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Performance of Direct Visual Inspection of the Cervix with Acetic Acid and Magnification in a Previously Screened Population

Rodríguez, Ana Cecilia MD, MPH1; Morera, Lidia Ana RN1; Bratti, Concepción MD, MPH1; Herrero, Rolando MD, PhD1; Cox, J. Thomas MD2; Morales, Jorge MD1; Alfaro, Mario MD4; Hutchinson, Martha MD5; Castle, Philip E. PhD, MPH3; Hildesheim, Allan PhD3; Schiffman, Mark MD, MPH3

Journal of Lower Genital Tract Disease: April 2004 - Volume 8 - Issue 2 - p 132-138

Objective. To assess the screening performance of direct visual inspection with acetic acid and ×2 magnification (VIAM) in a previously screened population, as performed by experienced gynecologic nurses with minimal training in VIAM.

Patients and Methods. Performance of VIAM was evaluated in 2,080 women from a population-based cohort in Guanacaste, Costa Rica, 5 years after they had negative enrollment results of conventional and liquid-based cytologic analysis, cervigram, and human papillomavirus DNA by Hybrid Capture Tube Test (Digene Corporation, Gaithersburg, MD). The VIAM results were compared with repeat conventional Pap smears, liquid-based cytologic examinations, and cervicography, with adjudication of differences by reference to MY09/MY11 L1 consensus primer polymerase chain reaction detection of oncogenic human papillomavirus DNA.

Results. Less than 5% of women were classified as having positive results using VIAM. The VIAM positivity was also very low among women with high-grade squamous intraepithelial lesion conventional Pap smear results (8.3%), high-grade squamous intraepithelial lesion liquid-based cytologic results (6.3%), or cervigrams suggesting cervical intraepithelial neoplasia 2,3 or cancer (30%). The VIAM positivity was not associated with human papillomavirus DNA positivity.

Conclusions. As we practiced it, VIAM was not sensitive for detection of possibly serious incident cervical lesions in this previously screened population where cytologic screening is in place.

Direct visual inspection of the cervix by nurses using acetic acid and magnification was not a useful screening method in a previously screened population.

1Proyecto Epidemiológico Guanacaste, FUCODOCSA, San José, Costa Rica; 2University of California Santa Barbara, Santa Barbara, CA; 3Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD; 4National Cytology Laboratory, Caja Costarricense de Seguro Social, San José, Costa Rica; and 5Women’s and Infant’s Hospital, Providence, RI

Reprint requests to: Ana Cecilia Rodríguez, MD, Proyecto Epidemiológico Guanacaste, Apdo 181-1250, Escazú, Costa Rica. E-mail:

©2004The American Society for Colposcopy and Cervical Pathology