title: Comparison of Pap Smear and Colposcopy in Screening for Cervical Cancer in Patients with Secondary Immunodeficiency.
abstract: BACKGROUND
  Cervical cancer is the second most common cancer among women worldwide. The sensitivity of conventional Pap smear in detecting cervical lesions before cervical cancer is 51%, which means the false negative value is 49%. The aim of this study was to compare two methods for screening for cervical cancer in patients with secondary immunodeficiency, i.e., the conventional Pap smear and colposcopy.
  
  
  METHODS
  This cross-sectional study was conducted on 101 immunodeficient patients who were referred to the Gynecologic Clinic at Shahid Sadughi Hospital in Yazd from March 2011 to August 2012. All patients underwent the Pap test, a colposcopy, and a cervical biopsy, with the latter being considered as the gold-standard test.
  
  
  RESULTS
  The most frequency of immunodeficiency was noted among patients with rheumatoid arthritis (53.3%), and this was followed by patients who were undergoing chemotherapy (30.7%), patients with lupus erythematosus (12.9%), and patients with AIDS (3%). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the Pap smear were 18.2, 98.5, 85.5, 71.3, and 72.2%, respectively. The respective values for colposcopy were 66.7, 98.94, 80, 97.9, and 97%, respectively.
  
  
  CONCLUSIONS
  In this study the accuracy, sensitivity, specificity, and negative predictive values of colposcopy were higher than those for the Pap smear in detecting high-grade, cervical, pre-malignant lesions (cervical intraepithelial neoplasia: CIN ≥ 2). Therefore, an annual colposcopy is advised for secondary immunodeficient patients instead of a Pap smear.
authors.affiliation: Gynecology Oncology Fellowship, Associate Professor, Gynecology Department, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Mojgan
authors.initials: M
authors.lastname: Karimi-Zarchi
authors.affiliation: Gynecologist, Gynecology Department, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Leila
authors.initials: L
authors.lastname: Zanbagh
authors.affiliation: Immunologist, Associate Professor, Immunology Department, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Shafii
authors.affiliation: Pathologist, Associate Professor, Pathology Department, Faculty of Medicine, Shahid Sadoughi University of Medical Science, Yazd, Iran.
authors.forename: Shokouh
authors.initials: S
authors.lastname: Taghipour-Zahir
authors.affiliation: Medical Student, Young Researchers and Elites Club, Faculty of Medicine, Islamic Azad University, Yazd Branch, Yazd, Iran.
authors.forename: Soraya
authors.initials: S
authors.lastname: Teimoori
authors.affiliation: Medical Student, Student Research Committee, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Pouria
authors.initials: P
authors.lastname: Yazdian-Anari
keywords: cervical cancer; colposcopy; conventional Pap smear; immunodeficiency; sensitivity; specificity