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[Cytologic-colposcopic-histopathologic correlations in preinvasive cervical lesions and cervical Human Papillomavirus infections].

Cervico-uterine cancer is the most frequent gynecological neoplasia in Mexico and cervico-vaginal cytology is the most practical and dependable resource in lesions detection. During the last years precursory lesions detection (NIC and HPV infection) has increased. So, every patient presenting with an abnormal cytology should be included in an evaluation program, that includes a colposcopic study with biopsy of suspicious lesions, in order to know cellular abnormality degree, as these studies combination increases diagnosis certainty. Ninety three patients were evaluated by colposcopy, as the Papanicolaou showed abnormality ICN type in any degree or HPV infection data, during the first three years of the Unidad de Colposcopia de la Beneficiencia del Hospital ABC. In 49 patients histopathological study, was done. A correlation of all studies was carried out. There was a correlation cytology-histopathology of 59.18%; and colposcopy-histopathology of 89.79%. It was concluded that evaluation by cytology is insufficient to establish a final diagnosis and treatment, and that colposcopic study is fundamental in the evaluation of the patient with abnormal exfoliative cytology.

Adult↗

[Birth injury and colposcopic status of the cervix uteri following labor].

A colposcopic examination is made of uterine cervix 3 to 4 months after delivery to 629 women divided into 4 groups: with Caesarian section and vaginal delivery without cervical rupture after inspection, with suture and without suture after cervical rupture. Higher incidence and severe colposcopic changes in the uterine cervix were found in unsutured cervical ruptures after delivery. Suturing of the cervical ruptures after delivery reduces these changes by 25 per cent. For this reason the author recommends cervical inspection and suturing of the existing cervical ruptures after every delivery.

Cervix Uteri↗

[An evaluation of agreement between cytologic, colposcopic and histologic results in neoplasms of the uterine neck].

There was carried out a retrospective analysis of cytologic, and colposcopic examination results in a group of 748 women with diagnosed cervical intraepithelial neoplasia (CIN) basing on histologic examinations of topical biopsy samples. In the CIN III group, in addition, results of preoperative histologic examinations were compared with those of postoperative histologic examinations. The examinations showed that a complex CIN diagnosis, including cytologic and colposcopic examination combined with taking topical biopsy samples achieves high accuracy and makes surgical conization a safe medical procedure in such cases. Histologic examination of the postoperative material determines further (follow-up) procedures.

Adult↗

[The colposcopic, cytological and histological changes in the cervix uteri of women under 20 with a first pregnancy].

The study includes 42 pregnant women chosen at random under the age of 20, in their first trimester presented for voluntary termination of pregnancy. Colposcopic, cytologic and histological test was performed. Chronic, often acute, non-specific inflammatory changes were observed, probably connected with early sex life. The establishing of a histologically atypical results in 33.3% of the cases as well as the observation of 21.7% falsely negative results from the colposcopic study support the theory of pregnancy as a factor causing complication for diagnosis. The relatively low sensitivity of the cytology method and 16.7% false negative results none the less the existence of high specificity (100%) is due to coexistence of low-stage dysplasia (I and II stage) and chronic non-specific inflammatory processes and the early, pilot character of the research.

Abortion, Legal↗

Colposcopic documentation. An objective approach to assessing sexual abuse of girls.

Accurate measurements of the genital anatomy of victims of child sexual abuse can be documented with colposcopic photography. Most colposcopies available, however, do not have a built-in measuring grid for medicolegal documentation. Because of the unique optics designed for the colposcope, an accurate comparison can be provided if the measuring tool is photographed in the same focal plane and at the same magnification as the object of concern. Properly labeled slides may then be used as clear evidence in court.

Anthropometry↗

The new colposcopic terminology.

