ORIGINAL ARTICLE Can Revised Visual Inspection with Acetic Acid (VIA) Test Improve the Performance of Crude VIA Test of in Low-Resource- Setting Countries? Amany A. Makroum 1 • Reda Hemida 1 • Yasser Mosbah 1 • Maher Shams 1 • Rafik Barakat 1 • El-Said Mohamed Abdel-Hady 1 Received: 15 September 2017 / Revised: 16 October 2017 / Accepted: 20 October 2017 / Published online: 30 October 2017 Ó Association of Gynecologic Oncologists of India 2017 Abstract Purpose To compare the performance of our suggested ‘‘revised VIA’’ test to the traditional crude VIA test. Methods A cross-sectional study was conducted in the early cancer detection unit. During the period from June 2014 to January 2016, 500 patients were included in our study. After clinical assessment, VIA test was performed followed by applying the five criteria of the revised test at the same time. All cases were referred to colposcopy for confirmation. Cervical punch biopsy was performed for cases with positive colposcopic findings. Results The prevalence of CIN in this study was 11/500 (2.2%). The positive cases with crude VIA test were 236 of 500 screened women (47%). Its sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy (100, 53.98, 4.66, 100, and 55%, respectively). When we applied the five criteria of our suggested ‘‘revised VIA’’ test, only 175 cases (35%) were positive. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accu- racy became 100, 66.46, 6.28, 100, and 67%, respectively. Conclusion The suggested ‘‘revised VIA’’ test improved the performance of the crude VIA test by improving its specificity. We recommend further studies to evaluate its performance. Keywords Cervical cancer Á Screening Á Acetic acid test Á Improving accuracy Introduction Globally, cervical cancer is the fourth most common can- cer among women and the second most common type in the developing countries [1]. The majority of the diagnosed cases and deaths occur in developing countries. The high burden of cervical cancer in developing countries reflects the absence of cervical cancer prevention programs as resources for screening and treatment are limited [2]. There is no doubt that regular screening is the single most important public health strategy to reduce cervical cancer incidence and subsequent mortality [3]. Cervical cancer is a good example for screening as it has a long natural his- tory, a long preclinical phase, and a premalignant lesion, cervical intraepithelial neoplasia (CIN). CIN is a prema- lignant lesion that may be diagnosed at one of the three stages: CIN1, CIN2, or CIN3. The last two lesions can progress to invasive cervical carcinoma if left untreated [4]. Screening with use of Pap smear, liquid-based cytology, and screening for human papillomavirus using DNA testing resulted in the reduction in cervical cancer in developed countries [5, 6]. However, these methods of screening are very difficult to implement in low-resource countries. Therefore, alternative preventive methods for cervical cancer in developing countries are needed. Non-cytology tests include visual inspection with acetic acid (VIA), visual inspection with acetic acid and magni- fication (VIAM), and visual inspection with Lugol’s iodine (VILI). They provide immediate results and have been investigated extensively in low-resource settings as alter- native screening methods to cervical intraepithelial neo- plasia two or higher [7, 8]. VIA test can be performed by a range of trained providers including physicians, nurses, and nurse-midwives, and has been shown to be safe, rapid, and & Reda Hemida redaelshouky@hotmail.com 1 Faculty of Medicine, Mansoura University, 35111 Elgomhoria Street, Mansoura, Egypt 123 Indian J Gynecol Oncolog (2017) 15:65 https://doi.org/10.1007/s40944-017-0159-4