Cytology versus visual inspection with acetic acid among women treated previously with cryotherapy in a low-resource setting

Int J Gynaecol Obstet. 2010 Dec;111(3):249-52. doi: 10.1016/j.ijgo.2010.06.022.


Objective: To compare visual inspection with acetic acid (VIA) with conventional cervical cytology as a follow-up cervical cancer screening method in women who had been treated previously with cryotherapy.

Methods: Salvadoran women screened with VIA and treated with cryotherapy within 3 years were eligible to participate. Study participants were rescreened with VIA, Pap smear, colposcopy, 4-quandrant biopsy, and endocervical curettage.

Results: Of 147 women enrolled in the study, post-cryotherapy VIA was positive in 39 women (26.5%; 95% CI, 19.6%-34.4%). Of these 39, 1 woman had CIN 1 or higher on biopsy. Post-cryotherapy Pap smear was positive (ASCUS or higher) in 6 women (4.1%; 95% CI, 1.5%-8.7%). Of these 6, 2 women had CIN 1 or higher on biopsy. Post-cryotherapy specificity was significantly higher for Pap compared with VIA (95.8% [138/144]; 95% CI, 91.2%-98.5% vs 73.6% [106/144]; 95% CI, 65.6%-80.6%; P<0.001).

Conclusion: As the single-visit approach for cervical cancer screening gains popularity, more women will have been treated with cryotherapy. Appropriate follow-up screening is therefore vital. Cytology may be a more suitable screening method than VIA in low-resource settings for women treated previously with cryotherapy.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetic Acid / analysis*
  • Adult
  • Aged
  • Cervical Intraepithelial Neoplasia / pathology*
  • Cervical Intraepithelial Neoplasia / therapy*
  • Cervix Uteri / pathology
  • Colposcopy
  • Cryotherapy*
  • Early Detection of Cancer / methods*
  • El Salvador
  • Female
  • Humans
  • Middle Aged
  • Papanicolaou Test
  • Sensitivity and Specificity
  • Uterine Cervical Neoplasms / pathology*
  • Uterine Cervical Neoplasms / therapy*
  • Vaginal Smears
  • Young Adult


  • Acetic Acid