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

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. © 2025 by Türkiye Klinikleri.