COMPARISON OF THE ACCURACY OF PAP SMEAR CYTOLOGY,VISUAL INSPECTION WITH ACETIC ACID(VIA) AND VISUAL INSPECTION WITH LUGOL’S IODINE(VILI) IN SCREENING FOR CERVICAL NEOPLASIA IN SOUTH- EAST NIGERIA.

Egede JO1, Ajah LO2, Ibekwe PC1, Agwu UM1 , Nwizu E1, Iyare F3, 1. Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Ebonyi State 2. Department of Obstetrics and Gynaecology,Faculty of Medical Sciences, University of Nigeria,Ituku-Ozalla Campus,Enugu. 3. Department of Pathology, Federal Teaching Hospital, Abakaliki, Ebonyi state Corresponding author: Dr. Leonard Ogbonna Ajah. Department of Obstetrics and Gynaecology,Faculty of Medical Sciences, University of Nigeria,Ituku-Ozalla Campus,Enugu.E-mail: [email protected]. Phone:+2348033920789. Abstract:

Background: Though Pap smear cytology is an important cervical cancer screening method, cytology-based screening programs are difficult to organize in low resource settings. This necessitates the need for affordable and accurate, alternative screening methods.

Objective: This study aimed to compare the accuracy of Pap smear cytology, visual inspection with 5% acetic acid (VIA) and visual inspection with Lugo’s iodine( VILI).

Methodology: This was a cross-sectional comparative study of consenting 200 participants at

Federal Teaching Hospital, Abakaliki (FETHA) over a 6 months period. All the participants had

Pap smear cytology. Subsequently, they were classified into 2 groups of 100 each through systematic random sampling: group 1 had VIA and group 2 had VILI. Thereafter, all the participants had cervical punch biopsy at the 6 and 12 O’clock cervical positions. Cervical punch biopsy was also done on the suspicious lesions of the cervix irrespective of their positions. The data obtained were analyzed using SPSS version 20. The tests of validity of the 3 methods were calculated using the histology of the biopsy specimen as the gold standard. Results: Among the VIA group, 19(19%) had cervical epithelial abnormalities on Pap smear cytology while VIA was positive in 14(14%).Histology results showed cervical neoplasia in

15(15%) of the participants. Among the VILI group, 15(15%) had cervical epithelial abnormalities on Pap smear cytology while VILI was positive in 19 (19%).Histology results showed cervical neoplasia in 15(15%) of the participants.There was no significant difference in overall accuracy of Pap smear cytology, VIA and VILI. The overall accuracy of the Pap smear cytology + VIA was significantly more than Pap smear cytology alone.

Conclusion: VIA or VILI can be used as a stand-alone cervical cancer screening test when compared with Pap smear cytology particularly in low resource settings. The VIA can also complement Pap smear cytology.

Key words: Pap smear cytology, visual inspection with acetic acid, Visual inspection with

Lugol’s iodine, Nigeria