Screening for cervical neoplasia in a developing country utilizing cytology, cervicography and the acetic acid test

Objective: To compare three screening tests for cervical neoplasia. Method: Women (6301) were screened simultaneously with cytology, cervicography and the acetic acid test (AAT). Biopsies were taken from the acetowhite lesion s and every fifth seemingly normal cervix. Positive cases (both at screenin g and histology) were referred for colposcopy. The histology results served as the golden standard. Results: Cytology was positive in 1.7% of cases, c ervicography in 10.7% and the AAT in 17.8%. The sensitivity of cytology was 19.3%, of cervicography 41.8% and the AAT 49.4%. Corresponding specificiti es were 99.3%, 78.8% and 48.5%. In 23% of biopsies showing cervical intraep ithelial neoplasia (grade I-III), all three screening tests were negative. By combining the three tests, a sensitivity of 76.9% was achieved. Conclusi on: The sensitivity of cytology alone is not great enough for implementing as a screening test in a developing country where screening programs are of ten inadequate. Screening with a combination of tests, once or a few times per woman's life, is a more acceptable alternative since it allows for less screening events without sacrifying sensitivity. (C) 2001 International Fe deration of Gynecology and Obstetrics. All rights reserved.