A One Year Cross Sectional Study to Evaluate Downstaging, Visual Inspection with Acetic Acid and Lugol’s Iodine in Detection of Cervical Cancer

Abstract

Primary Objective To detect sensitivity and specificity of downstaging Secondary Objective To compare the efficacy of downstaging with visual inspection with acetic acid and Lugol’s iodine with cervical biopsy. Study type: Cross sectional study carried over a period of one year. Setting: Study was carried out in a Primary health center, Kinaye which is attached to Dr.Prabhakar Kore Hospital and Medical Research Centre, Belgaum. Sample Size: All women who fulfilled the inclusion criteria and willing to participate in the study. Method: All women enrolled in this study underwent downstaging, visual inspection with acetic acid ( VIA ) and visual inspection with Lugol’s iodine ( VILI ) . Results of downstaging were interpreted according to WHO atlas by ANMs. International Agency for Research on Cancer ( IARC ) guidelines were used to interpret results of VIA and VILI. Punch biopsy was taken for all downstaging, VIA and VILI positive patients. Results: The sensitivity, specificity, positive predictive value and negative predictive value for downstaging was 54.55%, 93.42%, 12% and 99.2% respectively. The sensitivity, specificity, X positive predictive value and negative predictive value of VIA was 63.64%, 95.07%, 17.5% and 99.37% respectively. The sensitivity, specificity, positive predictive value and negative predictive value of VILI was 90.91%, 97.46%, 35.71% and 99.85% respectively. False positive rate of downstaging, VIA and VILI were 6.58%, 4.93% and 2.54% respectively. False negative rates of downstaging, VIA and VILI were 45.45%, 36.36% and 9.09% respectively. Conclusion: VIA and VILI are suitable primary screening procedures as compared to downstaging because of high sensitivity and specificity. VILI has high sensitivity and specificity. Downstaging can be used in rural areas where acetic acid and lugol’s iodine are not available.