Comparison of direct visual inspection (DVI) with pap smear in diagnosis of precancerous lesion of cervix

The aim of this study was to compare direct visual inspection (DVI) with Pap smear in diagnosis of
precancerous lesion of cervix. A total of 1500 women were screened cytologically as well as clinically with direct
visual inspection of cervix after application of acetic acid (DVI). A total of 1500 women were screened
cytologically as well as clinically with direct visual inspection of cervix after application of acetic acid (DVI).
Women with abnormal findings in either Pap smear or DVI were investigated with colposcopy and biopsies were
obtained from colposcopically assessed abnormal lesions. Seven women had abnormal Pap smear (6 ASCUS, 1
CIN1) with colposcopy and biopsies. 3 of 7 were actually positive. All of 3 positive tests were positive in DVI but
one of the 4 false- positive tests was positive in DVI. Nine women had abnormal DVI which colposcopy and
biopsies confirmed 8 of them as premalignant or malignant lesions of cervix. Two of them were invasive cancer
(negative Pap smears), 3 CIN1 (one of them negative in Pap smear, one CIN1, one ASCUS), 2 CIN2 (one of them
negative in Pap smear, one ASCUS) and 1 CIN3 (negative Pap smear). Test efficiency parameters particularly
sensitivity, specificity, and positive predictive values of DVI were 88.8%, 99.9% and 88.8%, respectively; those of
Pap smear were 37.5%, 99.06%, 42.85%, respectively. Direct visual inspection (DVI) is feasible and easy to
perform with superior sensitivity and specificity to Pap smear in detecting cervical premalignant and malignant
lesions. Direct visual inspection can be used as an efficient primary screening tool with a satisfactory low biopsy
rate in low resources settings