Fluorescein colposcopy-A more specific diagnostic method for detection of high-grade cervical precancer lesions than acetic acid.

Objective: To compare the sensitivity and specificity of topical fluorescein sodium (FNa) to acetic acid (AA) for the detection of high-grade cervical lesions in colposcopy.

Materials and methods: This prospective, cross-sectional study was conducted between January and November 2017 at Christus Muguerza Hospital Conchita in Monterrey, Mexico. 78 women between 18 and 65 years age with a documented abnormal cervical smear test were included. Colposcopy by independent application of 5% AA and 0.06% topical FNa was performed and biopsy obtained for each woman.

Results: 68 (87%) women tested positive with FNa, while 10 (13%) tested negative. Biopsy demonstrated high grade cervical lesions in 31 of the FNa positive but none of the FNa negative women. FNa staining demonstrated 100% sensitivity, 21% specificity, 46% positive predictive value (PPV), and 100% negative predictive value (NPV) to detect high-grade lesions. In comparison, acetic acid staining demonstrated 100% sensitivity, 9% specificity, 42% PPV, and 100% NPV.

Conclusion: FNa had a 133% higher diagnostic specificity than AA (21% vs. 9%) for high-grade lesions at a comparable cost and convenience. Visual inspection with FNa has the potential to replace visual inspection with AA in low-resource settings, thus enabling true "diagnose and treat".