title: Improved cervical cancer screening in premenopausal women by combination of Pap smear and speculoscopy.
abstract: OBJECTIVE
  This study was done to evaluate the efficacy of the Pap smear, speculoscopy, and a combination of Pap smear and speculoscopy (PapSure examination) in pre- and postmenopausal women.
  
  
  METHODS
  All women were screened using the Pap smear and speculoscopy and combination of both (PapSure examination) in the multicenter trial. Final diagnosis of each patient was based on a histological evaluation of the colposcopic target biopsy. Results were analyzed using a proportional comparison test, sensitivity, specificity, and predictive value with significance determined at p<0.05.
  
  
  RESULTS
  Of 1813 women screened, 1701 were eligible for analysis. Two hundred and fourteen women (12.6%) received at least one positive screening test result. Of the 1084 colposcopic biopsy specimens obtained, 24 showed low-grade squamous intraepithelial lesion (LSIL) and 19 high-grade SIL (HSIL). HSIL were considered test-positive. Rate of colposcopy was 21.5% (125/582) in the premenopausal group and 63.9% (321/502) in the postmenopausal group (p<0.001). For premenopausal women, speculoscopy (75.0%) or PapSure (91.7%) provided higher sensitivity than Pap smear (50%) (p<0.05). In postmenopausal women, no statistical significance in sensitivity existed between PapSure (85.7%) and Pap smear (57.1%). Speculoscopy (96.8%) or PapSure (96.5%) had lower specificity than Pap smear (99.6%) (p<0.001).
  
  
  CONCLUSIONS
  PapSure was an accurate alternative screening method to Pap smear or speculoscopy for cervical intraepithelial lesions because of a significantly higher sensitivity along with adequate specificity for premenopausal women; however, PapSure was not a more effective cervical screening method for postmenopausal women.
authors.affiliation: Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taiwan.
authors.forename: Nae-Fang
authors.initials: NF
authors.lastname: Twu
authors.forename: Yi-Jen
authors.initials: YJ
authors.lastname: Chen
authors.forename: Peng-Hui
authors.initials: PH
authors.lastname: Wang
authors.forename: Bill Ken-Jen
authors.initials: BK
authors.lastname: Yu
authors.forename: Chung-Ru
authors.initials: CR
authors.lastname: Lai
authors.forename: Kuan-Chong
authors.initials: KC
authors.lastname: Chao
authors.forename: Chiou-Chung
authors.initials: CC
authors.lastname: Yuan
authors.forename: Ming-Shyen
authors.initials: MS
authors.lastname: Yen
mesh_terms: D000328:Adult; D003127:Colposcopy; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D065006:Papanicolaou Test; D011237:Predictive Value of Tests; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears