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The aim of this review was to provide an updated summary estimation of the accuracy of visual inspection with acetic acid (VIA) and with Lugol's iodine (VILI) in detecting cervical cancer and precancer. Studies on VIA/VILI accuracy were eligible in which VIA/VILI was performed on asymptomatic women who all underwent confirmatory testing of histology, combination of colposcopy and histology, or combination of multiple screening tests, colposcopy and histology, to detect cervical intraepithelial neoplasia grade 2 or worse (CIN2+ or CIN3+). A bivariate model was fitted to estimate the accuracy of VIA/VILI and provide estimates of heterogeneity. Subgroup analysis was used to investigate the source of heterogeneity. A total of 29 studies on VIA and 19 studies on VILI were included finally in the meta-analysis. The summary sensitivity and specificity of VIA for CIN2+ were 73.2% (95%CI: 66.5-80.0%) and 86.7% (95%CI: 82.9-90.4%), respectively, and those for VILI were 88.1% (95%CI: 81.5-94.7%) and 85.9% (95%CI: 81.7-90.0%), respectively. VIA and VILI were both more sensitive in detecting more severe outcome, although there was a slight loss in specificity. Apparent heterogeneity existed in sensitivity and specificity for both VIA and VILI. High sensitivity of both VIA and VILI for CIN2+ was found when a combination of colposcopy and histology was used as disease confirmation. VIA, VILI, even a combination of them in parallel, could be good options for cervical screening in low-resource settings. Significant differences in sensitivity between different gold standards might provide a proxy for optimization of ongoing cervical cancer screening programs., (© 2015 Japan Society of Obstetrics and Gynecology.)

As part of China's 2009 health-care system reform, a national cervical cancer screening programme was launched, offering free screening by cytology or visuaI inspection with acetic acid and LugoI's iodine (VIA/VILI). We evaluated high-risk HPV (hrHPV) testing as a new screening modality for the national programme. This multicentre, open-label randomised trial was undertaken at nine urban and 11 rural primary-care centres in mainland China. Women aged 35–64 years without history of cervical cancer or hysterectomy, no clinical symptoms of pregnancy, who could understand the study procedures, and voluntarily participated were included. At baseline, women in urban areas were randomly assigned (1:2) to primary screening by cytology or hrHPV, and women in rural areas were randomly assigned (1:1:1) to cytology, hrHPV, or VIA/VILI. Women with baseline hrHPV positive tests were randomly assigned to triage strategies using cytology, VIA/VILI (rural sites), or directly refer to colposcopy. At 24-months, women in urban regions were rescreened with cytology and hrHPV co-testing; rural women received combined hrHPV, cytology, and VIA/VILI screening. Women who showed positive in cytology or VIA/VILI were referred to exams for further colposcopy, and biopsy was then required for participants with abnormal colposcopy results. The primary outcome was cervical intraepithelial neoplasia 2 or worse (CIN2+) and cervical intraepithelial neoplasia 3 or worse (CIN3+). Data analyses were done in the intention-to-screen population (ie, all women assigned to screening). This trial is registered with Chinese Clinical Trial Registry, number ChiCTR1900022530. Between May 18, 2015, and Sept 30, 2016, 61 484 women were assessed as eligible and 60 732 were randomly assigned to screening. Among women in urban regions, 8 955 were assigned to cytology and 18 176 to hrHPV-genotyping; among women in rural regions, 11 136 were assigned to VIA/VILI, 7080 to cytology, and 15 385 to hrHPV-testing. Compared with cytology and VIA/VILI-based primary screening, hrHPV without triaging had 2·0–2·7 times higher baseline CIN2+ or CIN3+ detection (risk ratios: urban hrHPV vs cytology CIN2+ 2·2 [95% CI 1·5–3·1], p<0·0001, CIN3+ 2·0 [1·2–3·3], p=0·0084; rural hrHPV vs cytology CIN2+ 2·6 [1·7–4·0], p<0·0001, CIN3+ 2·7 [1·5–4·6], p<0·0001; rural hrHPV vs VIA/VILI CIN2+ 2·0 [1·5–2·8], p<0·0001, CIN3+ 2·3 [1·5–3·6], p=0·00012). At the 24-month follow-up, hrHPV without triage had lower new CIN2+ or CIN3+ than cytology in urban sites (risk ratio: CIN2+ 0·5 [0·3–0·97], p=0·038; CIN3+ 0·2 [0·03–0·8], p=0·026), and lower baseline false negative results in rural sites (risk ratio: cytology CIN2+ 0·3 [0·2–0·6], p=0·00019 and CIN3+ 0·3 [ 0·1–0·6] p=0·0025; VIA/VILI CIN2+ 0·3 [0·2–0·6], p=0·00012 and CIN3+ 0·4 [0·2–0·8], p=0·013). HrHPV-testing offered better performance than current cytology and VIA/VILI-based primary screening and could be incorporated into China's national programme, but with the longer screening intervals recommended by WHO. National Health Commission of China. [ABSTRACT FROM AUTHOR]