Visual inspection with acetic acid Archives - Revista Brasileira de Ginecologia e Obstetrícia

PURPOSE: to estimate the validity of visual inspection of cervical intraepithelial neoplasia (CIN) and HPV-induced lesion screening, after acetic acid application (VIA), and to compare its performance with that of colpocytology and colposcopy. METHODS: a diagnostic test validation study involving 893 women aged 18 to 65 years, simultaneously screened with colpocytology, VIA and colposcopy was carried out at a public health unit in Recife, PE. VIA was performed by applying 5% acetic acid onto the cervix and observing it with the help of a clinical spotlight. The finding of any aceto-white lesion on the cervix was considered positive. The gold standard was the histopathology of cervical biopsy, carried out whenever any of the three test results was abnormal. Validity indicators were estimated for each test, within 95% confidence intervals. The analysis of agreement between test results was done by the kappa coefficient. RESULTS: of 303 women submitted to biopsy, the histopathological study was abnormal in 24. Among this total, VIA was positive in 22, yielding an estimated 91.7% sensibility, 68.9% specificity, and 7.5% positive predictive value and 99.7% negative predictive value. Comparing 95% confidence intervals, VIA was more sensitive than colpocytology, despite a lower specificity and positive predictive value. There was poor agreement between VIA and colpocytology (k=0.02) and excellent agreement with colposcopy (k=0.93). CONCLUSION: VIA was much more sensitive than colpocytology in the screening of CIN and HPV-induced lesions and presented a performance similar to colposcopy. Its low specificity determined a high number of false-positive results.