Young Tae Kim, et al. jective test materials with the use of a special camera. The procedure is to take pictures of the outside of cervix, develop the pictures and in- terpret the pictures. Hence, compared with colposcopy, the advantages of cervicography are that it is relatively inexpensive, the equipment can be moved readily and specialists can perform the interpretation objectively and reproducibly.10 Cervicography has been reported to be applicable to mass screening for cervical cancer, and it can facilitate the selection of therapy for patients with abnormal cells detected by the Pap test.11 Recently, regardless of the findings of the Pap test, several institutes have performed cervico- graphy in combination with the Pap test screen- ing. Therefore, we evaluated the effectiveness of applying cervicography in combination with the Pap test for the primary screening of cervical neoplasia. MATERIALS AND METHODS Materials Among all patients screened by cervicography at the Yonsei Cancer Detection Center of the Department of Obstetrics and Gynecology, Yonsei University College of Medicine from January to July 2003, 294 patients who were examined by the Pap test and cervicography as a screening pro- cedure for cervical cancer and taken by the subsequent colposcopy directed biopsy or surgical resection as required, were analyzed. Patients whose results of cervicography had a technical defect were excluded from this study. The mean age of the subjects was 43 years, and the ages ranged from 19 years to 83 years. Methods The Pap test was performed first, followed by cervicography. A cytobrush or spatula was used to obtain specimens for the Pap test. The results were interpreted according to the Bethesda clas- sification: negative for intraepithelial lesion or ma- lignancy (N), atypical squamous cells of undeter- mined significance (ASC-US), atypical squamous cells can not exclude HSIL (ASC-H), low-grade Yonsei Med J Vol. 46, No. 2, 2005 squamous intraepithelial lesion (LSIL), high- grade squamous intraepithelial lesion (HSIL), and squamous cell carcinoma (SCC). Cervicography was performed with a cervis- cope (NTL lab Ltd, Korea), and we used Ektachrome film (ASA 200). The procedure was to insert a speculum, expose the cervix of uterus adequately, remove mucus or blood with cotton swabs, apply 5% acetic acid, and examine the condition of the cervix for 15-20 seconds and note any discharge and bleeding. After applying the acetic acid again, the camera was focused and two cervicograms were taken within 30 seconds. The results of cervicograms were analyzed by the new cervicogram program developed in Korea, and this program was recommended by Korean Woman's Cancer Research Foundation of Catholic Medical Center (Table 1). To analyze the data, the Pap test classified as atypical squamous cells of undetermined signi- ficance (ASC-US), atypical squamous cells can not exclude HSIL (ASC-H), low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL), and squamous cell carcinoma (SCC) were considered as positive, and suspicious atypia (S1, S2) and positive (PH, PL, and PC) on a cervicogram were considered as positive. The diagnosis of histology above cervical intraepithelial neoplasia (CIN) I was considered as positive. Data was analyzed using parametric and nonparametric statistics, SPSS 10.0 (Chicago, IL, USA). Differences were considered significant when the probability of the error was below 5% (p < 0.05). RESULTS The result of screening tests and histology Among 294 women, the Pap test was negative for intraepithelial lesion or malignancy in 130 cases (44.2%), ASC-US in 45 cases (15.3%), ASC-H in 4 cases (1.4%), LSIL in 46 cases (15.6%), HSIL in 46 cases (15.6%), and SCC in 23 cases (7.8%). Cervicographies were negative (N1, N2) in 55 cases (18.7%), benign atypia (B1, B2) in 147 cases (50.0%), suspicious atypia (S1, S2) in 80 cases (27.2%), and positive (PH, PL, PC) in 12 cases