A Comparative Study Between Pap Smear and Visual Inspection with Acetic Acid in Screening of Cervical Intraepithelial Neoplasia and Cervical Cancer at a Tertiary Maternity Hospital (Erbil/Iraq)

Background and objectives: Global concern persists over cervical cancer, demanding efficient early detection methods. The aim of the study was to assess the diagnostic efficacy of Pap smear and visual inspection with acetic acid in detecting cervical intraepithelial neoplasia and early cervical cancer. Methods: This was a cross-sectional, comparative study conducted from the 1st of January 2023 to the 31st of December 2023 at the Maternity Teaching Hospital/Erbil, Iraq, to screen 200 patients, aged between 18-60 years by doing Pap smear and visual inspection with acetic acid for detecting cervical intraepithelial neoplasia and early cervical cancer. The indicators of diagnostic value including sensitivity, specificity, positive and negative predictive values were analyzed. Results: Pap smear exhibited a sensitivity of 94.12% while visual inspection with acetic acid showed a sensitivity of 82.35%. The specificity of Pap smear was 64.52%, whereas the visual inspection with acetic acid test had a specificity of 25.8%. The positive predictive value of Pap smear was 59.26% compared with 37.84% for visual inspection with acetic acid. In terms of negative predicted value, Pap smear achieved 95.24%, whereas visual inspection with acetic acid reached 72.73%. Finally, the diagnostic accuracy of Pap smear was 75%, whereas visual inspection with acetic acid had an accuracy of 45.83%. Conclusion: Pap smear and visual inspection with acetic acid tests possess a high sensitivity and, to a lesser extent, specificity, making them effective screening tools for detecting cervical intraepithelial neoplasia and early cervical cancer.