Cervicography for triage of women with mildly abnormal cervical cytology results

OBJECTIVE: To estimate the sensitivity and specificity of cervicography in detecting cervical cancer precursor lesions in women participating in the N ational Cancer Institute's multicenter atypical squamous cells of undetermi ned significance and low-grade squarrous intraepithelial lesion triage stud y (ALTS). STUDY DESIGN: Cervigrams were obtained from 3134 women with a referral Papa nicolaou smear diagnosis of atypical squamous; cells of undetermined signif icance or low-grade squamous intraepithelial lesion. Cervigram and cervical histology results were compared by using cervical intraepithelial neoplasi a (CIN) 2 and CIN 3 disease end points. RESULTS: Of 3134 women, 444 had histologic findings of more than or equal t o CIN 2 and 222 had CIN 3. Cervicography interpretation by using a threshol d of greater than or equal to atypical had a sensitivity, specificity, and positive and negative predictive values of 79.3%, 61.0%, 13.4%, and 97.5%, respectively, for detecting greater than or equal to CIN 3. Cervicography w as more sensitive (80.8% vs 57.1 %), but less specific (55.7% vs 81.8%), fo r detecting CIN 3 in women younger than 35 years compared with women 35 yea rs or older, respectively. CONCLUSIONS: Cervicography functioned moderately well at detecting CIN 2 or CIN 3 in women with atypical squamous cells of undetermined significance a nd low-grade squamous intraepithelial lesion Papanicolau smear results. Cer vigram sensitivity was better for younger women.