Cervicography for evaluating the "atypical" Papanicolaou smear

A study was designed to compare various case-finding procedures in the evaluation of patients with an "atypical" Papanicolaou smear. Six hundred eighty-one consecutive patients were referred to the Denver General Hospital Colposcopy Clinic for smears showing evidence of atypical nuclear and/or cytoplasmic changes insufficient to justify a cytologic diagnosis of dysplasia. A full colposcopic evaluation with appropriate directed biopsies was carried out on all the patients. Fourteen percent of the patients demonstrated cervical intraepithelial neoplasia (CIN), and 29% had condyloma without CIN. Both cervicography and the colposcopist's impression, though not ideal, were superior to a repeat smear, human papillomavirus typing or both. Cost effectiveness criteria and ease of training appear to justify the use of cervicography in the evaluation and triage of patients with atypical Papanicolaou smears.