Diagnostic accuracy of visual inspection with acetic acid for cervical neoplasia in symptomatic women in a low-resource setting: a prospective cross-sectional study

Objective: To evaluate the diagnostic accuracy of visual inspection with acetic acid (VIA) for detection of cervical neoplasia in symptomatic women using histopathology as the reference standard. Design: Hospital-based prospective cross-sectional diagnostic accuracy study. Setting: Tertiary care teaching hospital in northern India. Population: One hundred and twenty women attending the gynaecology outpatient department with complaints suggestive of cervical pathology. Methods: All participants underwent VIA using 3% acetic acid. Cervical biopsy was performed in all of these women. Histopathology served as the reference standard. Diagnostic accuracy parameters were calculated for VIA. Main outcome measures: Sensitivity, specificity, positive and negative predictive values, likelihood ratios, diagnostic accuracy, and area under the receiver operating characteristic (ROC) curve. Results: The mean age of participants was 35 years (SD 4.5). VIA was positive in 55% (66/120) women, while histopathology detected cervical intraepithelial neoplasia or invasive cancer in 48% (58/120). VIA demonstrated a sensitivity of 94.8% (95% CI 89.1–99.9) and specificity of 82.2% (95% CI 72.7–91.7). The area under the ROC curve was 0.885 (95% CI 0.820–0.951; p