CERVICOGRAPHY - ADJUNCTIVE CERVICAL-CANCER SCREENING BY PRIMARY-CARE CLINICIAN

Background. Cervicography is an adjunct method of cervical cancer scre ening intended to complement cervical cytologic sampling, ie, Papanico laou (Pap) smear. Cervicography involves obtaining and evaluating a ph otographic image of the cervix. The purpose of this investigation was to evaluate the screening use of cervicography as an adjunct to clinic al cytologic screening. Methods. Women presenting at four clinical sit es for annual cervical cytologic screening or for follow-up evaluation after receiving an abnormal Pap smear result were enrolled in the stu dy. Each patient received a Pap smear and a cervigram. Those women in whom abnormalities were detected by either test subsequently underwent colposcopy, and when appropriate, histologic specimens were obtained. Results. Pap smear and cervigram data were obtained for 1449 women. W hen premalignant or malignant histologic test results were considered as a true positive, the Pap smear correctly identified 25.6% of subjec ts with dysplasia and 37.5% with severe dysplasia. The Pap smear faile d to identify the one patient with invasive cancer. The cervigram dete cted 50.5% of the subjects with dysplasia and 77.8% of the subjects wi th severe dysplasia, and it identified the one patient with invasive c ancer when a positive cervigram was considered a true positive. When t he results were combined, the two tests identified 62.9% of subjects w ith histologically confirmed dysplasia, 81.3% of subjects with severe dysplasia, and 100% (one patient) with cancer. Conclusions. The cervig ram detected twice the number of patients with premalignant disease as the Pap smear alone, and correctly identified the invasive cancer. Ce rvicography improved the detection of cervical