Accuracy of Cervical Visual Inspection with Acetic Acid Guide for 4-Quadrant Random Cervical Biopsies by General Practitioners in Women with Abnormal Pap Smears

Document Type : Research Articles


1 Lampang Hospital, Thailand.

2 Department of Obstetrics and Gynecology, Sappasitthiprasong, Ubonratchathani, Thailand.


Objective: To study the performance of visual inspection with acetic acid plus 4-quadrant cervical biopsy (V4B) by general practitioners in detecting high grade cervical lesion, compared to highest histopathologic grade from the American Society for Colposcopy and Cervical Pathology American Society for Colposcopy and Cervical Pathology (ASCCP) 2013 work up guidelines. Materials and methods: Patients with abnormal cervical cytologic screening results suggesting low grade lesions underwent V4B by general practitioners followed by colposcopy on the same day bases on ASCCP 2013 guidelines. Those with Pap smears indicative of high grade lesions or cervical cancer were sent to V4B before confirmed diagnosis and and therapeutic excisional procedures.Predictive performance of V4B was evaluated against the reference diagnosis. Results: Compared with the reference diagnosis in 100 of patients, V4B by general practitioners had sensitivity, specificity, PPV, and NPV of 67.9%, 100%, 100%, and 88.9%, respectively. There were 11.1% false negatives with no false positives. No complications were observed following this technique. Conclusion: Overall, V4B by general practitioners demonstrates moderate accuracy when compared with definite diagnosis by colposcopy and/or LEEP. This novel strategy performed better in those with low grade lesions on cervical cytological screening.


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