A generally acceptable scheme for the classification of colposcopic findings is critical for the more widespread acceptance of this valuable diagnostic tool. Older schemes have tended to confuse students. The scheme described in this article sets appearances against an order of events in time and place based on the biological life history of the organ. This amounts to the history of exposed columnar epithelium as it changes, by a typical or atypical process, into squamous epithelium to produce, respectively, a typical or atypical transformation zone. The former produces a homogeneous appearance, the latter a heterogeneous appearance requiring further subdivision by the use of the categories of white epithelium, blood vessel abnormalities such as punctation and mosaic and other atypical patterns, and leukoplakia. Not all of these abnormal appearances are associated with greatly altered histological appearances and, therefore, a further system of their grading is introduced. Other categories include appearances associated with overt cancer, with miscellaneous noncancerous conditions and with states in which the complete transformation zone is not viewed and, therefore, the colposcopic findings are not satisfactory. Finally, the present scheme is integrated as far as possible with older schemes.

Cervix Uteri↗

Effect of retinoic acid on HPV titration and colposcopic changes in Korean patients with dysplasia of the uterine cervix.

Retinoids, a family of molecules capable of profound impact on many biological functions, have antiproliferative, differentiative, and immunomodulatory properties. The present study assessed the effect of 13-cis-retinoic acid (13-CRA) treatment in 13 chronic cervicitis and 52 cervical intraepithelial neoplasia patients. We examined low- and high-risk human papilloma virus titer (using the hybrid capture method) and made a colposcopic and cervicographic examination before and after treatment with 13-CRA at 1 mg/kg for 4 to 12 weeks. Patients were between 27 and 64 years, the average age being 36.6 years. Histology revealed chronic cervicitis in 13 cases, mild dysplasia in 18 cases, moderate dysplasia in 18 cases, and severe dysplasia in 16 cases, totaling 65 cases. The expression rate of high-risk human papilloma virus (HPV 16, 18) was 9 of 13 cases (69%) in chronic cervicitis, 7 of 18 cases (38%) in mild dysplasia, 9 of 18 cases (50%) in moderate dysplasia, and 12 of 16 cases (75%) in severe dysplasia, with the overall expression rate being 37 of 65 cases (57%). Following 13-CRA treatment, decreases in high-risk titer were observed in 6 of 9 cases (66%) of chronic cervicitis, 4 of 11 cases (36%) of mild dysplasia, 7 of 9 cases (77%) of moderate dysplasia, and 8 of 12 cases (75%) of severe dysplasia. Overall, HPV titer decreased in 25 of 41 cases (61%). Minimal changes were found in colposcopic and cervicographic observations during the study. In summary, high-risk HPV titer decreased after treatment with 13-CRA in the majority of patients with cervical intraepithelial neoplasia. This study supports the potential of retinoids to interrupt multi-step carcinogenesis, possibly by down-regulation of gene products (E6,E7) produced by HPV infection.

Adult↗

Assessing colposcopic skills: the instructor's handbook.

BACKGROUND AND OBJECTIVES: In the United States, 93% of family practice residency programs teach colposcopy. Training should ideally include didactic teaching of basic knowledge, followed by practice on models and then supervised teaching with patients. Although various curricula have been published that outline basic principles of colposcopy education, methods of determining clinical competency among resident physicians are lacking. Methods of assessing psychomotor are cognitive skills in colposcopy are available for instructors, including the use of preclinical cervical practice models for colposcopic biopsy and endocervical curettage, visual skills tests that use images of colposcopic findings, colposcopy CD-ROMs, written pretest and posttest knowledge assessment instruments, and procedural checklists. Specific parameters for many of these tools can be used to define clinical competency in colposcopy.

Clinical Competence↗

[Cytologic correlation between the Bethesda system and colposcopic biopsy].

Bethesda system is useful in the citologic diagnosis of premalign diseases of cervix. It was determined the correlation between citologic report using Bethesda system and combined colposcopic index (CCI) or Reid, to diagnose premalign diseases of cervix by histologic diagnostic of punch biopsy by colposcopy. A total of 118 patients come to the colposcopy clinic having smear anormal citology to cervical intraepithelial neoplasia (CIN), only o associated to HPV. It was taken to all of them a new cervical smear, colposcopy and punch biopsy. We analized the findings for citology with Bethesda system and colpospic with CCI of Reid, using histologic diagnosis of punch biopsy by colposcopy. Diagnosis correlation between Bethesda system and the punch biopsy by colposcopy was 98.5% for 82 patients with low grade squamous intraepithelial lesions with a concordance of 100% for HPV and 97% for CNI I (p < 0.05). In the other hand 92% from 36 patients classified as high grade squamous intraepithelial lesions with a concordance of 84% to CIN II and 100% to CIN III (p < .05) Sensibility of 93%, especifidad and positive predictive value of 96% and negative predictive value of 98%. We conclude correlation between citologic report with Bethesda system and the Combined Colposcopic Index of Reid which are effective to diagnose premalign disease of cervix.

