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Visual techniques for cervical cancer screening in Colombia
Óscar Gamboa1, Mauricio González, Jairo Bonilla
1Subdirección de Investigaciones y Salud Pública, Instituto Nacional de Cancerología, Bogotá, D.C., Colombia. biomedica@ins.gov.co.
Biomedica : Revista Del Instituto Nacional De Salud
|April 26, 2019
Summary
Direct visual inspection methods like VIA and VIA-VILI show promise for cervical cancer screening, especially in resource-limited settings. While VIA had lower detection and false positive rates than colposcopy, VIA-VILI
Area of Science:
- Gynecology
- Oncology
- Public Health
Background:
- Cervical cancer screening methods, including direct visual inspection (VIA, VIA-VILI) and colposcopy-biopsy, are crucial for early detection of preneoplastic lesions.
- Direct visual inspection remains controversial compared to the gold standard colposcopy-biopsy.
Purpose of the Study:
- To compare the detection and false positive rates of cervical intraepithelial neoplasia grade 2 or more (CIN2+) using direct visual inspection (VIA, VIA-VILI) versus colposcopy.
- To evaluate the performance of different diagnostic thresholds for colposcopy.
Main Methods:
- A study involving 5,011 women aged 25-59 compared direct visual inspection with acetic acid (VIA), visual inspection with Lugol's iodine (VIA-VILI), and colposcopy.
- Histology served as the gold standard; punch biopsies were obtained for all positive tests.
- Sensitivity and false positive rates were calculated and compared across methods and age groups.
Main Results:
- Colposcopy showed positivity rates of 1.6% (high-grade) and 10.8% (low-grade). VIA and VIA-VILI had positivity rates of 7.4% and 9.9%, respectively.
- VIA demonstrated significantly lower detection and false positive rates compared to colposcopy with a low-grade threshold.
- VIA-VILI showed comparable detection and false positive rates to colposcopy's low-grade threshold, but both visual inspection methods had higher rates than colposcopy's high-grade threshold.
Conclusions:
- Visual inspection with Lugol's iodine (VIA-VILI) achieving detection rates similar to colposcopy's low-grade threshold offers potential for reducing cervical cancer mortality via see-and-treat approaches in underserved populations.
- Lower detection rates with VIA suggest a need to reconsider high-grade colposcopy findings as the sole biopsy threshold in specific contexts.
- False positive rates for visual inspection methods were generally higher than for colposcopy across all age groups.
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