Comparison Of Pap Smear With Visual Inspection With Acetic Acid In Screening Of Carcinoma Cervix

Background: Cervical cancer is the second most common among women globally. In most cases of  Ca Cervix is detected late due to lack of effective screening programme. 
  
Aim: Present aim is to detecting the efficacy of visual inspection of cervix with acetic acid with Pap smear in early detection of carcinoma of cervix. 
Materials and methods:  The cross sectional study conducted in 100 women attending GYN OPD were included in the study. They were screened with Pap smear and VIA, those positive with either of the method were subjected to biopsy. The sensitivity, specificity, PPV and NPV were calculated using biopsy report as the reference standard. 
Results: The mean age of the study subjects and those with screen positivity were 39.04 yrs and 39.96yrs respectively. Multipara constituted majority of the screened positive cases. Among the study group, white discharge was the predominant complaint. Cervix was clinically healthy in (45%) of the patients and unhealthy in rest of the patients. 21.4 %( 3 out of14) of the cases having healthy cervix on examination had dysplasia. VIA was positive in all the 3 cases and Pap smear was positive in only one case. 25% of the patients had positive VIA. 29% of the patients had mild dysplasia, 16.1% of the patients had moderate and severe dysplasia. Pap smear missed 5 cases of dysplasia and VIA missed 1 case of dysplasia. The VIA sensitivity-92.8%, specificity-29.4%,  PPV-52% and  NPV-83%. In pap smear sensitivity-64.2%, specificity-76.4%,  PPV-69.2% and  NPV-72.2% respectively. 
Conclusions: Thus VIA was more sensitive than cytology. Whereas Pap smear was more specific.