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PubMed1981

Follicular cervicitis--colposcopic appearances and association with Chlamydia trachomatis.

Follicular cervicitis was recognised in 15 (44 per cent) of 34 women who were examined colposcopically and who were sexual partners of men with non-gonococcal urethritis. Valid results of culture for Chlamydia trachomatis were obtained in 26 cases: the organism was isolated from the cervix of five of 11 women in whom follicular cervicitis had been diagnosed, but from only one of 15 whose cervices did not have this change. A similar correlation was not found for infection with Mycoplasma hominis or Ureaplasma urealyticum.

Adolescent↗
PubMed1985

Complications of cone biopsy related to the dimensions of the cone and the influence of prior colposcopic assessment.

A retrospective study of the complications of cone biopsy showed that among 915 women examined between the years 1976 and 1982, 121 (13%) had primary or secondary haemorrhage, 153 (17%) cervical stenosis and 39 (4%) subsequent infertility or an abnormal pregnancy. Cervical stenosis was commonest among women who had had long cones removed. Stenosis occurred more often in the group of women who had been assessed by colposcopy before operation but this was due to the fact that prior colposcopy selected a favourable group of patients with lesions of limited extent that were susceptible to treatment by local destructive therapy, so that prior colposcopic assessment resulted in the removal of longer cones.

Adult↗
PubMed1990

Using Lamicel to expose high cervical lesions during colposcopic examinations.

Women with abnormal cervical cytology and an unsatisfactory colposcopic examination were offered Lamicel in an attempt to expose the entire transformation zone. The sponge, which softens, dilates and effaces the cervix, was passed intracervically in 41 patients in whom the entire squamocolumnar junction could not be seen. After 3-4 h the sponge was removed and colposcopy repeated. In 29 of the 41 patients the lesion and the squamocolumnar junction were now fully visible. Twenty-five of these patients were spared a cone biopsy.

Adult↗
PubMed1991

Is large loop excision of the transformation zone (LLETZ) more accurate than colposcopically directed punch biopsy in the diagnosis of cervical intraepithelial neoplasia?

In 100 women with suspected cervical intraepithelial neoplasia (CIN) attending the colposcopy clinic the histological diagnoses made from excision biopsies taken by large loop excision of the transformation zone (LLETZ) were compared with those from colposcopically directed punch biopsies taken concurrently. One unsuspected microinvasive tumour was found and the diagnosis made by LLETZ was significantly worse than that made by punch biopsy in 24 cases (24%: 95% CI 15.6 to 32.4%). LLETZ improves the accuracy of diagnosis of CIN.

Biopsy↗
PubMed1991

Colposcopically directed punch biopsy: a potentially misleading investigation.

OBJECTIVE: To determine the relation between the histology of an initial colposcopically directed punch biopsy and a subsequent diathermy loop excision biopsy of the transformation zone, and the effect of lesion size on this relation. DESIGN: Prospective observational study of loop diathermy excision biopsies of the cervical transformation zone. SETTING: Academic unit colposcopy clinics at The Birmingham and Midland Hospital for Women and Dudley Road Hospital, Birmingham. SUBJECTS: 243 women managed by colposcopy and directed punch biopsy followed by loop diathermy excision. OUTCOME MEASURES: The histology of the punch biopsy and the excised transformation zone and the size of the abnormal lesion. RESULTS: In 132 (54%) of the 243 women the histology of the punch biopsy and loop excision specimen did not agree. In 62 (47%) of these 132 women a more severe lesion was found in the excised transformation zone, including three unsuspected adenocarcinoma in situ and one stage Ia1 cancer. In 39 (41%) of the 96 women in whom a lesion of CIN 3, or greater severity, was found in the loop excision specimen, the paired punch biopsy had suggested a lesion of lesser severity. In small area lesions, the punch biopsy was more likely to show more severe disease than the loop excision specimen (P = 0.0014). CONCLUSIONS: The results suggest that directed punch biopsy is an inadequate endpoint by which to judge the severity of an epithelial lesion. The findings have important implications for patient management and the design of trials and cast doubt on the results of studies using punch biopsy as an endpoint.

Biopsy↗
PubMed1999

A prospective follow up study of women with colposcopically unconfirmed positive cervical smears.

