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Screening for cervical neoplasia in a developing country utilizing cytology, cervicography and the acetic acid test
H S Cronjé1, B F Cooreman, E Beyer
1Department of Obstetrics and Gynecology, University of the Orange Free State, Bloemfontein, South Africa. gnoghsc@med.uovs.ac.za
Objective:
To compare three screening tests for cervical neoplasia.
Method:
Women (6301) were screened simultaneously with cytology, cervicography and the acetic acid test (AAT). Biopsies were taken from the acetowhite lesions and every fifth seemingly normal cervix. Positive cases (both at screening and histology) were referred for colposcopy. The histology results served as the golden standard.
Results:
Cytology was positive in 1.7% of cases, cervicography in 10.7% and the AAT in 17.8%. The sensitivity of cytology was 19.3%, of cervicography 41.8% and the AAT 49.4%. Corresponding specificities were 99.3%, 78.8% and 48.5%. In 23% of biopsies showing cervical intraepithelial neoplasia (grade I--III), all three screening tests were negative. By combining the three tests, a sensitivity of 76.9% was achieved.
Conclusion:
The sensitivity of cytology alone is not great enough for implementing as a screening test in a developing country where screening programs are often inadequate. Screening with a combination of tests, once or a few times per woman's life, is a more acceptable alternative since it allows for less screening events without sacrifying sensitivity.