The Italian experience of a Pap test and speculoscopy based screening programme

Objectives-The main objective of the study was to evaluate if speculoscopy, a magnified chemiluminescent examination, combined with a Pap smear, could improve the detection of early cervical lesions compared with the Pap smea r alone. Setting-Pap tests and speculoscopies were performed in two family planning centres located in the surrounding areas of Modena. Colposcopic investigati ons and biopsies of the uterine cervix were performed in a second level cen tre (Gynaecological Prevention Centre of Modena Policlinico). Histological specimens were analysed at the Section of Pathological Anatomy of Modena Po liclinico. Subjects-The study population comprised invited to undergo a Pap smear ever y three years in accordance with the screening programme for cervical cance r started in Modena in 1997. Methods-Midwives performed the Pap smear and speculoscopy in succession. Wo men with a positive Pap test and/or positive speculoscopy underwent colposc opy and, if colposcopic findings were positive, targeted punch biopsies wer e performed. Results-A total of 1000 patients were subjected to cytology and speculoscop y examinations. Among these women, 10 had abnormal Pap smear findings where as 144 had an abnormal speculoscopic pattern. Only three of 59 patients wit h a histological diagnosis of cervical intraepithelial neoplasia grade I (C IN I)/human papillomavirus and only three of seven patients with CIN II/CIN III had a positive Pap test. Conclusions-Speculoscopy combined with a Pap test can significantly increas e the detection of cervical lesions when included in a screening programme.