Comparing visual inspection with acetic acid plus random cervical biopsy plus endocervical curettage to colposcopic directed biopsy plus endocervical curettage in detecting cervical lesions in low-resource settings.

OBJECTIVE: To compare the sensitivity, specificity, positive and negative predictive values of visual inspection with acetic acid directed cervical biopsy (VDB) in combination with random cervical biopsy (VRB) and endocervical curettage (ECC) to colposcopic directed biopsy (CDB) plus ECC in detecting cervical lesions (HSIL or more) in Thailand. MATERIALS AND METHODS: A diagnostic-test study was carried out on 164 women with abnormal Pap smear at a tertiary care teaching hospital from March 2011 to June 2011. The women with abnormal Pap smears had further investigations such as; VDB and/or VRB, and CDB plus ECC, and/or loop electrosurgical excision procedure (LEEP). Either VDB plus VRB plus ECC or CDB plus ECC, sometimes LEEP, were used to diagnose cervical lesions. Severest histopathology from any means was taken as the gold standard. RESULTS: There were 164 patients included in analyses. The sensitivity of VDB plus VRB plus ECC to detect cervical lesions was 95.9% (95%CI, 91.4%-98.1%) compared to the sensitivity of CDB plus ECC of 97.3% (95%CI, 93.2%-98.9%). The two were very similar (mean difference -1.4%, 95%CI, -5.4%-2.6%, by Z-test). CONCLUSIONS: Thus VDB plus VRB plus ECC can substitute for CDB plus ECC in detecting cervical lesions in low-resource settings.