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543 Triaging low-grade cervical smears: comparative analysis of VIA, colposcopy, and HPV 16/18 genotyping for high-grade cervical lesion detection
  1. Saloni Chadha and
  2. Gauri Gandhi
  1. Lok Nayak Hospital, Delhi, India


Introduction/Background Cervical cancer is a significant global health concern, and early detection is vital for effective management. Low-grade cervical smears like Atypical Squamous Cells of Undetermined Significance (ASCUS) and Low-grade Squamous Intraepithelial Lesion (LSIL) require accurate triage to identify high-grade lesions such as Cervical Intraepithelial Neoplasia (CIN 2 and CIN 3). Several triage methods, such as Visual Inspection with Acetic acid (VIA), Colposcopy, and HPV 16/18 Genotyping, have been explored to improve accuracy and reduce unnecessary interventions.

Methodology Over 18 months, 89 women with low-grade smears (54 ASCUS, 35 LSIL) were recruited from Lok Nayak Hospital and ICMR. Each participant underwent VIA, Colposcopy, and guided cervical biopsy, with histopathology as the reference standard for comparison. HPV 16/18 Genotyping was performed using PCR, excluding nine samples with inadequate DNA. The study employed a prospective cross-sectional design.

Data were meticulously analyzed using SSPS version 25. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy for each triage test were calculated, with histopathology as the gold standard.

Results The combined evaluation of all low-grade smears revealed that HPV 16/18 Genotyping displayed a sensitivity of 66.7%, specificity of 77.1%, and accuracy of 83.5% (p = 0.03). The calculated PPV and NPV for this test were 10.4% and 90.1%, respectively.

VIA demonstrated a sensitivity of 83.3% and a specificity of 80.4%, with PPV and NPV values of 22.7% and 98.5%, respectively. For colposcopy, both sensitivity and specificity were 83.3%, while the PPV and NPV were 23.8% and 98.5%, respectively.

Conclusion The study findings suggest that all three triage methods (VIA, Colposcopy, and HPV 16/18 Genotyping) exhibit reasonably accurate performance in predicting High-Grade Cervical Lesions among women with low-grade smears. In Low resource setting, the credibility of VIA should not be undervalued, especially when compared to newer, albeit more expensive, methods that offer similar accuracy.

Disclosures None.

Abstract 543 Table 1

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