Concordance of Cervical Cancer Screening Methods in a Low-Resource Setting

Abstract

Background: Cervical cancer poses a major public health challenge, especially in low-resource settings where advanced screening is scarce. Visual Inspection with Acetic Acid (VIA) and Visual Inspection with Lugol’s Iodine (VILI) serve as alternatives to HPV testing. This study evaluates their concordance with HPV testing for cervical cancer screening in Imo State, Nigeria. Materials and Methods: A cross-sectional study was conducted from February to June 2023 across three geopolitical zones of Imo State. A total of 257 women underwent VIA, VILI, and HPV DNA testing. Sensitivity, specificity, Cohen’s kappa value, and Youden’s Index were used to assess concordance. Results: HPV positivity was 43.6%, while VIA and VILI positivity rates were 11.3% and 28.8%, respectively. VIA had a sensitivity of 18.8%, specificity of 94.5%, positive predictive value (PPV) of 72.4%, and negative predictive value (NPV) of 60.1%. VILI showed higher sensitivity (42.0%) but lower specificity (81.4%), with a PPV of 63.5% and NPV of 64.5%. Cohen’s kappa values for VIA and VILI were 0.142 and 0.243, respectively, indicating slight to fair agreement with HPV testing. Youden’s Index values were 0.133 for VIA and 0.234 for VILI, reflecting low diagnostic performance. Conclusion: VIA and VILI demonstrated limited sensitivity and low concordance with HPV testing. VILI performed slightly better, but both methods exhibited poor agreement, highlighting the need for improved screening strategies. Combining visual inspection with more sensitive techniques may enhance diagnostic accuracy. Further research is needed to refine and integrate screening methods in low-resource settings.