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PubMed1977

Some observations on the value of endocervical curettage performed as an integral part of colposcopic examination of patients with abnormal cervical cytology.

A total of 259 patients underwent endocervical curettage as an integral part of colposcopic examination of patients with abnormal cervical cytology. The transformation zone was entirely visualized in 140 patients (54.1 per cent), and, in 8.6 per cent of this group, the endocervical curettings were abnormal. On no occasion did the endocervical curettage harbor the worst lesion when compared to the histology of the ectocervical biopsy, cone biopsy, and hysterectomy specimens. In 117 patients (45.2 per cent), the transformation zone could not be visualized in its entirety, and in 57.3 per cent the endocervical curettings were abnormal. In one patient of this group invasive carcinoma was present in the endocervical curettage, and in another patient invasive carcinoma was present in both the ectocervical biopsy and the endocervical curettage. Thus, when the entire transformation zone is not visualized in its entirety or at all, endocervical curettage appears to be of value since a frank invasive carcinoma may be diagnosed and a cone biopsy avoided.

Biopsy↗
PubMed1985

The changing concepts of condyloma. A retrospective study of colposcopically directed cervical biopsies.

Human papillomavirus has been implicated in the etiology of cervical intraepithelial neoplasia. A retrospective audit was conducted on all colposcopically directed biopsies performed from June through November, inclusive, in the years 1980 and 1982, a total of 317 cases. In 1980, the misdiagnosis rate for condyloma was 88.9% (69 of 78) and, in 1982, the misdiagnosis rate was reduced to 28.5% (40 of 140). On review, the association of cervical intraepithelial neoplasia with condyloma was 73% (107 of 146), p less than 0.005. The differences in mean ages of patients with condyloma alone, cervical intraepithelial neoplasia with condyloma, and cervical intraepithelial neoplasia alone were significant, p less than 0.02. When condyloma is not recognized, the pathologist tends to overdiagnose grade 3 cervical intraepithelial neoplasia as shown in 28 original cases; 16 of 28 (57.1%) were condyloma alone on review. Fifteen (53.6%) of these 28 patients underwent a cone biopsy or hysterectomy when a less radical procedure would have been acceptable. The morphologic changes indicating cervical condyloma were not fully appreciated by the pathologist, and this resulted in overdiagnosis and later overtreatment by the gynecologist.

Adult↗
PubMed1988

Correlation of cytologic, colposcopic, and histologic studies with immunohistochemical studies of human papillomavirus structural antigens in an unselected patient population.

A study was undertaken to determine the prevalence of human papillomavirus infection in the general population. The first phase evaluated cytologic and colposcopic diagnoses in 962 consecutive patients in a community practice. The second, detailed phase evaluated 110 consecutive patients making routine visits in the same practice. Studies performed for each patient in phase two were cervical cytology, cervical cytologic immunohistochemistry for human papillomavirus, colposcopy with biopsy of all acetowhite epithelium (stained with hematoxylin and eosin and immunohistochemically), saline and potassium hydroxide preparations. All studies were carried out at the initial nonreferral office visit. There was positive cytologic evidence of human papillomavirus in 144 of 962 (15%) of the patients in the first phase and concurrent cytologic and histologic immunohistochemical positivity in 18% of those in the detailed second phase of the study.

Antigens, Viral↗
PubMed1985

Colposcopic diagnosis of ovarian carcinoma spreading to cervix: a case report.

Secondary carcinoma of the cervix is uncommon. A patient with a history of ovarian carcinoma had an abnormal cervical smear and colposcopy was performed. Colposcopy and directed biopsy led to the diagnosis of ovarian cancer which had spread to the cervix. The unusual colposcopic features which allowed a clinical diagnosis are correlated with histopathology and the findings discussed.

Adult↗
PubMed1995

Children's anticipation of and response to colposcopic examination.

Just prior to and following general physical and colposcopic anogenital exams, 43 mothers and daughters (3-15 years), referred because of allegations of sexual abuse, were interviewed separately to determine their knowledge of and feelings about the exam. Children were not retraumatized by the examination of their anogenital anatomy. Although poorly prepared for it, children reported medical staff touch to their genitals, anus, and buttocks at a higher rate than touch to all other body locations, 84.5% versus 16%, but did not rate that touch as more painful. Children were significantly less distressed after the exam; mothers were not.

Adaptation, Psychological↗
PubMed2005

Lea's Shield: colposcopic and microbiological testing during 8 weeks of use.

