Yonsei Medical Journal Vol. 46, No. 2, pp. 213 - 220, 2005 Clinical Usefulness of Cervicogram as a Primary Screening Test for Cervical Neoplasia Young Tae Kim1,2, Jae Wook Kim1,2, Sung Hoon Kim1,2, Yu Ri Kim1, Jae Hoon Kim1, Bo Sung Yoon1, and Yong Won Park1,2 1Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea; 2Institute of Women's Life Science, Yonsei University College of Medicine, Seoul, Korea. The purpose of this study is to evaluate the clinical usefulness of the cervicogram as a primary screening test for cervical neoplasia. A total of 294 women who had undergone a cervicogram and a Pap test between January and July 2003, were selected. The diagnostic accuracy of the Pap test, cervicogram, and the Pap test combined with a cervicogram were compared with the histopathologic diagnosis. Among 294 women, the Pap test was negative in 130 cases and positive in 164 cases. Among patients with positive Pap test, cervico- gram were negative in 101 cases (61.6%) and positive in 63 cases (38.4%). The diagnostic accuracy between cervicogram with positive Pap test and histology was as follows; sensitivity 44.9%, specificity 78.3%, positive predictive value 84.1%, negative predictive value 32.7%, false positive rate 15.9%, and false negative rate 67.3%. Although the adjunctive use of cervicogram with the Pap test in the initial screening of cervical neoplasia showed a higher specificity and higher positive predictive value compared to the Pap test alone, con- sideration in terms of lower sensitivity, lower positive predictive value, higher false positive rate and cost-effective- ness should be given in lieu of clinically applying cervicogram with the pap test as an initial screening test. Key Words: Cervicogram, primary screening test, diagnostic accuracy, the Pap test INTRODUCTION Cancer of the cervix is the most common form Received July 9, 2004 Accepted November 23, 2004 This study was supported by Brain Korea 21 Project for Medical Science, Yonsei University. Reprint address: requests to Dr. Sung Hoon Kim, Department of Obstetrics and Gynecology, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemoon-gu, Seoul 120-752, Korea. Tel: 82-2-2228-2242, Fax: 82-2-361-8357, E-mail: ytkchoi@ yumc.yonsei.ac.kr of cancer for women in developing countries, the second most frequent cancer worldwide, and the most frequent gynecological cancer seen in Korean women.1,2 If cervical carcinoma can be de- tected early, the prognosis is excellent and com- plete control may be expected in the premalignant status.3-5 The Pap test, developed by Papanicolaou in 1940s, reduced the incidence and mortality rate of cervical cancer significantly. In the USA, the Pap test reduced the death rate of cervical cancer patients by 70% and it presently saves approxi- mately 10,600 women's lives annually.6 However, reasonable test performance using a competent laboratory results in false negative rates of about 15 - 45% for cervical neoplasia, and supplemental tests that make up for the shortcoming of the cervico- vaginal method are required.6,7 Since Hans Hinselman in Hamburg, Germany, applied colposcopy to cervical cancer in 1925, colposcopy has been used as the other most required test, together with the Pap test, in the detection of cervical cancer and premalignant lesion. The drawbacks of colposcopy, however, are that a large number of patients can not be examined as it requires a specialist with great experience who is excellent in diagnosis. It also requires expensive equipment. It takes a long time for diagnosis. Another shortcoming of colposcopy is the difficulty of its application to general screening and mass screening, as the equipment cannot be moved readily.8,9 Adolf Stafl at the Wisconsin University College of Medicine, USA, developed cervicography in 1981.8 The principle of cervicography is based on colposcopy. However, cervicography obtains ob- Yonsei Med J Vol. 46, No. 2, 2005