Cervical cancer screening by simple visual inspection after acetic acid

OBJECTIVE: To estimate the sensitivity and specificity of visual inspection using acetic acid as a primary screen for cervical intraepithelial neoplas ia (CIN). METHODS. Visual inspection was done on 1997 women aged 35-45 years in a scr eening trial in rural China. Each women had colposcopy and at least five ce rvical biopsies (directed biopsy of lesions, one biopsy at 2, 4, 8, or 10 o 'clock at the squamocolumnar junction in each normal quadrant, and an endoc ervical curettage). RESULTS: Forty-three women had biopsy-proven CIN II, 31 had CIN III, and 12 had invasive cancer. In two women only the endocervix was positive (one wi th CIN II and one with CIN III). Visual inspection yielded normal results i n 1445 women (72%), low-grade intraepithelial neoplasia in 525 (26%), high- grade in 21 (1%), and cancer in six (0.3%). With abnormal visual inspection defined as low-grade intraepithelial neoplasia, or worse, the sensitivity for detecting biopsy proven CIN II or worse was 71% (61 of 86, 95% confiden ce interval [CI] 60%, 80%); the specificity was 74% (1420 of 1911, 95% CI 7 2%, 76%); the sensitivity was 65% for smaller lesions (37 of 57, 95% CI 51% , 77%), and 89% for larger lesions (24 of 27, 95% CI 71%, 98%) (P = .03). CONCLUSION: The sensitivity of visual inspection equaled or exceeded report ed rates for conventional cervical cytology. Visual inspection and colposco py have similar specificity profiles for CIN II and greater. The benefit of an inexpensive point-of-care diagnosis and treatment algorithm will be a p owerful incentive to pursue visual inspection for cervical cancer screening in developing countries. (C) 2001 by the American College of Obstetricians and Gynecologists.