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Speculoscopy vs. the acetic acid test for cervical neoplasia
H S Cronjé1, E van Rensburg, B F Cooreman
1Department of Obstetrics and Gynecology, University of the Orange Free State, Bloemfontein, South Africa. gnoghsc@med.uovs.ac.za
Objective:
To compare the specificity of speculoscopy and the acetic acid test (AAT).
Methods:
A randomized controlled trial was performed on 1150 women in a primary healthcare clinic. The main end-points were the sensitivity and specificity of speculoscopy and the AAT.
Results:
The mean age of the patients was 37.7 years in the speculoscopy group (n=545) and 37.5 years in the AAT group (n=605). Cervicography (the golden standard) was positive in 11.3% of the participants, speculoscopy in 20.4% and the AAT in 25.1%. The sensitivity, specificity and the kappa value for speculoscopy were 53.5%, 83.6% and 0.23, respectively. For the AAT, the corresponding figures were 51.1%, 77.3% and 0.15. No statistically significant differences were found between these two groups. Of clinical importance, however, was a finding that speculoscopy did not miss a single case of high grade squamous intra-epithelial lesion or cancer whilst the AAT missed five such lesions.
Conclusion:
Speculoscopy could not be shown to have an improved specificity when compared with the acetic acid test. The low specificity of both the tests will result in the referral of too many patients for colposcopy.