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PubMed1976

[The development of colposcopy (author's transl)].

In 1925, in this Journal, Hans Hinselmannn gave the reslults of his experience with the method of colposcopy he devised for the early recognition of cancer of the uterine cervix. In 50 years it has proved to be an indispensable procedure in experienced hands, by which the prestages and early stages of the most frequent genital cancer in women, carcinoma of the cervix, can be detected while still of microscopic dimensions (microcarcinoma). Papanicolaou's vaginal cytology used in combination with colposcopy increases diagnostic accuracy to more than 95%. Cytology, as a preliminary orienting laboratory procedure, and colposcopy as a clinical investigation method togethe - if the two individual methods are used in their proper places - offer optimal diagnostic prospects. The opportunities of mastering colposcopy and its use in the cancer prophylaxis program are pointed out.

Adult↗
PubMedDate not supplied

Detection of human papillomavirus DNA in patients referred to a family practice colposcopy clinic.

BACKGROUND: Human papillomavirus (HPV) is strongly implicated in the pathogenesis of cervical neoplasia. The ability of a commercially available kit (Virapap/Viratype) to detect evidence of HPV is compared with cervical cytology, colposcopy, and directed biopsies. METHODS: During a period of 16 months, cervical samples from 241 consecutive new patients referred for a colposcopy examination were obtained for HPV-DNA hybridization typing according to the kit instructions. Samples were sent to a reference laboratory for testing. The results were compared with results of the colposcopy examination, cervical cytology, and directed cervical biopsy samples processed and evaluated by our hospital laboratory. RESULTS: HPV DNA was detected in 27 of 107 patients who had abnormal colposcopy findings for a sensitivity of 25 +/- 7.5 percent at the 90 percent confidence interval. One of 134 patients with normal findings was positive for a specificity of 99 +/- 5 percent at the 95 percent confidence interval. Based on a 75 percent probability of HPV in the population, the positive predictive value was 99 percent and the negative predictive value 30 percent. CONCLUSIONS: With the low negative predictive value and sensitivity, HPV-DNA testing by this commercial kit is not an adequate tool for screening HPV in this population.

Biopsy↗
PubMed1995

Microcolpohysteroscopy compared with colposcopy in evaluation of abnormal cervical cytology.

Microcolpohysteroscopy (MCH) permits in vivo visualisation of cervical epithelium and is a useful procedure in the diagnostic workup of a patients with abnormal pap smear. Our study compared standard colposcopy with MCH in 45 patients with dysplasia reported on cytology. On comparing with final histopathological diagnosis colposcopy had an accuracy of 95.6 percent in diagnosing cervical intraepithelial neoplasia (CIN) within one grade. MCH had a diagnostic accuracy of 84.4 percent in predicting CIN changes. Further MCH was able to evaluate the endocervical squamocolumner junction in all cases of unsatisfactory colposcopy. Microcolpohysteroscopy is a useful adjunct to colposcopy and is also of value in locating the epicenter of lesions and is diagnosing HPV infection. MCH prior to conisation is of value in tailoring the biopsy to fully include the CIN lesion.

Adult↗
PubMed1997

Cytology, histology, and colposcopy in the diagnosis of neoplastic non-invasive epithelial lesions of the cervix.

The purpose of our study was to examine the concordance among colposcopy, cytology, and histology in the diagnoses of intraepithelial lesions of the uterine cervix. We compared the results of Pap tests, biopsies, and colposcopy in 190 patients, who had histologically proven CIN and/or HPV infection, using histology as "the gold standard". The chi 2 (chi square) test was used for the statistics analysis. The sensitivity of cytology for the detection of CIN was 70%, and was lower for LGL (low grade lesions) than for HGL (high grade lesions): 61.2% versus 88.5%, respectively (p < 0.0001). We obtained a high rate of false negative smears (30%), with a relatively high rate of inadequate samples (59.6%). The sensitivity of colposcopy was 92%. Our results suggest that the Pap test alone is no longer sufficient for the screening of precancerous lesions of the cervix, and colposcopy is compulsory each time the smear is inadequate or altered.

Adolescent↗
PubMed1998

Comparison of magnified chemiluminescent examination with incandescent light examination and colposcopy for detection of cervical neoplasia.

Magnified Chemiluminescent Examination (MCE) or speculoscopy is a new visual method for detection of cervical neoplasia. It utilizes low magnification and a special "blue-white" chemiluminescent light. The study includes 125 women with unhealthy cervix who were subjected to magnified examination with projected incandescent light (PIL) and chemiluminescent light (MCE). This was followed by colposcopy and directed biopsy from acetowhite areas. Of all 125 subjects, 20 patients showed cervical neoplasia of varying degree on histopathology. MCE could detect 18/20 neoplasias while PIL detected 11/20 cases. Sensitivity of MCE (90%) was significantly superior (P < 0.05) to PIL (55%) in detecting cervical neoplasia. Colposcopy, as compared to MCE, is better than speculoscopy as it facilitates grading of lesions due to higher magnification but antecedent MCE detected the acetowhitening in majority of patients (32/43). However, tendency to "overall" acetowhite lesions was significantly less during MCE when compared with colposcopy. Thus, MCE is a new diagnostic tool which is better than routine incandescent light examination and correlates well with colposcopy.

