title: Cervical cancer screening with papanicolaou smear plus speculoscopy by nurse practitioners in a health maintenance organization.
abstract: OBJECTIVE
  We set out to evaluate the utility of a magnified chemiluminescent screening examination (speculoscopy) as an adjunct to the Papanicolaou (Pap) smear in detection of cervical pathological processes by nurse practitioners and midwives in a health maintenance organization setting.
  
  
  METHODS
  Patients who presented for routine screening (N = 689) received a Pap smear and speculoscopy examination. If the Pap smear or speculoscopy result was positive, colposcopy was performed and biopsies were obtained from women with positive colposcopies. Data were analyzed using McNemar's adaptation of the chi-square test for correlated proportions.
  
  
  RESULTS
  In 80 patients from whom biopsies were obtained, Pap smear alone detected 67% of (6 of 9) and speculoscopy alone detected 77% of (7 of 9) high-grade squamous intraepithelial lesions (HGSILs). Pap smear alone detected 26% of low-grade squamous intraepithelial lesions (LGSILs) (10 of 38) whereas speculoscopy alone detected 84% (32 of 38) (p < .001). Combined use of Pap smear and speculoscopy showed a trend (p = .073) toward enhanced detection of HGSIL compared with either the Pap smear alone or speculoscopy alone.
  
  
  CONCLUSIONS
  Speculoscopy can be included in a nurse practitioner- and midwife-based cervical screening program, and the addition of this modality enhances the sensitivity of cervical screening by finding more high-grade and low-grade cervical disease than does pap smear alone.
authors.affiliation: Departments of Obstetrics and Gynecology *Kaiser Permanente Medical Office, La Palma †Kaiser Permanente Medical Center, Anaheim, CA.
authors.forename: G
authors.initials: G
authors.lastname: Edwards
authors.forename: C
authors.initials: C
authors.lastname: Rutkowski
authors.forename: C
authors.initials: C
authors.lastname: Palmer