Screening for Preneoplastic Cervical Lesions: A Comparison of Visual Inspection with Acetic Acid, Liquid-based Cytology and HPV-DNA Testing

Abstract

Background: Cervical cancer is the third most common malignancy and fourth leading cause of cancer death among women.  Persistent infection with high-risk human papillomavirus (hrHPV) particularly HPV-16 and -18 is a necessary prerequite for the development of invasive carcinoma of the cervix.
Objective: To screen for cervical preneoplastic lesions among female staff of our University using Visual Inspection with Acetic acid (VIA), Liquid-Based Cytology (LBC) and Human Papillomavirus DNA testing and to compare the detection rates of the screening methods.
Methods: Following informed consent, VIA, LBC smear and HPV samples were collected. Individuals with abnormal result from any of the 3 screening modalities were recalled for colposcopy (± biopsy).
Results: Out of the 208 screened, 9 (4.3%) were VIA positive and 13 (6.3%) had abnormal smear. The HPV DNA testing showed 15 (7.2%) were high-risk positive, and 3 (1.4%) were high- and low-risk positive. High-risk HPV type 18 was the commonest followed by types 52 and 58, and then type 31. All theVIApositive cases had normal LBC smear result and were negative for Hr-HPV DNA. Of the13 (6.3%) cases with LBC smear abnormality, 4 were Hr-HPV positive but all were VIA negative. Amongst the 4 cases with LBC and HPV
abnormality, 2 of them (both HSIL and Hr-HPV positive) had colposcopically directed biopsy confirmed at histology as CIN 3. There was  no significant correlation between VIA and HPV (p = 0.874) while LBC and HPV showed statistically significant correlation (p < 0.001)
Conclusion: VIA positivity rate was 4.3%, LBC 6.3% and HPV 8.6%. Confirmatory diagnostic test via colposcopically directed biopsy was possible in 2 out of the 34 women that were recalled for follow-up.

Keywords: Cervical cancer, cytology, high-risk, precancerous, screening.