Cytology alone versus cytology and cervicography for cervical cancer screening: A randomized study

Objective: To compare the ability of combined cytology and cervicography wi th cytology alone to decrease the number of premalignant cervical lesions f ound in subsequent screening. Methods: Five thousand five hundred fifty women 18-91 years old were random ized to cytology plus cervicography or cytology alone. One year later, wome n were rescreened using both cytology and cervicography. All women with pos itive lesions were referred for colposcopically directed biopsies and treat ment as indicated. We expected to decrease by half the number of cervical i ntraepithelial neoplasia (CIN) lesions at 1-year screening by adding cervic ography to cytology at initial screening. Results: Compared with cytology screening alone, screening with cytology pl us cervicography showed a 30% reduction in CIN I-II-III cervical lesions at 1-year screening round (relative risk [RR] 0.70; 95% confidence interval [ CI] 0.32, 1.55, P = .35) and a 43% reduction in CIN II-III cervical lesions (RR 0.57; CI 0.14, 2.16, P = .36). Most lesions detected by one test were not detected by the other. In a retrospective search, nine biopsies (one no rmal and eight revealing CIN I or more on histopathology) were found to be positive for the human papillomavirus; five of the nine biopsies were found by cytology, three by cervicography, and one by both tests. Conclusion: The addition of cervicography to cytology in initial screening did not significantly decrease the number of premalignant cervical lesions detected 1 year later, probably because of the transient nature of most of these lesions. Because cytology and cervicography seemed to detect differen t premalignant lesions, it is possible that cervicography could detect lesi ons that do not express the cellular abnormalities necessary for detection by cytology. (C) 1999 by The American College of Obstetricians and Gynecolo gists.