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Cited by 319Cervical Cancer and HPV ResearchWomen's cancer prevention and managementReproductive tract infections research

Accuracy of visual screening for cervical neoplasia: Results from an IARC multicentre study in India and Africa

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Sankaranarayanan, Rengaswamy, Basu, Parthasarathy, Wesley, Ramani S., Mahe, Cédric, Keita, Namory, Mbalawa, Charles C. Gombe, Sharma, Rameshwar, Dolo, Amadou +9 more·2004·International Journal of Cancer
DOI 10.1002/ijc.20190
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Abstract

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. © 2004 Wiley‐Liss, Inc.

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  • VIA leads to an excess detection of low-grade abnormalities due to the naked eye-detectable acetowhitening of lesions.

    “It is obvious that VIA leads to an excess detection of low-grade abnormalities, due to the naked eye-detectable acetowhitening of lesions.7,19”

    From A cluster randomized controlled trial of visual, cytology and human papillomavirus screening for cancer of the cervix in rural India (2005) · cites this paper as [7]

    The Test methods section describes VIA findings becoming visible after acetic acid application, and Table I defines a positive VIA result by visible acetowhite lesions. Table IV in Test results reports 1,640 VIA-positive women with low-grade lesions. The paper does not establish that VIA causes *excess* detection of low-grade abnormalities or attribute such an excess specifically to acetowhitening; page numbers are unavailable in our copy. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • VIA has a higher sensitivity but lower specificity than cytology in developing countries.

    “Reportedly, VIA has a higher sensitivity but lower specificity than that of cytology in developing countries.5,7”

    From A cluster randomized controlled trial of visual, cytology and human papillomavirus screening for cancer of the cervix in rural India (2005) · cites this paper as [7]

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Research works printed but not linked: 7

  1. Robles SC, White F, Peruga A. Trends in cervical cancer mortality in the Americas. Bull Pan Am Health Organ 1996;30:290 -301.
  2. Sankaranarayanan R, Wesley R. A practical manual on visual screen- ing for cervical neoplasia: IARC Technical Publication No. 41. Lyon: International Agency for Research on Cancer, IARC Press, 2003.
  3. Sellors J, Sankaranarayanan R. Colpscopy and treatment of cervical intraepithelial neoplasia: a beginners' manual: IARC non-serial pub- lication. Lyon: IARC Press, 2003.
  4. Choi BCK. Sensitivity and specificity of a single diagnostic test in the presence of work up bias. J Clin Epidemiol 1992;45:581-6.
  5. Schiller W. Early diagnosis of carcinoma of the cervix. Surg Gynecol Obstet 1933;66:210 -20.
  6. Megavand E, Denny L, Dehaeck K, Soeters R, Bloch B. Acetic acid visualization of the cervix: an alternative to cytologic screening. Obstet Gynaecol 1996;88:383-6.
  7. Kuhn L. Denny L. Pollack A, Lorincz A, Richart RM, Wright TC. Human papillomavirus testing for cervical cancer screening in low- resource settings. J Natl Cancer Inst 2000;92:818 -25.

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Authors
Sankaranarayanan, R., Basu, P., Wesley, R. S., Mahe, C., Keita, N., Mbalawa, C. C. G., Sharma, R., Dolo, A., Shastri, S. S., Nacoulma, M., Nayama, M., Somanathan, T., Lucas, E., Muwonge, R., Frappart, L., Parkin, D. M., & for the IARC Multicentre Study Group on Cervical Cancer Early Detection
Affiliations
  • Centre international de recherche sur le cancer (FR)
  • Chittaranjan National Cancer Institute (IN)
  • Regional Cancer Center, Thiruvananthapuram (IN)
  • Bhagwan Mahaveer Cancer Hospital and Research Centre (IN)
  • Tata Memorial Hospital (IN)
  • Hôpital Edouard Herriot (FR)
Corresponding author
Sankaranarayanan, Rengaswamy
ORCID
Venue
International Journal of Cancer
Publisher
Wiley
Published
2004-05-26
Volume
110
Issue
6
Pages
907-913
ISSN
  • 0020-7136 (ISSN-L)
  • 1097-0215
DOI
10.1002/ijc.20190
OpenAlex
W2068498451
Cited by
319
References
25
Citations by year
2026: 8 · 2025: 9 · 2024: 8 · 2023: 6 · 2022: 11 · 2021: 11 · 2020: 10 · 2019: 11 · 2018: 10 · 2017: 21 · 2016: 11 · 2015: 25 · 2014: 17 · 2013: 19 · 2012: 21
FWCI
12.18
Type
journal article
Language
en
Open access
Licence
Locations
  • International Journal of Cancer (publishedVersion, other-oa)
  • PubMed (publishedVersion)
Funders
  • Bill and Melinda Gates Foundation
  • PATH
  • National Cancer Institute
Topics
  • Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
  • Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
Keywords
cervical cancer screening, visual inspection with acetic acid, visual inspection with Lugol's iodine, high-grade squamous intraepithelial lesion, screening accuracy, sensitivity and specificity, predictive value, resource-limited settings, colposcopy, Africa, India, sub-Saharan Africa, South Asia
MeSH terms
Adult, Africa, Aged, Biopsy, Uterine Cervical Neoplasms, Colposcopy, Demography, Female, Geography, Humans, India, Mass Screening, Menopause, Middle Aged, Predictive Value of Tests, Reproducibility of Results, Age Distribution

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