OBJECTIVE: To examine a cohort of women with positive cervical smears, but negative colposcopy, in order to ascertain whether there is a subsequent difference in the incidence of squamous dyskaryosis and cervical intraepithelial neoplasia when compared with a control group. DESIGN: Prospective follow up study. SETTING: Colposcopy clinics, antenatal clinics, GP surgeries. METHODS: A study group of 255 women with reported abnormal cervical smears but negative colposcopy was subdivided into three groups according to referral smears suggesting high grade dyskaryosis (n = 34), mild dyskaryosis (n = 120) and borderline changes (n = 101). They were followed for at least five years and were compared with a control group of 726 women followed up after a negative smear, using the first and worst follow up smears over a five year recall period. MAIN OUTCOME MEASURES: Incidence of subsequent cervical cytological and histological abnormalities. RESULTS: The control group had a similar incidence of squamous dyskaryosis as that expected in the screening population. Forty-six per cent of the study group with colposcopically unconfirmed ('false positive') cervical smears subsequently had abnormal smears. When the three groups were compared with controls using a chi2 test, their incidence of abnormal smears was significantly increased. Cervical intrepithelial neoplasia was found in 19% of the study group, and in 3% of the control group (P < 0.0001). CONCLUSIONS: The analysis demonstrates that women with so-called 'false positive' smears defined by negative colposcopy have an increased risk of subsequent abnormal smears and cervical intrepithelial neoplasia, suggesting that lesions may have been missed on colposcopy. However, in a significant proportion of women, further abnormalities were not detected during the follow up period, indicating that there may be other causes for positive smears and negative colposcopy.

Colposcopy↗
PubMed1988

Colposcopic assessment of the accuracy of cervical cytology screening.

Two hundred asymptomatic women in a general practice were screened both cytologically and colposcopically for evidence of cervical intraepithelial neoplasia. The prevalence detected by cytology alone was 5%, but the prevalence detected by cytology and colposcopy together was 11%. None of the larger lesions of cervical intraepithelial neoplasia (affecting more than two quadrants of the cervix) was associated with negative cytology. The false negative cytology rate for smaller lesions was 58%. The clinical importance of the smaller lesions that were not accurately detected by cytology screening is unknown. As these lesions affected 6% of the screened population further studies of their clinical course are urgently required. Local destructive treatment in such cases may represent considerable overtreatment. If these lesions prove to be clinically important, however, the results of this study predict an increasing epidemic of preinvasive and invasive disease of the cervix.

Adolescent↗
PubMed2000

The borderline cervical smear: colposcopic and biopsy outcome.

AIMS: To review the outcome of women referred with smears showing borderline nuclear change (BNC), and to determine any differences in outcome if BNC was persistent, preceded by dyskaryosis, or followed treatment for cervical intraepithelial neoplasia (CIN). In addition, to determine criteria that might permit delineation of a BNC subtype, predictive of CIN. METHODS: The records of 178 women referred for colposcopy in 1993, with last smear showing BNC, were obtained from our laboratory database. The cytology, colposcopy, and biopsy follow up for a five year period were also obtained. The patients were divided into three categories according to their smear status before the last referral borderline smear: category 1, persistent BNC (n = 39); category 2, BNC preceded by dyskaryotic smears (n = 100); and category 3, BNC after treatment for CIN (n = 39). The referral borderline smears were reviewed on cases with negative outcome and those with a biopsy diagnosis of CIN2 and CIN3. RESULTS: In 50 women (28%) no biopsy was deemed necessary after colposcopic assessment. The biopsy results in the remaining 128 (72%) women were as follows: normal in 18 (10%), koilocytosis in 12 (7%), CIN1 in 45 (25%), CIN2 in 32 (18%), and CIN3 in 21 (12%) women. High grade lesions (CIN2, CIN3) were seen on biopsy in 14 of 39, 33 of 100, and six of 39 cases in category 1, category 2, and category 3, respectively. Blind review of the referral borderline smears from 53 women with a biopsy diagnosis of high grade lesions (32 CIN2, 21 CIN3) confirmed they were borderline in 23, upgraded them to mild dyskaryosis in 15, and found that 14 cases of isolated moderate or severe dyskaryotic cells had been missed originally. The borderline change was in mature squamous cells in five of 23 and in immature metaplastic epithelium in 18 of 23 cases. After smear review in 68 women with negative outcome, 36 smears were reclassified as negative in keeping with inflammation and atrophy, three were considered unsatisfactory, one was upgraded to CIN1, and 28 were confirmed as BNC. Of the latter, 25 of 28 were in mature squamous cells. The five year follow up on women with negative colposcopy (n = 50), negative loop excision of transformation zone (LETZ) (n = 18), and LETZ with koilocytosis (n = 12) showed subsequent high grade CIN on LETZ in 16, 0, and two patients, respectively. CONCLUSIONS: On referral of women for colposcopy with last smear showing BNC, the outcome was high grade CIN in over 30% of cases, irrespective of whether the borderline smear was preceded by another borderline smear or by a dyskaryotic smear. In contrast, in those referred because of BNC after treatment of CIN, high grade CIN was seen less frequently (15% of cases). Furthermore, in cases that necessitated loop excisions, high grade CIN was seen in 41%. This study also showed that BNC associated with inflammation or atrophy, or BNC in mature squamous cells, appears to have lower predictive value for CIN than those cases where BNC is associated with immature metaplastic epithelium. The use of terms such as "BNC favour reactive" for the former and "BNC favour dyskaryosis" for the latter is recommended, together with follow up by cytology and colposcopy, respectively.

