Screening accuracy of PAP and VIA in terms of Colposcopy guided cervical biopsy: A comparative study



Partha Sarathi Mitra (Associate Professor, Department of Obstetrics and Gynecology, Calcutta Medical College, Kolkata, West Bengal, India.)
Abhoy Chand Na (Department of obstetrics and gynecology, Kalna sub divisional Hospital, Purba Bardhaman)
Medhatithi Barman (Department of obstetrics and gynecology, Burdwan Medical College, Bardhaman)
Debobroto Roy (Department of obstetrics and gynecology, Burdwan Medical College, Bardhaman)
Tara Shankar (Department of obstetrics and gynecology, Calcutta Medical College, Kolkata)
Tapan Kumar Naskar (Department of obstetrics and gynecology, Calcutta Medical College, Kolkata)


Introduction: Approximately 80% of cervical cancer occurs in developing countries of which India contributes about 20-30% of the global burden. WHO considers cervical cancer as a preventable disease because it can be diagnosed in its precancerous phase. Cytology and VIA for screening and colposcopy for directed biopsy jointly may achieve accuracy of approximately 90% to 99%.Methods: An observational cross sectional comparative study was performed to find accuracy of screening protocols of exfoliative cervical cell cytology and visual inspection under acetic acid in terms of the diagnostic test of Colposcopy guided biopsy on 300 symptomatic women of age 18-60 years over the period of one year.Result: Both PAP and VIA positivity increased with age, increasing parity, gynaecological symptoms. PAP and VIA positive results co related with Colposcopy directed biopsy histopatholgy reports in a statistically significant proportion.Discussion: VIA can screen out a large number of women suspected to have cervical cancer in an easy method done in OPD in naked eye and does not require any meticulous microscopic examination with a high degree of sensitivity and high false positivity but on the other hand PAP was less sensitive but more specific test when both combined with Colposcopy guided biopsy.Conclusion: The associations between distribution of women who were Pap +ve and histology +ve as well as VIA and histo +ve were statistically significant.


Papanicoula (PAP), Visual inspection with acetic acid (VIA), Colposcopy guided biopsy, Cervical Cancer

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Suraiya UB. Cancer screening in gynecology. In: Ratnam SS, Rao KB, Arulkumar S. eds. Obstetrics and gynecology. New Delhi: Orient Longman; 1994. p.454-64.

DeMay, M (2007). Practical principles of cytopathology. Revised edition. Chicago, IL: American Society for Clinical Pathology Press. ISBN 978-0- 89189-549-7

Papanicolaou GN. Introduction of Pap Smear in early detection of cervical malignancies. Am J Clin Path 1940; 19:301-8.

Chase DM, Kalouyan M, DiSaia PJ: May 2009: Colposcopy to evaluate abnormal cervical cytology in 2008. Am. J. Obstet. Gynecol. 200 (5): 472-80

Hutchinson ML, Agarwal P, Denant T, Cibas E. A new look atcervical cytology: thin prep multicenter trial results. ActaCytol 1992; 36: 499-54.

Diaz Rosario LA, Kabawat SE. Performance of a fluid based thin layer Papanicolaou smear method in the clinical setting of an independent lab and outpatient screening of population in New England. Arch Path Lab Med 1999, 123: 817-21.

Kenneth DH, Yao S Fu. Cervical and vaginal cancer, Novak's Textbook of Obstetric and Gynaecology, 13th ed. Baltimore: WB Saunders Co; 2002.p.471-93.

Campion MJ, McCance DJ, Gizick J, Singer A. Progressive potential of mild cervical atypia: prospective cytological and colposcopic study, Lancet 1986; 2: 237-40.

Sankaranarayanan R, Basu P, Wesley RS, Mahe C, Keita N, Mbalawa CC, et al. Accuracy of visual screening for cervical neoplasia: Results from an IARC multicentre study in India and Africa. Int J Cancer 2004;110:907-13.

Panten J, Adami HO, Bergstrom R, Dillner J, Friberg LG, Gustafsson L, et al. Strategies for Global Control of Cervical Cancer. Int J Cancer 1995;60:1-26.

University of Zimbabwe/JHPIEGO Cervical Cancer Project Visual inspection with acetic acid for cervical-cancer screening: test qualities in a primary-care setting. Lancet 1999;353:869-73

Denny L, Kuhn L, Pollack A, Wainwright H, Wright TC Jr. Evaluation of alternative methods of cervical cancer screening for resource-poor settings. Cancer 2000;89:826-33.

Shakarnarayana R, Nene BM, Dinshaw K, Raj Kumar. Early detection of cervical cancer with visual impaction methods: a summary of completed and ongoing studies in India. Shawad Publica de Mexico 2003; 45: 291- 301.

Twu Nae-fang, Chen Yi-Jen, Wang Peng-Hui, Bill Ken-Jen, Laietchung¬Ru, Chao kuan-chong, et al. Improved cervical cancer screening in premenopausal women by combination of Pap smear and speculoscopy. European journal of Obstetrics and Gynecology and Reproductive Biology 2007;133:114-18

Khutzen VK, Sherwood AG. Colposcopy an selective biopsy in patients

with abnormal cervical cytology. S Afr Med J 1997; 52(12): 478-81.

Ratnam SS, Rao KB, Arulkumaran S. eds. Obstetrics and gynecology for post graduate. 2nd ed. New Delhi: Orient Longman; 1999. P.364-79

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