OBJECTIVES: The aims of this study were to assess the effects of Lea's Shield(R) plus nonoxynol-9 spermicide on signs and symptoms of female genital irritation and cervical and vaginal microflora during 8 weeks of use with intercourse and to analyze problems associated with the use of the device. METHODS: In this open-label, single-arm study, participants were evaluated by pelvic examination, colposcopy and vaginal and cervical cultures. RESULTS: About 13% of women (4/30) reported symptoms of irritation, and minor product-related colposcopic findings were seen in about one third (11/30). Although average colony counts for enterococcus, Escherichia coli and anaerobic gram-negative rods increased during product use, no clinical diagnoses of infection were made. Most users reported at least one problem using Lea's Shield. CONCLUSION: Lea's Shield, when used for 8 weeks during intercourse, is associated with evidence of genital irritation in a minority of users and with changes in vaginal microflora that do not appear to correlate with clinical infections.

Adolescent↗
PubMed2003

Independent determinants of inaccuracy of colposcopically directed punch biopsy of the cervix.

OBJECTIVE: The goal of this study was to determine the clinical factors independently associated with inaccuracy of colposcopically directed punch biopsy in defining extent and severity of epithelial lesions of the cervix. METHODS: The study was conducted in a colposcopy clinic devoted to the management of patients with abnormal Pap smear and/or histology diagnosis of cervical intraepithelial neoplasia (CIN) on punch biopsy or endocervical curettage. Seven hundred and thirty-nine patients (median age, 33 years; range, 18-83 years) referred with a punch biopsy diagnosis of CIN2-3 and treated with electrosurgical conization were evaluated. Cone histology diagnosis was assumed to supply the correct diagnosis. Two types of deviation of biopsy diagnosis were considered: (1). unconfirmed high-grade CIN diagnosis, defined as a cone diagnosis of CIN1 and reactive/reparative changes, and (2). nondiagnosis of carcinoma, defined as a cone diagnosis of microinvasive and invasive squamous carcinoma. Multinomial logistic regression analysis was used to assess the determinants of the probability of each type of deviation. RESULTS: The probability of unconfirmed high-grade CIN diagnosis (n = 190, 25.7%) was inversely related to number of quadrants involved, severity of referral Pap smear, and grade of biopsy. The probability of nondiagnosis of carcinoma (n = 43, 5.8%) was positively related to patient age, invisibility of the squamocolumnar junction, number of quadrants involved, and cone width. Endo-ectocervical location, cone depth, and time period had no effect whatsoever. CONCLUSIONS: The study confirmed previous observations regarding the positive association of patient age and invisibility of squamocolumnar junction with the probability of nondiagnosis of carcinoma. The concomitant positive effects of number of quadrants involved and cone width were suggested to mirror the effect of circumferential development and, respectively, surface area of CIN. Severity of referral Pap smear and grade of biopsy were shown to be inversely related to the probability of a cone diagnosis of CIN1 and benign changes.

Adolescent↗
PubMed1986

Progressive potential of mild cervical atypia: prospective cytological, colposcopic, and virological study.

A prospective study of 100 women with cytological and colposcopic evidence of mild cervical atypia consistent with cervical intraepithelial neoplasia (CIN) grade I was started in October, 1983. 26% of early preinvasive cervical lesions progressed to histologically proven CIN III. Spontaneous regression of mild cervical atypia occurred in only 11 cases, and in 4 of these CIN recurred. The overall prevalence of human papillomavirus type 16 (HPV 16) in the study group, detected by filter DNA-DNA hybridisation of a cervical cytological specimen, was 39%. However, 22 of the 26 (85%) cases of progressive disease were positive for HPV 16. Detection of HPV 16 may be a non-invasive way of identifying women at high risk of rapid progression of mild cervical atypia to CIN III.

Adult↗
PubMed1988

Colposcopic evaluation of men with genital warts.

Colposcopy, which is the examination of the female genital tract that generally is performed after the application of acetic acid, has been an effective tool in the diagnosis of genital warts (condyloma acuminatum) in women for years. With the help of colposcopy, both microscopic and flat warts that cannot be visualized with traditional, noncolposcopic methods can be seen and, hence, treated. Recently, studies reported in the gynecologic and urologic literature have evaluated the usefulness of colposcopy in male patients. We present a patient whose genital warts were recalcitrant to treatment. When examined with colposcopy he was noted to have multiple additional areas of involvement. In view of the neoplastic potential of the human papillomavirus, the ease with which it is transmitted sexually, and the difficulty in discerning certain kinds of warts without colposcopy, we believe colposcopic examination should be routine in all men with genital warts and in those whose sexual partners have tested positive for human papillomavirus.

Adult↗
PubMed1996

Regular audit of colposcopic biopsies from women with a mildly dyskaryotic or borderline cervical smear results in fewer cases of CINIII.

