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Comparison of Papanicolaou Test With Visual Detection Tests in Screening for Cervical Cancer and Developing the Optimal Strategy for Low Resource Settings
  1. Pakhee Aggarwal, MS,
  2. Swaraj Batra, MD, FICOG,
  3. Gauri Gandhi, MD and
  4. Vijay Zutshi, MD, MICOG
  1. Department of Obstetrics and Gynaecology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.
  1. Address correspondence and reprint requests to Pakhee Aggarwal, MS, C-I/11, Ansari Nagar, AIIMS Campus (E), New Delhi-110029, India. E-mail:


Objectives: To compare the sensitivity, specificity, positive and negative predictive values, and accuracy of Papanicolaou test with visual inspection with acetic acid (VIA)/VIA using magnification devices (VIAM) and develop the best strategy for screening in low resource settings.

Materials and Methods: This is a prospective cross-sectional study on 408 symptomatic multiparous women in the reproductive age group, sequentially using the Papanicolaou test, the VIA, and the VIAM for screening. Women with a positive screening test underwent guided biopsy and endocervical curettage. The site of biopsy was recorded. Histopathological findings were taken as the "gold" standard in comparing the methods.

Results: The mean (SD) age was 32.3 (6.8) years (range, 15-49 years), whereas the mean (SD) parity was 2.9 (1.2) (range, 1-9). Abnormal cytological findings were detected in 2.9% patients, whereas the remaining smears were negative for any intraepithelial lesion or malignancy. A total of 113 cases were screened positive by one/all methods. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the Papanicolaou test, the VIA, and the VIAM were 24, 98, 42, 96, and 94%; 95, 78, 19, 99, and 79%; and 95, 78, 19, 99, and 79%, respectively, for high-grade lesions.

Conclusions: The Papanicolaou test had low sensitivity but high specificity, whereas visual detection methods had a high sensitivity in addition to being cheaper. Alternative methods of screening such as VIA/VIAM can be a valuable alternative to the Papanicolaou test for cervical cancer screening in low resource settings. Visual inspection using magnification devices may be of benefit over VIA in doubtful cases.

  • Cervical cancer screening
  • Visual inspection with acetic acid
  • VIAM
  • Magnavisualizer
  • Papanicolaou test
  • Low resource settings

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