Comparative utility of repeat papanicolaou smears, cervicography, and colposcopy in the evaluation of atypical papanicolaou smears

In an attempt to establish the significance and management of the atypical Papanicolaou smear, 97 patients with atypical Papanicolaou smears were each evaluated with a repeat Papanicolaou smear, cervicography, and colposcopy. In the detection of significant lesions, cervicography was more sensitive than a repeat smear, but less so than colposcopy. Forty-two percent of the colposcopically detected lesions would have gone undetected by repeat Papanicolaou smears, compared with 11% by cervicography. However, Papanicolaou smears were more specific than cervicography (55 versus 29%). The cost per case detected using cervicography for triage was equal to that using follow-up Papanicolaou smears, but was a third higher than referring all patients directly to colposcopy. Merely using repeat smears in patients with atypical Papanicolaou smears may result in nondetection of many significant lesions, especially in populations where follow-up is poor.