Adult↗
PubMed1997

Patient-based evaluation of a colposcopy information leaflet.

A questionnaire survey of new patients attending the colposcopy clinic of a teaching hospital was carried out. The intention was to evaluate the information leaflet routinely sent to women who have been referred for colposcopy because of abnormal cervical smear results and use the findings to propose changes that will make the leaflet more suitable, effective and patient-friendly. The majority of the respondents received (90%), read (90%) and understood most or all (96%) of the information leaflet. Patients who received the leaflet performed better in the knowledge quiz than those who did not (P < 0.0001). Of the 111 patients who received and read the leaflet 50 (45%) found it reassuring or very reassuring and 58 (52%) thought it made them less anxious. On the contrary 20 (18%) patients found the leaflet worrying or very worrying and 33 (30%) thought it made them more anxious. Overall, 91 (82%) patients found the leaflet helpful or very helpful and 99 (89%) were satisfied with the information provided. The commonest difficulties with the leaflet identified by patients concerned the use of abbreviations and technical terms. We found the leaflet to be a useful method of providing information for patients before colposcopy. Whilst the leaflet appeared to have a major impact on patients' knowledge about abnormal smears and colposcopy, its effect in reducing anxiety was less pronounced.

Journal Article↗
PubMed1999

Should women with genital condyloma acuminata have routine diagnostic colposcopy in addition to cervical smear screening?

We aimed to evaluate the difference in the pick up rate of high grade cervical abnormalities using both primary colposcopy and cervical smear compared with cervical cytology screen only on women with genital warts. We also wished to establish whether this group was at high risk of sexually transmittable infections (STIs) and whether there is a correlation between those with high grade CIN and other STIs. This was a retrospective analysis based in the Department of Genito-Urinary Medicine, Dundee Teaching Hospitals Trust, Dundee, UK. We studied all women (n =117) attending the Department with genital warts between January 1995 and March 1997 who were screened by both cervical cytology and colposcopy High grade cervical abnormalities (CIN II-CIN III) were diagnosed in 10 patients (8.5.%) using cervical screening only and in 41 patients (35%) (CIN II-III) when primary colposcopy and histopathology were undertaken. Of 117 women screened for sexual transmittable infection there were 53 with a positive diagnosis (48%). Of the 53 positive there were 17 women (30%) with high grade CIN. We conclude that women with genital warts are a high risk group, both in terms of having high grade cervical abnormalities and sexually transmittable infection. The result suggests that, when practicable primary colposcopy should be performed as a routine screening tool, on this group of patients over and above cervical cytology screening. All patients with genital warts should be referred to genitourinary medicine for STI screening.

Journal Article↗
PubMed1999

A 5-year follow up of mildly dyskaryotic smears, comparing colposcopy with expectant management.

The purpose of this study was to see if the National Health Service Cervical Screening Programme's guidelines were appropriate when they recommended that mildly dyskaryotic smears were repeated before referral for colposcopy. We identified all those with a mildly dyskaryotic smear, and followed them over 5 years, to compare those that had colposcopy and those that did not. In total, 269 women were followed and 35% of these only had the one mild smear. Of those whose smear returned to normal after the initial mild smear, 84% remained normal over the 5-year period. Of those whose smear did not return to normal, i.e. those that required a colposcopy, 74% returned to normal after the colposcopy.

Journal Article↗
PubMed2004

Measurement of colposcopy-associated distress using the psychosocial effects of having an abnormal pap smear-questionnaire in a Latina population.

OBJECTIVE: To elicit factors associated with distress in Latina colposcopy patients. MATERIALS AND METHODS: Three hundred two Caribbean Latinas attending a colposcopy clinic took the Psychosocial Effects of Having an Abnormal Pap Smear-Questionnaire, which measures distress using 14 questions grouped into four dimensions. A Spanish-language translation was tested. RESULTS: Age ranged from 15 to 65 years (mean = 27 years); 220 of 301 women (73%) were undergoing a first colposcopy; 51 of 301 (16.9%) reported depression, and 25 of 298 (8.4%) reported anxiety. A majority of women were distressed at the prospect of having cancer (166/299; 55.6%), of their results being positive for cancer (164/299; 54.8%), and of dying (150/300; 50%); "worry about the ability to have a baby" and "feeling tense" during the procedure followed. Younger women (<27 years) scored higher (p < 0.03) on all four dimensions. First-time patients scored higher on all questions and dimensions; "worry about infectivity" and "effect on sexual relationships,"p = .05 and p = .005. A Spanish translation correlated well with English, Po = (0.83-1.0), kappa >/= 0.73, for 13 of 14 questions. Depressed or anxious patients and Spanish speakers were not more distressed than their counterparts. CONCLUSIONS: The prospect of having cancer and dying is the greatest source of distress in Caribbean Latina colposcopy patients, not the procedure itself. Younger and first-time patients were more distressed than older, experienced ones. Speaking Spanish was not associated with greater distress.

