IMPROVEMENT OF PAP SMEAR SENSITIVITY USING A VISUAL ADJUNCTIVE PROCEDURE - A COOPERATIVE ITALIAN STUDY ON SPECULOSCOPY (GISPE)

The present study evaluates whether speculoscopy, a magnified chemilum inescence examination, combined with Pap smear can improve the detecti on of cervical lesions, as compared with Pap smear alone. The investig ation was a prospective practice-based research carried out as a multi centre cohort study throughout the Italian territory. The participants were 3,300 asymptomatic women age greater than or equal to 18 years u ndergoing routine pelvic and cytological screening, All participants w ere subjected to Pap smear, speculoscopy and colposcopy investigations in succession, The 646 women with positive colposcopy underwent biops y, Of the 267 women with positive histology 25 were high-grade intraep hitelial lesions (HGSIL) and 242 were low-grade intraephitelial lesion s (LGSIL), The histological findings were correlated with the results of Pap smear and speculoscopy alone and combined (PPS), Pap smear alon e detected 76% of HGSIL, speculoscopy alone identified 84% of HGSIL, a nd PPS indicated 100% HGSIL. Of the 242 women with LGSIL, Pap smear al one detected 37% of the cases, speculoscopy alone detected 54% of the cases, and PPS identified 91% of the cases, Together, the two tests mi ssed 9% of the LGSIL, The combination PPS was found to increase sensit ivity from 40% to 92%, but to lower specificity from 94% to 23%, Specu loscopy combined with Pap smear can yield a higher percentage of women with biopsy-confirmed cervical pathology than the use of Pap smear as a sole screening test. This is particularly true of patients with LGS IL, The mechanisms of pathological detection and the use of speculosco py should be investigated further. (C) 1998 Lippincott Williams & Wilk ins.