Comparison of cervical cancer screening by visual inspection with acetic acid versus cervical-cytology in pregnancy

Abstract

Aims: The aim of this study was to compare visual inspection with acetic acid (VIA) with cervical cytology for cervical cancer screening in pregnant women. Settings and Design: A prospective cohort study was conducted after institutional ethical committee approval in a tertiary care hospital in Northern India. Pregnant women of gestational age <28 weeks were randomly recruited from the antenatal clinic. Subjects and Methods: All eligible women had a Pap smear followed by VIA; colposcopy was performed if either test was positive. Swede score was used for grading of the acetowhite lesion; biopsy was planned if Swede score was ≥8. Statistical Analysis Used: The sensitivity, specificity, and predictive values for both screening methods were compared with colposcopy as the reference standard. Results: There were 370 low-risk pregnant women in the age group of 20–36 years in the study with a mean parity was 2.1, and the median period of gestation of 14.6 weeks. Abnormal Pap cytology was seen in 5.9% (n = 22) of patients; the abnormalities were ASCUS in 13 (59%), LSIL in 4 (18.2%), and AGC-NOS in 5 (22.7%) patients. VIA positivity was found in 8.4% (n = 31). The positive predictive value was 31.8% for cervical cytology and 48.4% for VIA (P = 0.001). No invasive lesion was detected. Positive predictive value of VIA was significantly higher than Pap cytology for detection of abnormal lesions. Conclusions: VIA is a cost-effective method with better predictive value than Pap smear for cervical cancer screening in pregnant women.

Keywords

Cervical cancer screening - cervical cytology - pregnancy - visual inspection with acetic acid