Journal Article↗
PubMed2004

Using the cone biopsy to compare colposcopy clinics in new york and london.

OBJECTIVE: To assess whether there were significant differences in cytologic and colposcopic assessments associated with conization specimens at a colposcopy clinic in New York compared with a colposcopy clinic in London. MATERIALS AND METHODS: A retrospective histopathologic survey of patients evaluated at the Mt. Sinai Hospital Colposcopy Clinic (MSH) in New York City and the Royal Free Hospital Colposcopy Clinic (RFH) in London between January 1, 1997, and December 31, 1998, was reviewed. Study groups included all patients who underwent conization at either clinic. Referral cytologic results, colposcopic findings, and conization histologic results were compared. RESULTS: Two hundred three cases from MSH and 457 cases from RFH were reviewed. Most patients undergoing conization in either clinic were referred with Pap smears suggesting high-grade squamous intraepithelial lesions (MSH, 77%; RFH, 77%). Colposcopic biopsy was performed on all patients at MSH. At RFH, colposcopic-directed punch biopsy was not performed on 35% of the patients who would have been treated regardless of biopsy results. There is a significant difference in the distribution of cone histologic diagnosis between the two clinics (p = .02); there are proportionally more women diagnosed with high-grade disease in RFH than in MSH, where there are more normal and low-grade cone histologic results. According to the kappa coefficients, there is only slight agreement between the Pap smear cytologic results and punch biopsy with the conization histologic results for either clinic (MSH, kappa = 0.13; RFH, kappa = 0.19), with the RFH performing slightly better. CONCLUSIONS: This study shows exact agreement between cytologic and final conization diagnosis and colposcopic biopsy and final conization as 47% to 64%. Treatment decisions and outcomes are different between the two clinics, with the RFH clinic performing fewer biopsies and having more procedures yielding high-grade disease. Recommendations regarding changing colposcopic practices could best be made after a prospective study.

Journal Article↗
PubMed2004

Trends in compliance with the national colposcopy guidelines.

This study aims to assess trends in compliance with current colposcopy guidelines in 10 gynaecological units in four English counties since 1996; to identify constraints on compliance and suggest change in practice. All 10 gynaecology units in Oxfordshire, Buckinghamshire, Northamptonshire and Berkshire participated. Data were collected prospectively by colposcopists from 23,500 new referrals across a 55-month period from September 1996 to March 2001. The Oxford Cancer Intelligence Unit performed collation, quality assurance and retrieval of data for incomplete records. Audit results were disseminated annually to colposcopists via the Regional Colposcopy Group. Colposcopy waiting times exceeded the standards, but waiting times for high-grade referrals showed statistically significant improvement. Six standards were achieved; relating to accuracy, appropriateness of management and outcomes. The seven unmet standards relate to waiting times, colposcopist's caseload, follow-up policy and the proportion of cervical epithelial neoplasia (CIN) on histology. Changes in practice are suggested, constraints on compliance are identified and the appropriateness of some guidelines is questioned.

Adult↗
PubMed2005

The impact of high risk human papillomavirus testing in an inner London colposcopy clinic.

This is an audit of a new technique to improve the colposcopy service. Samples were tested for high risk HPV DNA using Digene Hybrid Capture II. Sixty-four percent of the sampled women under 30 had detectable high risk HPV DNA, decreasing to 44% in 30--39 year olds and to 27% in women over 40. High risk HPV prevalence increased with severity of cytology, although 22% with normal colposcopy had detectable high risk HPV. Of those women treated for cervical dysplasia, 83% had detectable high risk HPV prior to treatment, compared to only 32% afterwards. The audit has shown that high risk HPV testing has considerable discriminatory value. It has been integrated successfully into the service, particularly to manage low grade cervical abnormalities and to add valuable information following treatment for cervical dysplasia. Results need to be interpreted alongside colposcopy, cytology, and histology, and care must be taken in the interpretation of a single high risk HPV result.

Adult↗
PubMed1990

Preference for information and involvement, information seeking and emotional responses of women undergoing colposcopy.

