Is magnification necessary to confirm visual inspection of cervical abnormalities? A randomized trial in Peru ¿Es necesaria la amplificación para confirmar los resultados de la inspección visual de alteraciones cervicouterinas? Ensayo aleatorizado en Perú

• Main Authors: Jennifer L. Winkler, Kristen Lewis, Roberto Del Aguila, Miguel Gonzales, José Manuel Delgado, Vivien D. Tsu, John W. Sellors
• Format: Article in Journal/Newspaper
• Language: English; Spanish; Portuguese
• Published: Pan American Health Organization 2008
• Subjects: Neoplasmas del cuello uterino; diagnóstico; cribado; Perú; Uterine cervical neoplasms; diagnosis; Peru; Medicine; R; Arctic medicine. Tropical medicine; RC955-962; Public aspects of medicine; RA1-1270; Arctic; San Martín
• Online Access: https://doaj.org/article/685794b5ac67456db5cf55d4542810c6

OBJECTIVES: Cervical cancer is the leading cause of cancer death among women in developing countries. This study was designed to evaluate whether visual inspection with acetic acid and magnification (VIAM) improved confirmation of cervical lesions as compared to confirmation with visual inspection with acetic acid (VIA) without magnification when used by physicians. METHODS: From April-December 2004, women in San Martin, Peru, who were referred as VIA-positive by an "obstetriz" (a professional midwife with 6 years of university training) were randomized into two groups for confirmatory screening by a physician using either VIA or VIAM with an AviScope,TM a hand-held 4x magnification scope with a green light source. The reference standard for the presence or absence of cervical neoplasia was colposcopy and directed biopsy, as required. RESULTS: A total of 358 women participated in the study; 161 had a confirmatory examination with VIAM and 159 with VIA. Sensitivity for low- or high-grade lesions was 68% with VIA and 77% with VIAM, and specificity was 62% with VIA and 63% with VIAM; however, these differences were not statistically significant. CONCLUSIONS: For settings where physician confirmation of cervical abnormalities identified through visual inspection is required and available, this study demonstrates that VIAM had no significant advantage over VIA. OBJETIVOS:En los países en desarrollo, el cáncer cervicouterino es la principal causa de muerte por cáncer en mujeres. Este estudio se diseñó para determinar si se puede mejorar la confirmación de lesiones cervicouterinas con la inspección visual con ácido acético y amplificación (VIAM) en comparación con la inspección visual con ácido acético (VIA) sin amplificación, cuando ambas las realizan médicos generales. MÉTODOS:Las mujeres de San Martín, Perú, con diagnóstico positivo mediante VIA realizado por una obstetriz (enfermera graduada con seis años de entrenamiento universitarios) entre abril y diciembre de 2004 se dividieron aleatoriamente en dos grupos ...