21 maart 2005: Bron: Int J Gynaecol Obstet. 2003 Nov;83(2):141-50.

In de Lancet wordt komende week een studie gepubliceerd over de accuraatheid van VIA = Visual inspection with acetic acid and flashlight oftewel visuele inspectie met een wijnachtig zuur en een lichtbron, een methode om baarmoederhalskankercellen op te sporen die heel eenvoudig is uit te voeren en veel minder kost dan een uitstrijkje. Bovendien is de accuraatheid beduidend hoger dan een uitstrijkje in het opsporen. Vooralsnog lijkt de VIA methode de aangewezen weg voor het opsporen van baarmoederhalskanker in een vroeg stadium te worden. Achtereenvolgens een kort berichtje over artikel uit The Lancet en daarna twee gerandomiseerde studies die het verschil aantonen tussen verschillende opsporingstechnieken van baarmoederhalskanker.

Vinegar Swab detects Precancerous Cervical Lesions

One new way to screen for precancerous or cancerous conditions is a simple low technology and relatively inexpensive method, reported in Lancet.
It turns out that precancerous cervical lesions can be detected by swabbing the cervix with a mild vinegar solution and then observing the tissue with a flashlight.
In the study, if the cervical tissue turned white when exposed to vinegar, it meant possible abnormal cell growth.
The women had Pap smears, followed by the vinegar test, and then checked by biopsy or colposcopy.
The tissue whitening following the vinegar test was 77% accurate in detecting precancerous lesions. Pap smears were only 44% correct (possibly due to flaws in sample collection or in laboratory evaluation).

Int J Gynaecol Obstet. 2005 Jan;88(1):25-30.

Visual inspection of the cervix with acetic acid for cervical intraepithelial lesions.
Goel A, Gandhi G, Batra S, Bhambhani S, Zutshi V, Sachdeva P.
Department of Obstetrics and Gynecology, Maulana Azad Medical College, New Delhi, India. dr_anjugoel@yahoo.co.in

OBJECTIVE: Evaluation of visual inspection of the cervix with acetic acid (VIA) for screening cervical intraepithelial neoplasia. METHODS: In this prospective study, 400 women were screened using the Papanicolaou (PAP) smear, VIA and colposcopy. Those who had positive results with any of the screening methods underwent large loop excision of the transformation zone (LLETZ). The sensitivity and specificity of each of the screening methods was analyzed.

RESULTS: The sensitivity of VIA (96.7%) was much higher than that of the Pap smear (50%), and almost as high as that of colposcopy (100%). The specificity of VIA (36.4%) was lower than that of the Pap smear (97%) and colposcopy (96.9%), resulting in high false-positive rates for VIA. Two cases of endocervical lesions were missed with VIA.

CONCLUSION: Visual inspection of the cervix with acetic acid is very sensitive for ectocervical lesions. The advantages of the VIA method are its low cost and ease of use (it can be used by paramedical workers), its high sensitivity and its immediate results (it is possible to "see and treat" at the first visit). Its main limitation is a high rate of false-positive results, which may lead to overtreatment if a "see and treat" policy is applied.

PMID: 15617701 [PubMed - in process]

Acetic-acid guided visual inspection vs. cytology-based screening for cervical cancer in the Philippines.

Ngelangel CA, Limson GM, Cordero CP, Abelardo AD, Avila JM, Festin MR; UP-DOH CCSHOSG. University of the Philippines Department of Health, Cervical Cancer Screening Health Operations Study Group, National Institutes of Health, Pedro Gil, Ermita, Manila, Philippines.

OBJECTIVES: To compare the validity and acceptability of acetic-acid visualization (VIA), magnified acetic-acid visualization (VIAM), spatula+cotton swab-Papanicolaou (Pap) smear (SS), and cervical brush-Pap smear (CB) in the detection of precursor/early cervical cancer lesions.

METHODS: A total of 12992 women aged between 25 and 65 years from 14 Philippine centers were randomly allocated to the four tests. The gold standard was colposcopy with biopsy for positive/suspicious cases.

RESULTS: Sensitivity rates [95% confidence intervals (CIs)] were 37 (CI, 26.8-48.5), 34.1 (CI, 24.8-44.8), 14.3 (CI, 6.4-27.8), and 19.1 (CI, 9.2-34.6) for VIA, VIAM, SS, and CB, respectively. Specificity rates were 90.7 (CI, 89.6-91.7), 90.7 (CI, 89-91.1), 97.5 (CI, 96.8-98), and 97.9 (CI, 97.3-98.4), respectively. Kappa for the Pap smear (PS) within centers ranged from -0.154 to 0.783, and between centers from -0.028 to 0.364. Screeners preferred CB; screened-women preferred VIA.

CONCLUSIONS: The acetic-acid visualization and VIAM methods are recommended for initial cervical cancer screening in the Philippines.

PMID: 14550588 [PubMed - indexed for MEDLINE]

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