Adult↗
PubMed1992

A colposcopic case-control study of cervical squamous intraepithelial lesions in women with anogenital warts.

OBJECTIVE: To assess whether anogenital warts, present or past, are an indication for women to be referred for colposcopy. DESIGN: A case control study comparing patients with and without a history of anogenital warts. SETTING: A department of genitourinary medicine in West London. PATIENTS: 468 patients examined by colposcopy between January 1985 and December 1987 of whom 147 (31%) had abnormal cytology, 163 (35%) had anogenital warts and 158 (34%) had both. MAIN OUTCOME MEASURES: Colposcopic findings and histology of cervical biopsies compared with behavioural and disease variables. RESULTS: Human papillomavirus infection (HPVI) of the cervix showed no relationship with a life time history of vulval warts, or with the presence of anogenital warts on clinical examination, or with any parameter of sexual behaviour included in the study. Cervical intraepithelial neoplasia (CIN) was strongly associated with current IUCD usage (RR = 7.75) and coitarche under 16 years of age (RR = 3.72), but a history of vulval warts yielded a negative association (RR = 0.34), suggesting a protective effect. This relationship held true when cytological dyskaryosis was made the dependent variable (RR = 0.24). CONCLUSIONS: Anogenital warts are not a risk for subclinical cervical HPVI or for CIN and therefore not an indication for colposcopy.

Adult↗
PubMed1998

How alarming is post-coital bleeding--a cytologic, colposcopic and histopathologic evaluation.

This retrospective analysis studies post-coital bleeding (PCB) in 110 patients presenting to the colposcopy clinic of the University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India, and covers a 2-year period from March 1994 to February 1996. All the patients were evaluated by cytology and colposcopy. Colposcopy-positive patients underwent a directed biopsy. Age, parity and duration of PCB were correlated with histopathologic findings, i.e. benign changes, viral HPV changes and cervical intra-epithelial neoplasia (CIN) 1, CIN 2 and 3 and invasive cancer for risk assessment. 85.5% of the patients had benign findings, 5.6% viral HPV and CIN 1, 3.6% CIN 2 and 3 and 5.5% invasive cancer. Vascular ectopy was the commonest benign colposcopic finding. Cytology had a sensitivity and specificity of 56% and 90%, respectively. The mean age of patients with invasive cancer was 41.3 years versus 32.9 years in patients with benign pathology, the difference being statistically significant (p < 0.05). Mean parity was 4.2 in patients with invasive cancer against 2.8 in benign cases (NS). There was no correlation between duration of bleeding and pathology.

Adult↗
PubMedDate not supplied

Sensitivity of the Pap test in detecting high grade lesions: what should be the acceptable cytologic threshold for colposcopic referral?

OBJECTIVE: To devise an optimal cytology threshold for colposcopy referral in resource-limited settings. STUDY DESIGN: Four hundred seventy-two symptomatic women 20-60 years old were screened by both cytology and colposcopy. Onsite biopsy was taken if lesions grade 1 or above were detected on colposcopy. Women found to have cervical intraepithelial neoplasia (CIN) 2 and above lesions on histopathology were stratified according to their cytologic diagnosis (atypical squamous cells of undetermined significance [ASCUS]+ threshold, low grade squamous intraepithelial lesion [LSIL]+ threshold, and high grade squamous intraepithelial lesion [HSIL]+ threshold). The comparative sensitivity, specificity and predictive values in each group were calculated, taking biopsy as the gold standard. RESULTS: The sensitivity of LSIL + cytology to detect CIN 2+ lesions was 91.5% (referral load, 30.7%). While the sensitivity of ASCUS+ cytology threshold was almost the same (92.3%), the referral load was much higher (42.2%). With HSIL+ cytology threshold, though the referral load was reduced substantially (21.9%), the sensitivity also decreased, to 81.5%. CONCLUSION: The results indicate that in order to achieve high sensitivity, the LSIL cytology threshold appears to be optimum for colposcopic referrals.

Adult↗
PubMedDate not supplied

Adenoma malignum. Report of a case with cytologic and colposcopic findings and immunohistochemical staining with antimucin monoclonal antibody HIK-1083.

