The performance of tele-cervicography for detection of preinvasive and invasive disease of the uterine cervix as an adjunctive test to Pap smears

Abstract

Aim of the study To evaluate the diagnostic capacity of tele-cervicography for the detection of cervical neoplasia as an adjunctive test with Papanicolaou (Pap) smears. Material and methods : Pap smear and tele-cervicography were performed on each subject. Histologic results were obtained for all patients. Results : Of the 863 females who had a tele-cervigram, 252 (29.2%) had a positive result. Of the 60 histologically confirmed cases of high-grade squamous intraepithelial lesions (HSILs), 56 (93.3%) were detected by tele-cervicography, including 16 (26.7%) with a positive grade of 1 and 40 (66.7%) with a positive grade of 2. With the positive threshold of tele-cervicography set as any positive grade (P0 to P3), the overall sensitivity was 94.0% (95% CI: 88.0–97.3%), the specificity was 80.9% (95% CI: 80.0–81.5%), and the positive likelihood ratio was 4.94 (95% CI: 4.23–5.77) for the detection of HSILs or cancer. The combination of tele-cervicography with Pap smear testing for the detection of HSILs or cancer resulted in an increase in sensitivity from 84.6% (Pap only: cutoff = atypical squamous cells of undetermined significance or more severe) to 98.3% (Pap plus tele-cervicography: cutoff = P0 or more severe). Conclusions : The sensitivity of tele-cervicography was higher than that of cytology for the detection of cervical neoplasia, and combining the two tests increased the sensitivity. Tele-cervicography can be considered a useful complementary tool to cytology.

Keywords

• cervicography
• cervical cancer
• cervical neoplasia
• screening