Cervical cancer screening tests: Visual inspection methods
- Lynette Denny, MD, PhD
Lynette Denny, MD, PhD
- Professor Obstetrics and Gynaecology
- University of Cape Town
- Groote Schuur Hospital and Institute of Infectious Diseases and Molecular Medicine
Visual inspection of the cervix after application of Lugol's iodine, the first method used for cervical cancer screening, was introduced in the 1930s by Schiller . However, Schiller's test has poor specificity and was almost entirely replaced with the advent of cervical cytology.
Current cervical cancer screening protocols typically include a combination of cervical cytology and human papillomavirus (HPV) testing. Visual inspection of the cervix has reemerged as a screening tool for low resource settings, despite its limited specificity, since it is economical and provides immediate results. Visual inspection can be performed with acetic acid (VIA) or Lugol's iodine (VILI). These procedures are also referred to as Visual Inspection with Acetic Acid (VIA) or Visual Inspection with Lugol’s Iodine (VILI).
Techniques for performing visual inspection of the cervix will be reviewed here. The utility of visual inspection methods, strategies for cervical cancer screening, and techniques for other tests are discussed separately. (See "Screening for cervical cancer in resource-limited settings" and "Screening for cervical cancer" and "Cervical cancer screening tests: Techniques for cervical cytology and human papillomavirus testing".)
Visual inspection is indicated for women for whom cervical cancer screening is recommended and for whom these methods are the best screening option (ie, women who do not have access to cervical cytology and HPV testing). (See "Screening for cervical cancer in resource-limited settings", section on 'Approach to cervical cancer screening'.)
There are NO absolute contraindications to visual inspection of the cervix. VIA, rather than VILI, should be performed in women with an allergy to iodine. Visual inspection can be performed during pregnancy, but cervical biopsies are relatively contraindicated in pregnant women unless invasive cancer is suspected.
- Schiller W. Leucoplakia, leucokeratosis, and carcinoma of the cervix. Am J Obstet Gynecol 1938; 35:17.
- http://screening.iarc.fr/viavilichap3.php?lang=1 (Accessed on April 11, 2012).
- World Cancer Report 2008, Boyle P, Levin B (Eds), International Agency for Research on Cancer, Lyon Cedex, France 2008.
- Arbyn M, Sankaranarayanan R, Muwonge R, et al. Pooled analysis of the accuracy of five cervical cancer screening tests assessed in eleven studies in Africa and India. Int J Cancer 2008; 123:153.
- Sankaranarayanan R, Shastri SS, Basu P, et al. The role of low-level magnification in visual inspection with acetic acid for the early detection of cervical neoplasia. Cancer Detect Prev 2004; 28:345.