Screening of cervical neoplasia by using pap smear with speculoscopy compared with pap smear alone

The objective was to compare the sensitivity and specificity of Pap smear plus speculoscopy with Pap smear alone.

The study was conducted in the Gynecology Clinic, Rajavithi hospital, Thailand between February 1st and July 31st 2003. Women who made a request for cervical screening underwent a Pap smear, speculoscopy and colposcopy. Colposcopically directed biopsies were obtained from women who had a positive colposcopy. Analytical methods were applied.

Of 257 women recruited to the study, Pap smear plus speculoscopy could increase sensitivity from 6.67% with Pap smear alone and to 33.33% when Pap smear plus speculoscopy is used. The false negative rate was reduced from 93.33% with Pap alone and to 66.67% with Pap smear plus speculoscopy. In using Pap smear alone compared with combination of two tests, the specificity decreased from 97.52% to 77.68% and false positive rate increased from 2.48% to 22.31%, respectively.

Adding speculoscopy to the Pap smear is able to significantly increase the sensitivity of the cervical screening. It also reduces the 'false negative" result. However, as expected, the specificity slightly decreases, due to the false positive from speculoscopy itself. One solution is to defer colposcopy for 6 months and to perform colposcopy only if either Pap smear or speculoscopy is positive.