BACKGROUND: Adenoma malignum of the uterine cervix was first described by Gusserow. We report here a case with cytologic, histologic and colposcopic findings and immunohistochemistry for HIK-1083. CASE: A 42-year-old female was noted to have a probable adenoma malignum due to the detection of atypical cells classified as V. On colposcopy, comma-shaped, atypical vessels spread over the entire cervical area. Histologic findings were characteristic of tumor invasion beyond the layer of cervical glandular ducts. Immunohistochemical detection of CEA was negative, but HIK-1083, which recognizes gastric glandular mucous cells, was positive. CONCLUSION: For a definitive diagnosis of adenoma malignum of the cervix, immunohistochemical examination for an appropriate marker, such as HIK-1083, should be added to the routine gynecologic examination, cytologic and histopathologic examination, and colposcopy.

Adenocarcinoma, Mucinous↗
PubMed1982

Colposcopic pattern of cervicitis, dysplasia and pre-invasive cancer of the uterine cervix.

The great majority of cervical neoplasia begin in the transformation zone between the squamous and the columnar epithelium, i.e. within the area in which metaplasia takes place. This process, both normal and atypical, can be studied colposcopically. Colposcopy increases the diagnostic accuracy and therapeutic success in cervical neoplasia as it is the only method that permits a topographical study of cervical lesions, and indicates the location of neoplastic epithelial proliferation.

Adolescent↗
PubMed1985

Colposcopic, cytological and histological evaluation of the cervical stump 3 years after supravaginal uterine amputation.

Colposcopic, cytological and histological (endocervical curettage) evaluation of the remaining cervical stump was done 3 years after 99 supravaginal uterine amputations performed for benign condition. Peroperative electrocoagulation of the endocervical mucosa had been done in all the patients and postoperative ectocervical electrocoagulation in 39 (39.4%) cases. No active inflammatory, premalignant or malignant changes were detected at the 3-year examination of the cervix. Furthermore, normal adenomatous epithelium had been wholly or partly relaced by squamous epithelium in 89% of the cases.

Adult↗
PubMed1999

[Colposcopic verification of cytologic smears containing atypical squamous cells of undetermined significance].

The aim of the study was the estimation of significance of smears containing Atypical Squamous Cells of Undetermined Significance (ASCUS) and presentation the own management of that cases. The study group consisted of 73 non-pregnant women (aged from 21 to 54 years) with ASCUS. The control group included 113 non-pregnant patients (aged between 20 and 57 years) with unsuspected cytology findings. Chi square test and Fisher test were used to compare the colposcopy findings in the two groups. Colposcopic pictures indicating a presence of dysplasia were significantly more often in study group. 14 cases (19.18%) of mild dysplasia and 8 cases (10.96%) of moderate and severe dysplasia were found in the group of patients with ASCUS. During the 18 month follow-up of the remaining patients in that group persistence of ASCUS was found in 2 cases (3.92%), progression to mild and moderate dysplasia was observed in 6 women (11.76%). Regression to normal smear occurred in 43 women (84.31%). Progression to dysplasia referred to women with suspected colposcopy findings. Until further research resolve all the questions regarding ASCUS smears or new more precise diagnostic methods are invented, colposcopy remains the method of choice in verification of ASCUS smears. Colposcopy together with cytology is the optimal mode of observation of such patients.

Adult↗
PubMed1975

Correlation of colposcopically directed biopsy and conization with histologic diagnosis of cervical lesions.

This study describes 50 patients with abnormal cervical Papanicolaou smears who had colposcopically directed biopsies and then subsequent cervical conization. The objective was to test the accuracy of directed biopsies compared with that of standard method of diagnosis. A significant difference between the two methods occurred in 4% of patients. This figure is the same as that gained from a review of current literature (3.8%). There were no invasive carcinomas in this series.

Biopsy↗
PubMed1975

[Development of ectopia. Colposcopic and colpotopographic studies].

On the basis of colposcopical observations a possible, though certainly rare, mode of development of ectopia is described. Proliferation of the glands of the upper part of the cervical canal up to the base of the squamous epithelium leads to exfoliation and desquamation of this and to extension of the columnar epithelium on the surface of the vaginal portio. The possible causes of this process are briefly presented.

Adult↗
PubMed1975

[Colposcopic findings during hormonal contraception].

The best way to recognize individual differences and alterations of colposcopic findings is by photography. The results of an improved colpophotographic technique is the reproduction of the complete portio. In consequence we can observe the changes of the cervix epithelium which often are extensive and hypertrophic and which in some cases are to be found during the time of hormonal contraception. The different effects of the combination-pill and of the sequential pill are described, the question of individual disposition concerning these alterations is discussed.

Adult↗