Two years after introducing mandatory review of cases in which the cervical smear was discrepant with subsequent colposcopic or histological finding, the predictive accuracy of a first abnormal smear and the need for treatment were analysed. The results were compared with performance figures prior to this form of audit policy. Over 12 months 415 women referred for colposcopy were studied. Three per cent of patients with a single borderline smear and 6% with mild dyskaryosis had cervical intraepithelial neoplasia grade III (CINIII) revealed in histopathological examinations after colposcopy. Only 25% with a borderline smear and 33% with mild dyskaryosis required treatment. Of women with moderate dyskaryosis, 18% had a biopsy showing CINIII and 46% were treated. Of women with severe dyskaryosis in their cervical smear, 61% were shown to have CINIII or invasive cancer on biopsy and 90% were treated. Regular audit improved cytological prediction of grade of epithelial abnormality found on biopsy, allowing accurate, safe surveillance for minor smear abnormalities.

Adult↗
PubMed1993

The reliability of the histologic diagnosis in colposcopically directed biopsies. A plea for LETZ.

A total of 121 patients with cervical intraepithelial neoplasia (CIN) in their punch biopsies were treated by LETZ. In all cases, the transformation zone was fully visible and there were no signs of abnormal cylindrical epithelium. The final diagnosis was classified in accordance with the histologic report showing the most severe lesion. The biopsy diagnosis underestimated the final diagnosis in 27 out of the 121 cases. Invasion was present in five out of these 27 cases. The discrepancies between the biopsy diagnosis and the final diagnosis were not related to the number of colposcopically directed biopsies. It is concluded that an important advantage of LETZ, as compared with tissue-destructive techniques, is the detection of previously unrecognized invasive disease.

Journal Article↗
PubMed1988

[Assessment of positive cytologic and/or colposcopic findings in the uterine cervix in pregnancy].

When cytologic and colposcopic findings are atypical during pregnancy, a differentiated diagnostic approach is necessary for the sake of an undisturbed course of pregnancy. Scraping of the portio with cervical curettage--a procedure with a low complication rate--for provisional diagnosis (to rule out an invasive carcinoma) permits a definitive diagnosis to be established after lying-in. Problems are pointed out.

Adolescent↗
PubMed1983

[Significance of vascular changes in the colposcopic diagnosis of precancerous and early stages of cervical cancer].

Blood vessels are visible in an average of 80% of patients on whom colposcopy is performed. This percentage share increases if there are pathological changes. The following vascular types occur as characteristic criteria in cervical intraepithelial neoplasia (CIN) and in carcinoma, their classification being based on structural properties such as calibre, long and intercapillary spaces, shape and arrangement of the vessels, as well as their functional state: Abnormal vessels; pathological vessels of the 1st and 2nd degree; uncharacteristic vessels (also known as "troubled vessels"). The author discusses the architecture, adaptive vasodilation and formation of new vessels in connection with morphological changes in the epithelium. Their occurrence is evaluated statistically, and an inference is drawn from these studies on the efficiency of vascular diagnosis. The following conclusions are arrived at on the basis of the examined material: The abnormal vessel result from a proliferation of the abnormal or dysplastic epithelium. The pathological vessels of the 1st degree occur as maximum type of adaptive vascular change resulting in the course of carcinomatous proliferation. The pathological changes of the 2nd degree, on the other hand, become visible as new formations in invasively growing carcinomas only. There is a connection between the presence of pathological types of vessels and the carcinomatous degeneration of the epithelium and the invasive growth. Assessment of the vessels must be performed parallel to the assessment of the epithelium via acetic acid or lactic acid test. This facilitates colposcopic diagnosis of precarcinomic and early stages of cervical carcinoma and enables conclusions to be drawn on an invasive growth of the carcinoma.

Blood Vessels↗
PubMed1999

Variations in vaginal epithelial surface appearance determined by colposcopic inspection in healthy, sexually active women.

A total of 107 sexually active women, aged 18-35 years, was recruited through family planning clinics in four centres in different countries. Each woman underwent two or three gentle but thorough and systematic vaginal inspections using a consistent technique with colposcopic magnification over a 4-6 month period to look for changes in vaginal and cervical appearance which might be related to sexual intercourse, tampon use, contraceptive method used, cigarette smoking or other environmental factors. Obvious changes in appearance were photographed at x10 magnification. These 'appearances' or 'conditions' were classified according to a modification of the recommendations of a workshop sponsored by the World Health Organization, the Population Council and the Conrad Program. Most of these alterations in the appearance of the vaginal epithelium were judged to be of such minor clinical importance that they have been termed 'conditions' or 'changes in appearance' rather than 'lesions'. In all, 56 'conditions' or 'appearances' were noted in 314 inspections, the commonest being petechiae (53.6%). Potentially significant conditions justifying the term 'lesions' (three microulcerations, two ecchymoses, five abrasions and one mucosal tear; 3.5% of inspections) usually healed spontaneously and disappeared rapidly. The incidence of these conditions was highest when the inspections followed intercourse in the previous 24 h (25.2 versus 14.2%; P < 0.0008), or tampon use (32.4 versus 15.9%; P < 0. 0001). These processes may be regarded as a reflection of regular minor trauma to the vaginal epithelium.