The relationship of individual differences in preference for information and involvement, information-seeking behaviors, and emotional responses was examined in 36 women undergoing colposcopy, a stressful medical procedure. The findings revealed that individual differences in preference for information and behavioral involvement in health care influenced women's information seeking about colposcopy. Women who asked more questions during their clinic visits reported higher preferences for information. Women who sought an information sheet about colposcopy reported higher preference for behavioral involvement in their health care. The findings also revealed that information seeking was associated with the positive emotional response confidence but not with fear or anger/depression.

Adolescent↗
PubMed1994

Positive cervical smear with subsequent normal colposcopy and histology--frequency of CIN in a long-term follow-up.

From a total of 1466 new cases of cervical smears suggesting cervical intraepithelial neoplasia (CIN) II or worse, all examined with colposcopy and biopsies, 328 cases (22.4%) were initially examined with vaginal and cervical colposcopy, directed biopsies of portio, and endocervical curettage (ECC) with normal results. Patients were followed-up with regular colposcopy and cervical smear for an average of 10.6 years (2-19 years). In 72 cases (22%) a CIN occurred, in general more than 1 year (mean 2.96 years) after entering the study. Possible explanations are discussed and careful monitoring of this group of patients is recommended.

Adolescent↗
PubMed1994

The adequacy of cytology and colposcopy in diagnosing cervical neoplasia in HIV-seropositive women.

The purpose of this study was to compare cytology and colposcopy as predictors of cervical intraepithelial neoplasia (CIN) in women infected with the human immunodeficiency virus (HIV). A cross-sectional analysis of cytology, colposcopy, and colposcopic biopsy results from 51 HIV-seropositive women attending an ambulatory HIV service was conducted. Cytology slides were reviewed by two cytopathologists blinded to patients' HIV status. There was strong agreement in the readings of two cytopathologists, with a kappa score of 0.9. Of 29 women with normal cytology, 21 (72%) had pathology on histology, including 7 (24%) with CIN. Colposcopic impression correlated well with histology results. Of 22 women with abnormal cytology, 82% had abnormal histology. The overall prevalence of CIN was high at 45%, increasing from 35% in women with CD4 counts over 400 to 56% in women with CD4 counts below 200. In conclusion, screening cytology is limited by false-negative results; routine colposcopy should be considered in this high-risk population.

Adult↗
PubMed2005

Contribution of combined colposcopy and cytology in cervical pathology.

AIM: The regular Papanicolaou (Pap) smear is the cornerstone of women's preventive healthcare. The introduction of the regular Pap smear as a screening tool for cervical cancer has markedly decreased the number of deaths from cervical cancer. During the past decade, however, the rate of death from cervical cancer has remained relatively static. This screening method is known to have a high percentage of false negative results. To improve the detection of cervical lesions using the Pap smear in screening, a number of adjunct procedures have been developed. The purpose of this study is to evaluate the utility of a magnified chemoluminescent screening examination (Colposcopy) combined with the Pap smear in detecting cervical abnormalities. METHODS: We investigated a cohort of 58 subjects who have been forwarded for colposcopic evaluation due to referral cytology suggestive of persistent inflammatory process not otherwise specified, and cervical intraepithelial or invasive neoplasia, in Chania Colposcopic clinic. RESULTS: The higher the lesion detected by cytology, the more severe the corresponding colposcopic impression viewed. CONCLUSION: The data presented here are in harmony with previous reports and share our experience in a Regional Community Hospital Colposcopy Clinic. An integrated cytology-colposcopy program facilitates the assessment and identification of women harboring cervical pathological conditions.

Adult↗
PubMed1977

False positive cervical cytology: an important reason for colposcopy.

Over an 18 month period, 352 patients with a report of abnormal cervical cytology ranging from mild dysplasia to invasive carcinoma were evaluated with colposcopy and, if indicated, directed biopsies. From the group, there were 26 women in which a lesion consistent with the cytologic diagnosis was not found in each of these cases, an error in the interpretation of the Papanicolaou smear, resulting in a false positive report, was suspected. The cytology was reviewed and the results were compared to the original reports. Twelve cases were reinterpreted as negative for cervical neoplasia. A similar review of the histology failed to reveal a previously missed lesion. Cervical conization in four patients and repeat cytology and colposcopy in 22 patients confirmed the false positive interpretations of the original cervical cytology. The importance of colposcopy as a means of recognizing false positive cytology and avoiding an unnecessary cervical conization is emphasized.

Cervix Uteri↗
PubMed1979

Evaluation of abnormal cervical cytology during pregnancy with colposcopy.

During a 6 1/2 year study period the authors used colposcopy to evaluate 174 pregnant patients with abnormal cervical cytology. The technique of colposcopy proved safe, accurate, and effective in determining the presence or absence of cervical cancer in the present patient's cervix. Colposcopy is mandatory for the evaluation of abnormal cervical cytology during pregancy.

Adult↗