Biopsy↗

Nurse-midwifery evaluation and management of cervical pathology and the colposcopic examination.

Over the last several years, there has been a steady increase in the number of women experiencing abnormal Papanicolaou test results. Whether the nurse-midwife is performing a colposcopic examination or making a referral, she or he needs to have a clear understanding of cervical pathophysiology, diagnostic modalities, and therapeutic management. This article provides the nurse-midwife with a basic review of the cytologic and histologic findings of the cervix, a description of the colposcopy procedure, observations, terminology, and follow-up treatment, and considerations for adding colposcopy to a nurse-midwifery practice.

Aftercare↗

Understanding the colposcope. Optics, light path, magnification, and field of view.

The colposcope, basically binoculars on a stand, is used for the evaluation of the genital tract. Its optics, although complicated in theory, are easy to use in practice. Certain adjustments are necessary for stereoscopic viewing. Other adjustments adapt the optics for high viewing and either adapt the optics for high magnification study of disease features or low magnification for seeing the entire surgical field during treatment.

Colposcopes↗

Nonisotopic human papillomavirus DNA typing of cervical smears obtained at the initial colposcopic examination.

To determine the prevalence of human papillomavirus (HPV) infection in 401 patients attending colposcopy for the first time, scraped cervical cells were investigated using dot blot hybridization and biotinylated DNA probes to HPV 6 and 11 (low-risk types) and 16, 18, and 33 (high-risk types). The HPV DNA was isolated from 52% of patients (low-risk types = 4%, high-risk types = 48%). Seventy-five percent had a cervical intraepithelial neoplasia (CIN)-condyloma. Low-risk types were infrequent (7%) and high-risk types (41%) predominant in condyloma/CIN I lesions when converse rates were expected. As CIN I lesions harboring high-risk types are at some risk of progressing to a higher grade dysplasia, colposcopic examination and treatment of this subgroup would seem justified. As expected, high-risk types were statistically associated with increasing grades of dysplasia. This hybridization method identified typeable HPV DNA in 60% of patients with a CIN-condyloma, and highlighted a unique HPV profile for this patient cohort.

Adolescent↗

Retrospective analysis of non-correlating cervical smears and colposcopically directed biopsies.

The purpose of this study is to evaluate the cause of discrepancies between non-correlating cytologic and histologic cervical samples. The biopsy results of 433 women examined colposcopically were compared to their referral cervical smears (RS). There was a discrepancy between the RS and the subsequent biopsy in 120 women (28%). One hundred of these 120 RS were available for review; and in each case, a reason for the discrepancy was established and classified as RS overcall, RS undercall, RS sampling error, or biopsy sampling error. Fifty-one discrepant RS were overcalled. They were reported initially as condyloma (19), mild dysplasia (22), and moderate dysplasia (10). One RS was undercalled. Nine RS were not diagnostic of the biopsy-proven lesion due to smear sampling error. The discrepancies in the remaining 39 cases were due to biopsy sampling error. Twenty-one of these 39 cases had additional biopsies or smears that confirmed the presence of condyloma/dysplasia, and 18 had negative follow-up. In summary, discrepancies were a result of pathologists' interpretative error, predominantly overcalls, in 52% of non-correlating cases, and smear or biopsy sampling error in the remaining 48%.

Biopsy↗

A colposcopic study of the effect of IUDs on cervical epithelium.

A case-control study was undertaken to investigate the effects of intrauterine contraceptive devices (IUDs) on the histology of cervical epithelium. Ninety-one women who had used IUDs for 2--13 years were case subjects and were compared with the same number of women who had never used any form of contraception (control subjects). Two subgroups were investigated, group A and group B. Group A consisted of 53 IUD users and 53 controls coming to family planning and gynecology clinics, and group B consisted of 38 IUD users and 38 controls from dysplasia clinics. Cervical cytology and colposcopically directed cervical biopsies were taken in all women. There was no difference between IUD users and control subjects in the proportion or the severity of dysplasia in either group A or group B. There was no evidence of an increase in the prevalence or severity of dysplasia with prolonged IUD use.

