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Direct visual inspection for cervical cancer screening
Author(s) -
Denny Lynette,
Kuhn Louise,
Pollack Amy,
Wright Thomas C.
Publication year - 2002
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.10381
Subject(s) - medicine , magnification , chlamydia trachomatis , colposcopy , cervix , gynecology , cervical cancer , gonorrhea , squamous intraepithelial lesion , cancer , pathology , radiology , cervical intraepithelial neoplasia , human immunodeficiency virus (hiv) , virology , computer science , computer vision
BACKGROUND The authors evaluated direct visual inspection of the cervix after the application of 5% acetic acid (DVI) as a cervical cancer screening test for use in low‐resource settings. METHODS Four tests were used to screen 2754 previously unscreened women: DVI with and without ×4.5 magnification and differentiating between all lesions and well‐circumscribed lesions; testing for high‐risk types of human papillomavirus DNA using the Hybrid Capture II assay, cervical cytology, and Cervicography™. Women with positive results on any of the four screening tests were referred for colposcopy and histologic sampling. All women were tested for N. gonorrhea, C. trachomatis, T. vaginalis, and human immunodeficiency virus 1. RESULTS Histologically confirmed carcinoma was diagnosed in 21 women (0.8%), high‐grade squamous intraepithelial lesions (SILs) were diagnosed in 96 women (3.5%), and low‐grade SILs were diagnosed in 102 women (3.7%). The estimated sensitivity of DVI when performed without magnification for high‐grade SILs was 70%, with an estimated specificity of 79%. Magnification did not significantly improve sensitivity for high‐grade SILs (74% with magnification) but significantly reduced specificity (77%). Restricting the definition of a positive DVI test to a well‐defined acetowhite lesion reduced sensitivity and significantly improved specificity. Infection with T. vaginalis, N. gonorrhea, and C. trachomatis did not alter sensitivity or specificity. CONCLUSIONS This study confirmed the utility of DVI as a primary screening test. Evaluation of the clinical effectiveness of screening with this low‐cost and simple test in low‐resource settings is necessary. Cancer 2002;94:1699–707. © 2002 American Cancer Society. DOI 10.1002/cncr.10381