Autor(es):
Sarian, L. O. 
; Derchain, S. F. ; Naud, P. ; Roteli-Martins, C. ; Longatto Filho, Adhemar ; Tatti, S. ; Branca, M. ; Dôres, Gerson B. das ; Costa, S. ; Syrjänen, S. ; Syrjänen, K. ; Eržen, M. ; Serpa-Hammes, L. ; Matos, J. ; Gontijo, R. ; Bragança, J. F. ; Lima, T. P. ; Maeda, Marina Yoshiê Sakamoto ; Lörincz, A.
Data: 2005
Identificador Persistente: http://hdl.handle.net/1822/4033
Origem: RepositóriUM - Universidade do Minho
Descrição
Objectives: To assess the performance indicators of visual inspection with acetic acid (VIA) and visual
inspection with Lugol’s iodine (VILI) in four Latin American centres participating in the ongoing Latin
AMerican Screening (LAMS) study, in settings with moderate incidence of cervical disease and with
poorly to moderately well-organized cervical cancer screening.
Setting: Three Brazilian centres (São Paulo, Campinas and Porto Alegre) and one Argentine centre
(Buenos Aires) recruited a total of 11,834 healthy women to undergo VIA, VILI, conventional Pap
smear and Hybrid Capture II (HCII).
Methods: Women who had a positive result from any of these tests were subjected to colposcopy and
biopsies (if necessary), and women with high-grade cervical intraepithelial neoplasia (CIN) were
properly treated. To control for verification bias, 5% of women with normal tests were referred for
colposcopy, as were 20% of HCII-negative women.
Results: Data on VIA (n = 11,834), VILI (n = 2994), conventional Pap smear (n = 10,138) and HCII
(n = 4195) were available for test comparisons, calculating sensitivity, specificity, and positive and
negative predictive values. Overall test positivity was 11.6% for VIA, 23.0% for VILI, 2.2% for Pap
smear (LSIL threshold), 1.1% for Pap smear (HSIL threshold) and 17.1% for HCII. VIA was positive in
61.8% of the women with CIN 1, 57.0% of those with CIN 2, 35.0% of women with CIN 3 and in 21
of 28 (75%) of women with cancer. Approximately 10% of women with no detectable disease had an
abnormal VIA. Regarding VILI, 83.3% of women diagnosed with CIN 1 and 62.5% of those with CIN
3 had an abnormal test. VILI failed to detect one of three cases of cancer. Both the sensitivity, specificity
and positive predictive value of VIA and VILI in detecting CIN 2 or CIN 3 could be significantly
improved depending on the combination with Pap smear or HCII (sensitivity up to 100.0% and
specificity up to 99.8%).
Conclusions: The LAMS study failed to reproduce the performance figures obtained with VIA and VILI
(as stand-alone tests) in some other settings, where the prevalence of cervical disease was higher.
However, a combined use of VIA or VILI with the Pap test or HCII allowed specific detection of cervical
abnormalities.
