Comparative Performance of Visual Inspection with Acetic Acid and Colposcopy for Detection of Cervical Precancer in Women with High-Risk Human Papillomavirus Infection: A Cross-Sectional Study
Issued Date
2026-01-01
Resource Type
ISSN
10732748
eISSN
15262359
Scopus ID
2-s2.0-105028877002
Journal Title
Cancer Control
Volume
33
Rights Holder(s)
SCOPUS
Bibliographic Citation
Cancer Control Vol.33 (2026)
Suggested Citation
Kuljarusnont S., Karnchanabanyong W., Ruengkhachorn I., Ularnwong M., Ittiamornlert P., Hanamornroongruang S. Comparative Performance of Visual Inspection with Acetic Acid and Colposcopy for Detection of Cervical Precancer in Women with High-Risk Human Papillomavirus Infection: A Cross-Sectional Study. Cancer Control Vol.33 (2026). doi:10.1177/10732748261422014 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/114383
Title
Comparative Performance of Visual Inspection with Acetic Acid and Colposcopy for Detection of Cervical Precancer in Women with High-Risk Human Papillomavirus Infection: A Cross-Sectional Study
Author's Affiliation
Corresponding Author(s)
Other Contributor(s)
Abstract
Introduction: The World Health Organization recommends 4 triage strategies for women with high-risk human papillomavirus infection (hrHPV). These include visual inspection with acetic acid (VIA), colposcopy, reflex cytology, and HPV16/18 partial genotyping. However, in many low-resource settings, access to colposcopy remains limited. This study aimed to compare the diagnostic accuracy of visual inspection vs colposcopy for detecting cervical intraepithelial neoplasia grade 2 or worse (CIN2<sup>+</sup>). Methods: Women who tested positive for hrHPV and were referred for colposcopy, with cytology results available as part of routine clinical care, underwent visual inspection with 3% acetic acid immediately before colposcopy. Colposcopic impressions were recorded, and images were scored using a modified Reid colposcopic index and a modified Swede score without iodine staining. We compared diagnostic performance for CIN2<sup>+</sup> across visual inspection, colposcopic impression, modified Reid index (score ≥4), and modified Swede score (score ≥5). Statistical analysis used IBM SPSS Statistics and the Cochran Q test, with significance set at P < .05. Results: Among 450 women, the median age was 38.0 years. A single hrHPV type was detected in 70.4% of cases; types 16, 52, and 18 were most common. Histopathological confirmation of CIN2<sup>+</sup> occurred in 97 women (21.6%). Diagnostic accuracy for predicting CIN2<sup>+</sup> was 78.2% with VIA and 77.5% with colposcopic impression. Accuracy was 78.4% for the modified Reid index ≥4 and 78.2% for the modified Swede score ≥5. No significant differences were observed among the 4 methods (P = .941). Conclusions: VIA demonstrates diagnostic accuracy comparable to colposcopy-based assessments in hrHPV-positive women evaluated within a cytology-informed clinical pathway, supporting its potential role in resource-limited settings.