Accuracy of Visual Inspection with Acetic Acid (VIA) for Cervical Cancer Screening: A Systematic Review
Paskorn Sritipsukho MD*, Yuthadej Thaweekul MD**
Affiliation : * Postgraduate Studies Program, Faculty of Medicine, Thammasat University, Pathumthani, Thailand ** Gynecologic Oncology Unit, Department of Obstetrics & Gynecology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
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 .
Keywords : Systematic review, Meta-analysis, Cervical cancer screening, Visual inspection after acetic acid, VIA, VIAM
