Cytology versus visual inspection with acetic acid among women treated previously with cryotherapy in a low-resource setting

Cremer, Miriam; Bullard, Kimberley; Maza, Mauricio; Peralta, Ethel; Moore, Elizabeth; Garcia, Lydia; Masch, Rachel; Lerner, Veronica; Alonzo, Todd A.; Felix, Juan

doi:10.1016/j.ijgo.2010.06.022

« Previous Next »International Journal of Gynecology & Obstetrics
Volume 111, Issue 3 , Pages 249-252, December 2010

Cytology versus visual inspection with acetic acid among women treated previously with cryotherapy in a low-resource setting

Miriam Cremer
- Department of Obstetrics and Gynecology, Mount Sinai School of Medicine, New York, NY, USA
- Basic Health International, San Salvador, El Salvador
- Corresponding author. The Mount Sinai Medical Center, One Gustave, L. Levy Place, Box 1170, New York, NY 10029-6574, USA. Tel.: +1 212 241 7961; fax: +1 212 241 6928.
Kimberley Bullard
- Basic Health International, San Salvador, El Salvador
Mauricio Maza
- Basic Health International, San Salvador, El Salvador
Ethel Peralta
- Basic Health International, San Salvador, El Salvador
Elizabeth Moore
- Basic Health International, San Salvador, El Salvador
Lydia Garcia
- Department of Obstetrics and Gynceology, New York University School of Medicine, New York, NY, USA
Rachel Masch
- Department of Obstetrics and Gynecology, Beth Israel Medical Center, New York, NY, USA
Veronica Lerner
- Department of Obstetrics and Gynceology, New York University School of Medicine, New York, NY, USA
Todd A. Alonzo
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
Juan Felix
- Basic Health International, San Salvador, El Salvador
- Department of Pathology, University of Southern California, Los Angeles, CA, USA

Received 17 May 2010; received in revised form 21 June 2010; accepted 20 July 2010. published online 01 September 2010.

Abstract

Objective

To compare visual inspection with acetic acid (VIA) with conventional cervical cytology as a follow-up cervical cancer screening method in women who had been treated previously with cryotherapy.

Methods

Salvadoran women screened with VIA and treated with cryotherapy within 3years were eligible to participate. Study participants were rescreened with VIA, Pap smear, colposcopy, 4-quandrant biopsy, and endocervical curettage.

Results

Of 147 women enrolled in the study, post-cryotherapy VIA was positive in 39 women (26.5%; 95% CI, 19.6%–34.4%). Of these 39, 1 woman had CIN 1 or higher on biopsy. Post-cryotherapy Pap smear was positive (ASCUS or higher) in 6 women (4.1%; 95% CI, 1.5%–8.7%). Of these 6, 2 women had CIN 1 or higher on biopsy. Post-cryotherapy specificity was significantly higher for Pap compared with VIA (95.8% [138/144]; 95% CI, 91.2%–98.5% vs 73.6% [106/144]; 95% CI, 65.6%–80.6%; P<0.001).

Conclusion

As the single-visit approach for cervical cancer screening gains popularity, more women will have been treated with cryotherapy. Appropriate follow-up screening is therefore vital. Cytology may be a more suitable screening method than VIA in low-resource settings for women treated previously with cryotherapy.

Keywords: Cryotherapy, Cytology, Follow-up screening, El Salvador, Low-resource setting, Visual inspection with ascetic acid, VIA