Young Tae Kim, et al. The correlation of cervicography based on Pap smear and histology For 130 women with negative Pap test, 101 cases (77.7%) were negative and 29 cases (22.3%) were positive on cervicography. For patients with negative Pap test, the sensitivity of cervicography was 26.1%, the specificity was 79.8%, the positive predictive value was 41.4%, the negative predic- tive values was 66.3%, the false positive rate was 58.6%, and the false negative rate was 33.7%. For women with negative Pap test, the instances of a positive result on cervicography and a negative result on histology were 17 cases (13.1%), and the instances of a negative result on cervicography and a positive result on histology were 34 cases (26.2%). For 164 women with positive Pap test, 101 cases (61.6%) were negative and 63 cases (38.4%) were positive on cervicography. For women with positive Pap test, the sensitivity of cervicography was 44.9%, the specificity was 78.3%, the positive predictive value was 84.1%, the negative predictive value was 32.7%, the false positive rate was 15.9%, and the false negative rate was 67.3%. For women with positive Pap test, the instances of a positive result on cervicography and a negative result on histology were 10 cases (6.1%), and the instances of a negative result on cervicography and a positive result on histology were 65 cases (39.6%) (Table 4, 5). Comparison of diagnostic accuracy according to screening tests Compared with the Pap test, the diagnostic accuracy of cervicography was inferior because of its lower sensitivity, positive/negative predictive value and higher false positive/negative, even if its specificity was higher. Combining the two screening tests may be partially helpful as the sensitivity of the combined screening tests was higher than the Pap test alone, and together the two tests had a higher negative predictive value and lower false negative rate. Because of its low specificity and low positive predictive value, however, and considering its cost and effectiv- eness together, the combined tests have limita- tions as screening tests. We assessed the accuracy of cervicography even in the patients that were Yonsei Med J Vol. 46, No. 2, 2005 classified based on their Pap test results, and although the specificity was slightly higher (79.8%, 78.3% > 64.6%) and the sensitivity was lower (26.1%, 44.9% < 72.0%), the positive/nega- tive predictive value and the false positive/nega- tive rate were not significantly different. The consistency of cervicography for Pap test was analyzed with Kappa test, and the result was fair (κ=0.71). DISCUSSION Cervical cancer is the most common cancer in the reproductive organs of women. Over 450,000 new cases were detected annually, and over 230,000 women die due to this disease with 80% of these deaths occurring in developing coun- tries.1,2 In developed countries, where the scre- ening program has been actively applied, the incidence as well as the mortality rate has been decreased significantly.12-15 The significant de- creases in cervical cancer incidence and mortality can be largely attributed to the success of widespread Pap test. The onset and the natural history of cervical cancer are well established. In addition, the early diagnosis of cervical cancer is feasible as its primary lesion is readily accessible. Therefore, cervical cancer is a curable disease if the appropriate treatments are administered at the early stage of disease. Over the past several decades, numerous studies have been performed to develop screening methods for cervical cancer, and presently, re- search is actively ongoing to develop methods that will allow doctors to detect premalignant lesions effectively. The Pap test that was devel- oped in 1942 is currently the most frequently and widely used method worldwide as an individual screening test and as a mass-screening test. Never- theless, its shortcomings of the low sensitivity and the high false-negative results (15-45%) have been reported,7,8 and the main factors contributing to the false-negative rate were specimen collection, laboratory error, and deficiencies in laboratory quality assurance system.16-18 Giles et al. reported that the Pap test failed to detect approximately 30% of invasive cancer and 58% of premalignant lesion of the uterine cervix.19