Adolescent↗
PubMed1998

Positive predictive rate of colposcopic examination of the cervix uteri: an overview of literature.

Study of literature revealed that the positive predictive rate of the colposcopic impression is better as the cervical lesion is more severe. When directed biopsies are taken, the positive predictive rate of colposcopy increases considerably. For microinvasive disease, the positive predictive rate is quite poor, probably because of the absence of characteristic features. Large loop biopsies diagnosed all cases of microinvasive disease missed by directed biopsies, but this technique has the disadvantage of considerable "overtreatment" when integrated in the management of all patients with abnormal cytology. The restrictions of colposcopy are the invisibility of the squamocolumnar junction and observer variability in the assessment of the impression. The levels of agreement among experienced colposcopists are in the same range as those in cytological and histopathological diagnosis. It is concluded that colposcopy is an indispensable tool in the management of premalignant cervical disease, as long as the restrictions of the technique are kept in mind by the colposcopist.

Adolescent↗
PubMed2003

Prospective evaluation of colposcopic features in predicting cervical intraepithelial neoplasia: degree of acetowhite change most important.

OBJECTIVE.: To prospectively evaluate the contribution of three colposcopic features-degree of acetowhite change, blood vessel pattern, and lesion margin-to the diagnosis of cervical intraepithelial neoplasia. MATERIALS AND METHODS.: A total of 301 women, who participated in two randomized controlled trials and a cross-sectional study of human papillomavirus testing and who were referred to a regional colposcopy center, were studied. Women were examined by colposcopists, who prospectively scored all abnormal transformation zones using three features. The site with the highest score (the most abnormal site) was biopsied and histology reviewed by two pathologists. RESULTS.: In multivariate analysis, degree of acetowhite change was the only feature significantly associated with cervical intraepithelial neoplasia. CONCLUSIONS.: Grading lesion severity using degree of acetowhite change alone gave comparable results to grading using the three combined features.

Journal Article↗
PubMed2003

Psychological effects women experience before and after a colposcopic examination and primary care appointment.

OBJECTIVE.: To estimate the psychological impact, health and behavior concerns, and coping styles of women awaiting colposcopic examination compared with women awaiting a scheduled primary care appointment. MATERIALS AND METHODS.: A convenience sample of 150 women presenting for a scheduled colposcopy examination and 201 women scheduled for a primary care appointment were assessed for demographic status, depression (Center for Epidemiologic Studies/Depressed Mood Scale), anxiety, health beliefs and concerns, and coping style (Miller Behavioral Style Score). Subjects also completed a postexamination questionnaire. Mean responses were compared using Wilcoxon rank sum test. RESULTS.: Mean anxiety scores were considered "mild" and equivalent for women in the two groups. Although the colposcopy group had a significantly greater mean depression score (36.3) compared with the noncolposcopy group (33.4, p = .03, Wilcoxon test), both mean scores indicated mild depression. Women undergoing colposcopy reported greater mean scores for concern about their disease, the procedure, and potential consequences (p < .01, Wilcoxon test). CONCLUSION.: Women scheduled for colposcopy have a similar level of mild anxiety and mild depression as women scheduled for a primary care appointment. Consequently, universal, instead of selective, use of anxiolytic agents before colposcopy appears unjustified. Avoidance of triage to colposcopy for atypical squamous cells of undetermined significance Pap smear results may be unwarranted based on concerns for causing excessive anxiety. In fact, colposcopy provides substantial reassurance.

Journal Article↗
PubMed2005

Endocervical curettage at the time of colposcopic assessment of the uterine cervix.

UNLABELLED: Colposcopic examination of the uterine cervix remains the gold standard in the evaluation of patients with abnormal cervical cytology. Endocervical curettage (ECC) still forms a limited part of the overall assessment of women with abnormal cervical smears (Pap test) in the United States and in certain other parts of the world. To date, there are no properly randomized trials on the place of ECC in the overall care of women with abnormal Pap test. This review critically appraises the available evidence to look at the possible role of ECC in the complete evaluation of abnormal cervical smears. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to list the proposed indications for endocervical curettage (ECC), to summarize the data in support of the routine use of ECC at the time of colposcopy, and to outline the evidence against the use of routine ECC at colposcopy.

Colposcopy↗