NAKED-EYE INSPECTION OF THE CERVIX AFTER ACETIC-ACID APPLICATION MAY IMPROVE THE PREDICTIVE VALUE OF NEGATIVE CYTOLOGIC SCREENING

Background. The purpose of this study was to assess the predictive val ue of naked-eye inspection of the cervix (NIC) after acetic acid appli cation as an adjunct to Papanicolaou (Pap) testing for cervical cancer screening. Methods. Study subjects were women attending a medical col lege student health clinic either for cervical cytologic screening (67 %) or because of a recent atypical cytologic screening result (33%). A ll study participants received cytologic screening, cervicography, and NIC. Results. Of the 95 patients, 71 (75%) had abnormal findings on N IC. Fifty-one patients underwent colposcopy with biopsy, including 48 of the 71 with an abnormal finding on NIC. The results of 40 of the bi opsies were abnormal: 36 showed human papillomavirus or low-grade squa mous intraepithelial lesions, 3 showed high-grade squamous intrepithel ial lesions, and 1 showed invasive cervical cancer. Sixty-five percent (26) of the abnormal biopsy findings occurred in women with normal cy tologic test results. NIC and cervicography both were effective in ide ntifying patients with abnormalities, but the combination of NIC follo wed by cervicography referred fewer women for colposcopy than did a po sitive result on NIC alone (52% vs 75%). The combination of a negative Pap smear and a negative NIC result had a 91% predictive value for th e absence of cervical intraepithelial neoplasia. This was a significan t improvement over cytologic screening alone. Conclusions. In this stu dy, the combination of cytologic screening (Pap smear) and NIC increas ed the screening yield as compared with a Pap smear alone but with som e loss of positive predictive value. NIC significantly improved the pr edictive value of negative cytologic screening results.