<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0120-4157</journal-id>
<journal-title><![CDATA[Biomédica]]></journal-title>
<abbrev-journal-title><![CDATA[Biomédica]]></abbrev-journal-title>
<issn>0120-4157</issn>
<publisher>
<publisher-name><![CDATA[Instituto Nacional de Salud]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0120-41572019000100065</article-id>
<article-id pub-id-type="doi">10.7705/biomedica.v39i1.4007</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Visual techniques for cervical cancer screening in Colombia]]></article-title>
<article-title xml:lang="es"><![CDATA[Técnicas visuales en la tamización del cáncer de cuello uterino]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Gamboa]]></surname>
<given-names><![CDATA[Óscar]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[González]]></surname>
<given-names><![CDATA[Mauricio]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Bonilla]]></surname>
<given-names><![CDATA[Jairo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Luna]]></surname>
<given-names><![CDATA[Joaquín]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Murillo]]></surname>
<given-names><![CDATA[Raúl]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Instituto Nacional de Cancerología Subdirección de Investigaciones y Salud Pública ]]></institution>
<addr-line><![CDATA[Bogotá D.C]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Instituto Nacional de Cancerología Grupo de Investigación Clínica ]]></institution>
<addr-line><![CDATA[Bogotá D.C.]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Fundación Universitaria Ciencias de la Salud Departamento de Ginecología ]]></institution>
<addr-line><![CDATA[Bogotá D.C]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,Organización Sanitas Grupo de Ginecología ]]></institution>
<addr-line><![CDATA[Bogotá D.C]]></addr-line>
<country>Colombia</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>03</month>
<year>2019</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>03</month>
<year>2019</year>
</pub-date>
<volume>39</volume>
<numero>1</numero>
<fpage>65</fpage>
<lpage>74</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_arttext&amp;pid=S0120-41572019000100065&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_abstract&amp;pid=S0120-41572019000100065&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_pdf&amp;pid=S0120-41572019000100065&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Introduction: Direct visual inspection for cervical cancer screening remains controversial, whereas colposcopy-biopsy is considered the gold standard for diagnosis of preneoplastic cervical lesions.  Objectives: To determine the rates of cervical intraepithelial neoplasia grade 2 or more and of false positives for colposcopy and direct visual inspection.  Materials and methods: Women aged 25-59 underwent direct visual inspection with acetic acid (VIA), Lugol&#8217;s iodine (VIA-VILI), and colposcopy. Punch biopsies were obtained for all positive tests. Using histology as the gold standard, detection and false positive rates were compared for VIA, VIA-VILI, and colposcopy (two thresholds). Sensitivity and false positive ratios with the corresponding 95% confidence intervals were estimated.  Results: We included 5,011 women in the analysis and we obtained 602 biopsies. Positivity rates for colposcopy high-grade and low-grade diagnosis were 1.6% and 10.8%. Positivity rates for VIA and VIA-VILI were 7.4% and 9.9%. VIA showed a significantly lower detection rate than colposcopy with low-grade diagnosis as the threshold(SR=0.72; 95% CI0.57-0.91), and significantly lower false positive rate (FPR=0.70; 95% CI 0.65-0.76). No differences between VIA-VILI and colposcopy low-grade threshold were observed. VIA and VIA-VILI showed significantly higher detection and false positive rates than colposcopy high-grade threshold. Sensitivity rates for visual inspection decreased with age and false positive rates increased. For all age groups, false positive rates for VIA and VIA-VILI were significantly higher than colposcopy.  Conclusions: Detection rates for VIA-VILI similar to colposcopy low-grade threshold representa chance to reduce cervical cancer mortality through see-and-treat approaches among women with limited access to health care. Lower detection rates suggest reviewing high-grade colposcopy findings as the threshold for biopsy incertain settings.]]></p></abstract>
<abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  Introducción. La inspección visual directa para la tamización del cáncer cervical sigue siendo controversial, mientras que la colposcopia y la biopsia siguen considerándose como métodos de referencia para diagnosticar lesiones cervicales precancerosas.  Objetivo. Determinar las tasas de detección de neoplasia intraepitelial cervical de grado 2 y de los falsos positivos en la colposcopia y la inspección visual directa.  Materiales y métodos. Se seleccionaron mujeres de 25 a 59 años sometidas a citología convencional, inspección visual directa con ácido acético y disolución de Lugol y colposcopia. Se practicó biopsia en todas las pruebas positivas. Utilizando la histología como el medio de verificación de referencia, se compararon las tasas de detección y de falsos positivos de cada prueba. Se estimaron las razones de sensibilidad y de falsos positivos con los correspondientes intervalos de confianza.  Resultados. Se incluyeron 5.011 mujeres. Las colposcopias positivas de alto y bajo grado correspondieron a 1,6 y 10,8 %, respectivamente. La inspección visual directa con ácido acético y solución yodada de Lugol fue positiva en 7,4 y 9,9 %, respectivamente. La inspección visual directa con ácido acético tuvo tasas de detección y falsos positivos significativamente menores que la coloscopia con umbral de bajo grado (razón de sensibilidad: 0,72; IC95% 0,57-0,91; razón de falsos positivos: 0,70; CI95% 0,65-0,76); no hubo diferencias entre la inspección visual directa con solución yodada de Lugol y la colposcopia con dicho umbral. Las tasas de detección y de falsos positivos de los dos tipos de inspección visual fueron significativamente más altas que las de la colposcopia con el umbral de alto grado. Las tasas de detección de la inspección visual disminuyeron con la edad y las de falsos positivos aumentaron.  Conclusiones: Las tasas de detección similares para la inspección visual directa con ácido acético o con solución yodada de Lugol y la colposcopia con umbral de bajo grado representan una oportunidad para reducir la mortalidad por cáncer de cuello uterino cuando el acceso a los servicios de salud es limitado. Las tasas de detección más bajas para la colposcopia con umbral de alto grado sugieren la necesidad de revisar dicho umbral en ciertos entornos.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Uterine cervical neoplasms]]></kwd>
<kwd lng="en"><![CDATA[mass screening]]></kwd>
<kwd lng="en"><![CDATA[sensitivity and specificity]]></kwd>
<kwd lng="en"><![CDATA[colposcopy]]></kwd>
<kwd lng="en"><![CDATA[Colombia]]></kwd>
<kwd lng="es"><![CDATA[neoplasias del cuello uterino]]></kwd>
<kwd lng="es"><![CDATA[tamizaje masivo]]></kwd>
<kwd lng="es"><![CDATA[sensibilidad y especificidad]]></kwd>
<kwd lng="es"><![CDATA[colposcopia]]></kwd>
<kwd lng="es"><![CDATA[Colombia]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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