The evaluation of cervical cancer screening by combining speculoscopy with Papanicolaou smear examination in Taiwan.

BACKGROUND: Cervical cancer is the most common malignancy in women in Taiwan. In order to improve the detection of cervical lesions using the Papanicolaou (Pap) smear in screening, a number of adjunctive tests have been developed. The purpose of this study is to evaluate the utility of a magnified chemiluminescent screening examination (speculoscopy) combined with the Pap smear (PapSure) in detecting cervical cancer. METHODS: A total number of 572 women underwent routine cervical cancer screening by receiving a Pap smear and speculoscopy examination. When either the Pap smear or speculoscopy result was positive, colposcopy was performed. Targeted biopsies were taken from any suspicious lesions that were found by positive colposcopies and the data analyzed using McNemar's test. RESULTS: Eighty-two women had a positive on either screening test. Of the 62 biopsy specimens obtained, 3 women showed high-grade squamous intraepithelial lesions (HGSIL), and 13 women showed low-grade squamous intraepithelial lesions (LGSIL). The histopathological findings were correlated at different levels with the results of the Pap smear alone and speculoscopy alone and both combined. The Pap smear alone detected 1.0% (6 of 572) of significant pathology, while speculoscopy alone detected 2.3% (13 of 572) of significant pathology. The use of the PapSure showed enhanced detection (16 of 572) compared with either the Pap smear alone or speculoscopy alone. CONCLUSIONS: Speculoscopy can be combined with the Pap smear (PapSure) as a cervical cancer screening test to yield a higher detection rate of biopsy-confirmed cervical pathology in women than the use of the Pap smear or speculoscopy alone.