Adult↗

Association between colposcopic findings and histology in cervical lesions: the significance of the size of the lesion.

The relation between eight specific colposcopic diagnostic findings and the histologic grade of a cervical lesion in 896 women was evaluated. The size of the transformation zone (TZ), the size of the lesion, the intensity of the color tone, distinct margins, the pathology of the vessels, and the presence of micropapillae as single findings were highly statistically correlated to the histologic grade (P < 0.0001). By logistic regression analysis the risk for a higher histologic grade when assessed by colposcopy was greatest in women with variation of the acetowhite color (odds ratio (OR) = 16.0; 95% CI, 10.0-26.0) followed by coarse vessels (OR = 10.0; CI, 3.2-34.0). Lesion-size larger than 50% of the visible cervix had an OR of 3.6 (CI, 2.1-6.3). Extention beyond TZ had an OR of 0.4 (CI, 0.2-0.4) and larger TZ had an OR of 0.5 (CI, 0.3-0.9). In conclusion we found that the size of the cervical lesion had some independent predictive value and should be considered in future trials.

Adolescent↗

Prospective follow-up of cervical HPV infections: life table analysis of histopathological, cytological and colposcopic data.

A total of 532 women with established cervical HPV infection have been prospectively followed (without treatment) since 1981 for a mean of 45 (SD 21) months. The patients were examined by colposcopy, PAP smears and/or punch biopsy every 6 months. The life-table method was applied to analyze the clinical course (i.e. regression and progression) of the HPV lesions, stratified by their colposcopic pattern, PAP smear findings and grade of CIN. During the follow-up, 107 (41.8%) of 256 patients with HPV-NCIN lesion in the first punch biopsy, experienced spontaneous regression. The corresponding proportions for HPV-CIN I, HPV-CIN II and HPV-CIN III lesions were 31.1%, 34.2%, and 20.7%, respectively. In the overall comparison between these four groups, the heterogeneity in the probability of regression was statistically significant (p = 0.0005). Clinical progression was also associated significantly with the histological grade of the lesions in the first biopsy. Progression rate was only 5.8% for HPV-NCIN lesions, as compared to 12.3% for HPV-CIN I, 20% for HPV-CIN II, and 55.2% for HPV-CIN III. The probability of progression varied significantly between the four groups (p less than 0.00001). Cumulative proportion of regression was 46% for patients with PAP smear class I, 84% with class II, and 82% for those with class III, cells, i.e. PAP smear was not of value in predicting the regression. However, PAP smears predicted clinical progression (p = 0.006 overall).(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗

Detection and typing of human papillomavirus infection affecting the cervix, vagina and vulva. Comparison of DNA hybridization with cytological, colposcopic and histological examinations.

The sensitivity of human papillomavirus (HPV) detection was compared by colposcopy, histology and DNA hybridization among 304 women with abnormal Papanicolaou (Pap) smear. Colposcopically directed biopsies revealed HPV infection in 71% of cases, DNA hybridization in 35%, and both together in 78%. DNA hybridization detected HPV in 24% of the 84 benign cases with no histological signs of HPV, in 32% of the 133 condylomas verified by biopsies and in 51% of the 85 cases with intraepithelial neoplasia, 95% of which presented histological signs of HPV. The pattern of occurrence of different HPV-types resembled findings in earlier reports. HPV infection is common with abnormal Pap smears and it can be identified relatively reliably by means of cytology, colposcopy and histology. DNA hybridization serves as a complementary technique which may reveal the oncological potential of the virus.

Adolescent↗

The correlation between colposcopic grading, directed punch biopsy, and conization.

In a study group of 102 patients in whom colposcopy examinations were done, a series of 67 selected biopsies and 47 cold-knife conizations were performed. All patients had suspicious or positive Papanicolaou smears. There was a 96 to 98 per cent correlation between the colposcopic findings, biopsies, and cone specimens.

Biopsy, Needle↗