Evaluation of visual inspection with acetic acid and Pap smear tests in early cervical cancer screening among women in Meru County, Kenya.

BACKGROUND

Early cervical dysplasia screening can save women from death resulting from cervical cancer.

OBJECTIVE

To evaluate and compare the diagnostic performance of the Papanicolaou (Pap) smear and visual inspection with acetic acid (VIA) against histopathology as the reference test.

METHODS

We recruited 160 women aged 25-60 years who were undergoing early cervical screenings at the Meru teaching and referral hospital, from June to October 2024. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated by comparing VIA and Pap smear outcomes against histology (gold standard).

RESULTS

Mean age of the study sample was 44.96 years (s.d. = 9.49). Eighteen (11%) had inflammation, 3 (1.9%) had squamous cell carcinoma against 11 (6.9%) detected by histology, and 14 (8.8%) had precancerous lesions. There was no statistical significance between age or number of pregnancies and histology-confirmed cervical lesions. Pap smear had a sensitivity of 100% (95% confidence interval [CI]: 86-100), specificity of 94% (95%CI: 89-97), PPV of 76% (95%CI: 58-89), and NPV of 100% (95%CI: 97-100). In comparison, VIA showed diagnostic performance with sensitivity of 72% (95%CI: 51-88), specificity of 81% (95%CI: 74-88), PPV of 42% (95%CI: 27-58), and NPV of 94% (95%CI: 88-98).

CONCLUSION

Pap smear showed higher overall diagnostic accuracy than VIA in diagnosing cervical lesions. While less specific, VIA showed a high NPV, suggesting its potential in ruling out disease in low-resource settings. Although age and pregnancy showed no statistical significance with cervical dysplasia, more studies including characteristics are required.

WHAT THIS STUDY ADDS: Results provide updated evidence on the relative diagnostic performance of VIA and Pap smear, to guide cervical cancer screening strategies in settings with limited resources.