Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Accuracy of Direct Visual Inspection Acetic Acid (VIA) and Smartphone-VIA (S-VIA) with Pap Smear in Cervical Cancer Screening in Low-Resource Setting: Cohort Retrospective Study
Düşük Kaynaklı Ortamlarda Serviks Kanseri Taramasında Asetik Asit ile Doğrudan Görsel İnceleme (VIA) ve Akıllı Telefon Destekli VIA (S-VIA) ile Pap Smear'in Karşılaştırmalı Doğruluğu: Kohort Retrospektif Çalışması
Moh Nailul FAHMIa , Patricia Alika KURNIAWANb , Tania Maharani CHANDRAb , Muhammad Yurizar YUDHISTIRAc , Shinta PRAWITASARIa , Ardhanu KUSUMANTOa
aGadjah Mada University, Faculty of Medicine, Public Health, and Nursing, Department of Obstetrics and Gynecology, Yogyakarta, Indonesia
bGadjah Mada University, Faculty of Medicine, Public Health, and Nursing, Yogyakarta, Indonesia
cSebelas Maret University, Faculty of Medicine, Department of Obstetrics and Gynecology, Jawa Tengah
Turkiye Klinikleri J Med Sci. 2025;45(3):166-72
doi: 10.5336/medsci.2025-108350
Article Language: EN
Full Text
ABSTRACT
 Objective: Cervical cancer is the 2nd most common cancer in Indonesia. Screening techniques can detect precancerous lesions, but direct visual inspection with acetic acid (VIA) can be subjective. Smartphones may assist healthcare providers in improving interpretation. This study aim to compare the accuracy of direct VIA, smartphone VIA (S-VIA) with 8-MP and 12-MP cameras, Pap smear, and biopsy in cervical cancer screening. Material and Methods: This cross-sectional diagnostic study follows the standards for the reporting of diagnostic accuracy studies (STARD 2015) guidelines. Each participant underwent screening and those with abnormal results proceeded to biopsy. The study included women aged 20-60 years who participated in the early detection cervical cancer program by the Yogyakarta Health Government from April to October 2017. Result: The study included 174 participants. Both direct VIA and S-VIA demonstrated low sensitivity but high specificity compared to the Pap smear. Direct VIA showed the highest accuracy relative to the Pap smear and the highest sensitivity to biopsy (100%), while the Pap smear had the highest specificity to biopsy (86.36%). The positive predictive values were low, whereas the negative predictive values were high. Direct VIA exhibited the highest positive likelihood ratio and the lowest negative likelihood ratio. The highest accuracy relative to biopsy was observed with the Pap smear, followed by direct VIA, S-VIA 12-MP, and S-VIA 8-MP. Conclusion: The highest accuracy was obtained from the Pap smear. VIA showed superior sensitivity and comparable specificity to the Pap smear. S-VIA with smartphone cameras offers a convenient alternative. Biopsy confirmation remains essential for accurate diagnosis and proper management.

Keywords: Cervical cancer; Pap smear; direct VIA; low-resource setting; smartphone-based VIA
ÖZET
 Amaç: Serviks kanseri, Endonezya'da en sık görülen ikinci kanserdir. Tarama yöntemleri prekanseröz lezyonları tespit edebilse de, asetik asit ile doğrudan görsel inceleme (VIA) öznel olabilmektedir. Akıllı telefonlar, sağlık çalışanlarının yorumlama becerilerini geliştirmelerine yardımcı olabilir. Bu çalışmanın amacı, serviks kanseri taramasında doğrudan VIA, 8 MP ve 12 MP kameralarla akıllı telefon VIA (S-VIA), Pap smear ve biyopsinin doğruluğunu karşılaştırmaktır. Gereç ve Yöntemler: Bu kesitsel tanısal çalışma, STARD 2015 kılavuzlarına uygun olarak yürütülmüştür. Her katılımcıya tarama yapılmış ve anormal sonuç saptananlara biyopsi uygulanmıştır. Çalışmaya, Nisan-Ekim 2017 tarihleri arasında Yogyakarta Sağlık Müdürlüğü tarafından yürütülen serviks kanseri erken tanı programına katılan, 20-60 yaş arası kadınlar dâhil edilmiştir. Bulgular: Çalışmaya 174 katılımcı dâhil edilmiştir. Hem doğrudan VIA hem de S-VIA, Pap smear ile karşılaştırıldığında düşük duyarlılık ancak yüksek özgüllük göstermiştir. Doğrudan VIA, Pap smear'e kıyasla en yüksek doğruluğu ve biyopsiye karşı en yüksek duyarlılığı (%100) ortaya koyarken, Pap smear biyopsiye karşı en yüksek özgüllüğe (%86,36) sahip olmuştur. Pozitif prediktif değerler (PPV) düşük, negatif prediktif değerler (NPV) ise yüksek bulunmuştur. Doğrudan VIA, en yüksek pozitif olasılık oranını (LR+) ve en düşük negatif olasılık oranını (LR-) sergilemiştir. Biyopsi ile karşılaştırıldığında en yüksek doğruluk Pap smear'de görülmüş, bunu sırasıyla doğrudan VIA, 12 MP S-VIA ve 8 MP S-VIA izlemiştir. Sonuç: En yüksek doğruluk Pap smear ile elde edilmiştir. VIA, Pap smear'e kıyasla üstün duyarlılık ve benzer özgüllük göstermiştir. Akıllı telefon kameraları ile yapılan S-VIA pratik bir alternatif sunmaktadır. Bununla birlikte, doğru tanı ve uygun yönetim için biyopsi doğrulaması temel önem taşımaktadır.

Anahtar Kelimeler: Serviks kanseri; Pap smear; doğrudan VIA; kaynak kısıtlı ortam; akıllı telefon destekli VIA
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