Abstract

Surprisingly Cancer of the cervix uteri is the second most common of cancer among woman worldwide and most common cancer in Indian woman. It is the one of the leading cause of cancer mortality, accounting for 17% of all cancer deaths among women aged between 30-69 years. The sensitivity of conventional Pap smear for screening of cancer cervix is reduced to less than 50% due to poor quality of sampling and preparation, presence of obscuring blood, inflammation and overlapping epithelial cells. This gave rise to false positive and false negative test results for which combining with VIA (visual inspection of cervix with acetic acid) increases the sensitivity and specificity for detection of precancerous lesions of cervix. Aims and Objectives: (1) To study the role of VIA and Pap smear in screening of pre-malignant lesion of cervix. (2) To compare the sensitivity and specificity of the above in diagnosing cervical cancer.(3) To correlate the findings of Pap smear, VIA and histopathology of cervical biopsy. Materials and Methods: This is a cross sectional study involving a total of 200 woman who were recruited in the outpatient department of Gynecology, MKCG Medical College, Berhampur; Odisha. The recruited women were from the age group 30-65 yrs of age with no previous history of hysterectomy and came with various complaints. After clinical history, cases subjected for Pap smear and subsequently application of 3-5 % acetic acid and observation after 30 sec. Biopsy was done if either VIA positive or Pap positive or suspicious .VIA results were documented as positive or negative and Pap smear as per Bethesda system. Results : Comparison VIA with HP study reports gives sensitivity of VIA : 88.09 %, specificity of VIA : 77.2 %, disease prevalence : 21 %, positive predictive value(PPV) : 50.68 % , negative predictive value(NPV) : 96.06 %, false negative rate(FNR) : 11.9 %, false positive rate(FPR) : 22.7 %, accuracy : 79.5 %, Chi square test : 61.0625. P value is 0.005 indicating that significant association between VIA and HP study report. Combined efficacy of Pap test and VIA revealed the sensitivity : 66.66 %, specificity : 98.73 %, PPV : 93.33 %, FNR : 6.67%, NPV : 91.76%, FPR : 8.24 %, accuracy : 92 %, Chi square test : 111.309 and p value : 0.0001 (p value is <0.05). Combined procedure is also significant. Among comparison between Pap, VIA and Combined procedure, VIA has the highest sensitivity and combined tests has the highest specificity. Conclusion: The Pap smear has been regarded as gold standard of cervical screening programs. The VIA is accurate screening test and suitable alternative to Pap smear. Thus by combining VIA along with Pap smear we can maximize the sensitivity and specificity of cancer cervix screening, which are more cost effective and practically implementable.

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