Is there a role for cervicography in the detection of premalignant lesions of the cervix uteri?

The characteristics of cervicography and the Papanicolaou smear test have been compared for the detection of cervix lesions classified as CIN I or more. A total of 4,015 women were entered into the study. The sensitivity of cervicography is significantly higher (McNemar test, P < 0.0001), but its specificity remains significantly lower (McNemar test, P < 0.0001), and its higher sensitivity does not apply to lesions classified as CIN II or more (high-grade lesions). Hence, if patients with a positive screen result are to be referred for colposcopy-biopsy, cervicography is not a suitable alternative to the smear test for the screening of cervical cancer. However, cervicography can be envisaged as a complementary tool to the smear test because of (a) its higher capability to detect high-grade lesions among women less than 35 years old and (b) its potential superiority in following low-grade lesions. It may also serve as a tool for quality assurance audit of the smear test.