AU - Muwonge, Richard
AU - Frappart, Lucien
AU - Parkin, D. Maxwell
PY - 2004/7/20
Y1 - 2004/7/20
N2 - Visual inspection-based screening tests, such as visual inspection with 4% acetic acid VIA) and with Lugol's iodine (VILI), have been proposed as alternatives to cytology in mass screening programs. To date, there is only limited information on the accuracy of these tests in detecting High-grade Squamous Intraepithelial Lesions (HSIL). Eleven cross-sectional studies involving 56,939 women aged 25-65 years were conducted in Burkina Faso, Congo, Guinea, India, Mali and Niger to evaluate the accuracy of VIA and VILI performed by health workers. A common protocol and questionnaire was used. For final diagnosis, all women were investigated with colposcopy and biopsies were taken when necessary. Data from the studies were pooled to calculate sensitivity, specificity and predictive values of the tests for the detection of HSIL. Of the screened women, 16.1% and 16.4% were positive on examination using, respectively, VIA and VILI; 1,063 were diagnosed with HSIL. The pooled sensitivity, specificity, positive and negative predictive values for VIA were 76.8% (95% CI: 74.2-79.4%), 85.5% (95% CI: 85.2-85.8%), 9.4% (95% CI:8.8-10.8%) and 99.5% (95% CI:99.4-99.6%), respectively. The values were 91.7% (95% CI: 89.7-93.4%), 85.4% (95% CI: 85.1-85.7%), 10.9% (95% CI: 10.2-11.6%) and 99.8% (95% CI:99.7-99.9%), respectively for VILI. The range of sensitivity and specificity for VIA was 56.1-93.9% and 74.2-93.8%, respectively, between studies and were 76.0-97.0% and 73.0-91.3% for VILI. VILI had a significantly higher sensitivity than VIA in detecting HSIL, but specificity was similar. VILI appears to be a more accurate visual test for use in screening and treatment programs in low-resource settings.
AB - Visual inspection-based screening tests, such as visual inspection with 4% acetic acid VIA) and with Lugol's iodine (VILI), have been proposed as alternatives to cytology in mass screening programs. To date, there is only limited information on the accuracy of these tests in detecting High-grade Squamous Intraepithelial Lesions (HSIL). Eleven cross-sectional studies involving 56,939 women aged 25-65 years were conducted in Burkina Faso, Congo, Guinea, India, Mali and Niger to evaluate the accuracy of VIA and VILI performed by health workers. A common protocol and questionnaire was used. For final diagnosis, all women were investigated with colposcopy and biopsies were taken when necessary. Data from the studies were pooled to calculate sensitivity, specificity and predictive values of the tests for the detection of HSIL. Of the screened women, 16.1% and 16.4% were positive on examination using, respectively, VIA and VILI; 1,063 were diagnosed with HSIL. The pooled sensitivity, specificity, positive and negative predictive values for VIA were 76.8% (95% CI: 74.2-79.4%), 85.5% (95% CI: 85.2-85.8%), 9.4% (95% CI:8.8-10.8%) and 99.5% (95% CI:99.4-99.6%), respectively. The values were 91.7% (95% CI: 89.7-93.4%), 85.4% (95% CI: 85.1-85.7%), 10.9% (95% CI: 10.2-11.6%) and 99.8% (95% CI:99.7-99.9%), respectively for VILI. The range of sensitivity and specificity for VIA was 56.1-93.9% and 74.2-93.8%, respectively, between studies and were 76.0-97.0% and 73.0-91.3% for VILI. VILI had a significantly higher sensitivity than VIA in detecting HSIL, but specificity was similar. VILI appears to be a more accurate visual test for use in screening and treatment programs in low-resource settings.
KW - Accuracy
KW - Acetic acid
KW - Cervical neoplasia
KW - Lugol's iodine
KW - Screening
KW - Sensitivity
KW - Specificity
KW - VIA
KW - VILI
KW - Visual inspection
UR - http://www.scopus.com/inward/record.url?scp=2942526835&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=2942526835&partnerID=8YFLogxK
U2 - 10.1002/ijc.20190
DO - 10.1002/ijc.20190
M3 - Article
C2 - 15170675
AN - SCOPUS:2942526835
SN - 0020-7136
VL - 110
SP - 907
EP - 913
JO - International journal of cancer
JF - International journal of cancer
IS - 6
ER -