Pap Plus Speculoscopy in adoelscents: A new cervical cancer screening technique

Abstract

<h3>Background</h3> The Papanicolaou (Pap) smear has been the mainstay for cervical cancer screening for over 50 years. However, the Pap smear has been shown to have a high false negative rate, a factor that may miss a considerable number of pre-malignant lesions. Accordingly, other tests are being evaluated that improve the sensitivity of cervical screening. One such adjunctive method is Speculoscopy™ (Trylon Corp., Torrance, CA) and involves the application of a chemiluminescent light source (blue-white spectrum) to the inner aspect of a speculum blade following routine Pap smear. <h3>Methods</h3> Observation of any cervical aceto-white areas constituted a "positive" speculoscopic screen. All patients with positive speculoscopic exams or positive Pap smears demonstrating non-inflammatory cellular changes were referred for colposcopic-directed biopsies. We have used Pap smear plus Speculoscopy (PPS) to evaluate 28 adolescents (≤ 16 years-old at time of exam) at their annual clinician visit for contraception. <h3>Results</h3> PPS was well tolerated by all 28 women. Two of the 28 Pap smears demonstrated cellular changes requiring colposcopic evaluation. These two patients also demonstrated aceto-white lesions during speculoscopy, as did 2 other adolescents in the cohort who had normal Pap smear results. One of the two women with dual positive screens required further treatment (cryotherapy). In addition, one of the two women with a positive speculoscopic exam alone required further treatment (cryotherapy). <h3>Conclusions</h3> This preliminary study shows PPS to be well tolerated by adolescents and enhancing the sensitivity of cervical screening. Further studies will be needed to assess the cost-effectiveness of PPS, as well as its applicability to high- and low-risk populations.