Comparison of Pap Smear and Colposcopy in Screening for Cervical Cancer in Patients with Secondary Immunodeficiency

摘要

Introduction: Cervical cancer is the second most common cancer among women worldwide. The sensitivity ofconventional Pap smear in detecting cervical lesions before cervical cancer is 51%, which means the falsenegative value is 49%. The aim of this study was to compare two methods for screening for cervical cancer inpatients with secondary immunodeficiency, i.e., the conventional Pap smear and colposcopy.Methods: This cross-sectional study was conducted on 101 immunodeficient patients who were referred to theGynecologic Clinic at Shahid Sadughi Hospital in Yazd from March 2011 to August 2012. All patientsunderwent the Pap test, a colposcopy, and a cervical biopsy, with the latter being considered as the gold-standardtest.Results: The most frequency of immunodeficiency was noted among patients with rheumatoid arthritis (53.3%),and this was followed by patients who were undergoing chemotherapy (30.7%), patients with lupuserythematosus (12.9%), and patients with AIDS (3%). The sensitivity, specificity, positive predictive value,negative predictive value, and accuracy of the Pap smear were18.2, 98.5, 85.5, 71.3, and 72.2%, respectively. Therespective values for colposcopy were 66.7, 98.94, 80, 97.9, and 97%, respectively.Conclusion: In this study the accuracy, sensitivity, specificity, and negative predictive values of colposcopy werehigher than those for the Pap smear in detecting high-grade, cervical, pre-malignant lesions (cervicalintraepithelial neoplasia: CIN ≥ 2). Therefore, an annual colposcopy is advised for secondary immunodeficientpatients instead of a Pap smear