OBJECTIVE: To evaluate whether speculosocopy, when combined with the Papanicolaou smear, can improve th detection rate of cervical pathology, as compared with Pap smear alone. MATERIALS AND METHODS: 100 patients were randomly selected and prospectively studied among those who wer referred to the department of obstetrics and gynecology, Yonsei University College of Medicine, Seoul, Korea from Feb to May 2002. All the 100 patients were subjected to Pap smear, speculospoy, and colposcopy investigations in successioi and und< rwent colposcopy directed biopsy, regardless of the findings of the colposcopy. RESULTS: Speculoscopy had a sensitivity of 80% and using colposcopy as a standard, it had a sensitivity of 81%, ; specificity of 97% and a positive precidtive value of 98%. Of the 14 patients with atypical cells on Pap smear, 6 ha( positive histologic findings and of these 6 patients, 4 had positive speculoscopic findings. Of the patients with negativ Pap smear result, 11 had positive histologic findings and of these 11 patients, 8 had positive speculoscopic findings. 0 the patients with negative results for PPS(Pap smear plus Speculospopy), 3 patients had positive pathologies, bu noteworthily, all of which were LGSIL(low grade squamous intraepithelial lesion). Of the 19 patients with ncgativ] results for PPS2 2 had positive findings on repeated Pap smear, which were CINIII, and CINI, respectively. CONCLUSION: Speculoscopy combined with Pap smear can yield a higher percentage of detection rate in women witl biopy-confirmed cervical pathology than the use of the Pap smear as a sole screening test and therefore, can prevent th] delay of the treatment due to the high false negative rate of Pap smear. In addition, the significantly higher prediction o positive colposcopic findings makes s1eculoscopy a promising tool for the selective screening of patients for colposcopy.