Publication History

Article published online:
08 June 2021

• References

• 1 Available from: https://www.gco.iarc.fr/today/data/factsheets/populations/356-india-fact-sheets.pdf. [Last accessed on 2018 Dec 05].
• 2 Connolly TP, Evans AC. Atypical papanicolaou smear in pregnancy. Clin Med Res 2005; 3: 13-8
• 3 Morimura Y, Fujimori K, Soeda S, Hashimoto T, Takano Y, Yamada H, Sarin YK. et al. Cervical cytology during pregnancy – Comparison with non-pregnant women and management of pregnant women with abnormal cytology. Fukushima J Med Sci 2002; 48: 27-37
• 4 Burghardt E, Pickel H, Girardi F. Colposcopy Cervical Pathology: Textbook and Atlas. 3rd ed. New York: Thieme; 1998.
• 5 Coppleson M, Reid BL. A colposcopic study of the cervix during pregnancy and the puerperium. J Obstet Gynaecol Br Commonw 1966; 73: 575-85
• 6 Luciani S, Winkler J, Sarin YK. Cervical Cancer Prevention in Peru: Lessons Learned from the TATI Demonstration Project. Washington, D.C.: Pan American Health Organization; 2006. Available from: http://rho.org/files/PAHO_PATH_TATI_report_2006.pdf. [Last accesed on 2019 Mar 06].
• 7 Owens GL, Kitchener HC. Pre-malignant disease in the genital tract in pregnancy. Best Pract Res Clin Obstet Gynecol 2016;33:33-43. Available from: https://doi.org/10.1016/j.bpobgyn.2015.10.009. [Last accesed on 2019 Mar 06].
• 8 Boardman LA, Robison K. Screening adolescents and young women. Obstet Gynecol Clin North Am 2013; 40: 257-68
• 9 Moyer VA. U.S. Preventive Services Task Force. Screening for cervical cancer: U.S. Preventive services task force recommendation statement. Ann Intern Med 2012; 156: 880-91, W312
• 10 Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain J. et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA Cancer J Clin 2012; 62: 147-72
• 11 Solomon D, Nayar R. The Bethesda System for Reporting Cervical Cytology Definitions, Criteria, and Explanatory Notes. 2nd ed. New York: Springer. 2004;2.
• 12 Bornstein J, Bentley J, Bösze P, Girardi F, Haefner H, Menton M. et al. 2011 colposcopic terminology of the international federation for cervical pathology and colposcopy. Obstet Gynecol 2012; 120: 166-72
• 13 Luesley D, Leeson S. Colposcopy and Programme Management. Guidelines for the NHS. Cervical Screening Programme. 2nd ed. Sheffield: NHS Cancer Screening Programmes. 2010:2.
• 14 Foster JC, Smith HL. Use of the cytobrush for papanicolaou smear screens in pregnant women. J Nurse Midwifery 1996; 41: 211-7
• 15 Smith-Levitin M, Hernandez E, Anderson L, Heller P. Safety, efficacy and cost of three cervical cytology sampling devices in a prenatal clinic. J Reprod Med 1996; 41: 749-53
• 16 Stillson T, Knight AL, Elswick RKJR. The effectiveness and safety of two cervical cytologic techniques during pregnancy. J Fam Pract 1997; 45: 159-63
• 17 Adekunle OO, Samaila MO. Prevalence of cervical intraepithelial neoplasia in Zaria. Ann Afr Med 2010; 9: 194
• 18 Stonehocker J. Cervical cancer screening in pregnancy. Obstet Gynecol Clin North Am 2013; 40: 269-82
• 19 Lertcharernrit J, Sananpanichkul P, Suknikhom W, Bhamarapravatana K, Suwannarurk K, Leaungsomnapa Y, Sarin YK. et al. Prevalence and risk assessment of cervical cancer screening by papanicolaou smear and visual inspection with acetic acid for pregnant women at a Thai provincial hospital. Asian Pac J Cancer Prev 2016; 17: 4163-7
• 20 Frega A, Scirpa P, Corosu R, Verrico M, Scarciglia ML, Primieri MR. et al. Clinical management and follow-up of squamous intraepithelial cervical lesions during pregnancy and postpartum. Anticancer Res 2007; 27: 2743-6
• 21 Mezei AK, Armstrong HL, Pedersen HN, Campos NG, Mitchell SM. et al. Cost-effectiveness of cervical cancer screening methods in low- and middle-income countries: A systematic review. Int J Cancer 2017; 141: 437-46
• 22 Sherwani RK, Khan T, Akhtar K, Zeba A, Siddiqui FA, Rahman K. et al. Conventional pap smear and liquid based cytology for cervical cancer screening – A comparative study. J Cytol 2007; 24: 167-72
• 23 Klug SJ, Neis KJ, Harlfinger W, Malter A, König J, Spieth S. et al. A randomized trial comparing conventional cytology to liquid-based cytology and computer assistance. Int J Cancer 2013; 132: 2849-57
• 24 Bowring J, Strander B, Young M, Evans H, Walker P. The swede score: Evaluation of a scoring system designed to improve the predictive value of colposcopy. J Low Genit Tract Dis 2010; 14: 301-5
• 25 Kärrberg C, Ryd W, Strander B, Brännström M, Rådberg T. Histological diagnosis and evaluation of the swede score colposcopic system in a large cohort of pregnant women with atypical cervical cytology or cervical malignancy signs. Acta Obstet Gynecol Scand 2012; 91: 952-8
• 26 Sarin RP, Glass AG, Rush BB, Sinha S. Diagnoses and outcomes in cervical cancer screening: A population-based study. Am J Obstet Gynecol 2004; 191: 105-13
• 27 Mailath-Pokorny M, Schwameis R, Grimm C, Reinthaller A, Polterauer S. Natural history of cervical intraepithelial neoplasia in pregnancy: Postpartum histo-pathologic outcome and review of the literature. BMC Pregnancy Childbirth 2016; 16: 74
• 28 Yost NP, Santoso JT, McIntire DD, Iliya FA. Postpartum regression rates of antepartum cervical intraepithelial neoplasia II and III lesions. Obstet Gynecol 1999; 93: 359-62
• 29 Mitchell MF, Schottenfeld D, Tortolero-Luna G, Cantor SB, Richards-Kortum R. Colposcopy for the diagnosis of squamous intraepithelial lesions: A meta-analysis. Obstet Gynecol 1998; 91: 626-31
• 30 Karimi-Zarchi M, Peighmbari F, Peighmbari F, Karimi N, Rohi M, Chiti Z. A comparison of 3 ways of conventional pap smear, liquid-based cytology and colposcopy vs. cervical biopsy for early diagnosis of premalignant lesions or cervical cancer in women with abnormal conventional pap test. Int J Biomed Sci 2013; 9: 205-10
• 31 Karimi-Zarchi M, Zanbagh L, Shafii A, Taghipour-Zahir S, Teimoori S, Yazdian-Anari P. et al. Comparison of pap smear and colposcopy in screening for cervical cancer in patients with secondary immunodeficiency. Electron Physician 2015; 7: 1542-8