Accuracy of visual inspection with acetic acid (VIA) for cervical cancer screening: a systematic review

Abstract

Objective: To systematically review the performance characteristics of VIA in cervical cancer screening.

Material and method: The Ovid (Medline) electronic database from January, 1996 to Febuary, 2007 was searched, using the following key search words of (1) MESH term "Uterine Cervical Neoplasms" with subheading "diagnosis", (2) Keywords "sensitivity" or "specificity" and (3) Keyword "visual inspection with acetic acid" Total of 11 studies were relevant and eligible for the review. Histology or combination of Colposcopy and histology were used as gold standard. Abnormal colposcopy must have histological confirmation by material obtained by colposcopic directed biopsy, loop excision, or endocervical curettage. Histologic threshold for positive outcome from screening tests was CIN2 (Cervical Intraepithelial Neoplasia 2) or higher (or equivalent categories by other classifications). A meta-analysis, yielding a quantitative summary measure was implemented with the random effect model.

Results: Using random effect method, the pooled estimates of sensitivity, specificity, positive predictive value and negative predictive value of VIA-VIAM were 71.8%, 79.4%, 16.7% and 99.0% respectively. When comparing with conventional cytology, VIA have favorably characteristics especially sensitivity and negative predictive value.

Conclusion: VIA may be incorporated in cervical cancer screening programme in low resource setting country because of high negative predictive value of the test is sufficiently high to assure screening for negative and CIN I women.