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PubMedDate not supplied

Can colposcopy replace conization?

The reintroduction of colposcopy and the introduction of outpatient therapy have significantly altered the management of the woman with an abnormal Pap smear. Routine conization is no longer considered mandatory, particularly for the lower grades of CIN. We estimate that over 10,000 gynecologists in North America have received instruction in colposcopy. Virtually every teaching hospital and medical center has colposcopy available. It is a valuable evaluative tool, particularly with the increasing risk of CIN in young women and the fact that more women are delaying childbearing until the third and fourth decades of life. The technique does, however, require a rigorous period of training, significant experience, and strict adherence to an established evaluation protocol. In the hands of the neophyte, the consequences of in-appropriate evaluation of the woman with an abnormal Pap smear can be tragic.

Adult↗
PubMed2003

Investigation of colposcopy information on the internet.

The Internet is a massively expanding body of information which includes medical resources. It is easier than in the past for anyone with some knowledge and effort to access the Internet. Medical professionals as well as patients have a similar ability to research a medical topic through the Internet. As medical professionals, we are concerned whether the medical information found on the Internet by patients is current and accurate. There are relatively few reports that critically examine where patients and family members acquire medical information. To assess the accuracy and completeness of information regarding colposcopy on the Internet, we categorized and defined the information on the Internet through systematic study. We chose eight search engines available on the homepage of Explorer to search and analyze the information obtained from a search for the topic of colposcopy. In addition, we analyzed whether the colposcopy information contained peer-review or reference in order to evaluate its reliability. The numbers of uniform/universe resource locators (URLs) varied considerably, ranging from 11 to 23300, when we tested the search engines using different combinations of capitalization and spellings. Descriptions of information from 181 sites located by a search engine (Yahoo) were also evaluated into five types, ranging from diagnostic to anecdotal information. In terms of the peer-review system, inaccurate or misleading information was found on web pages which might lead patients to doubt and distrust their medical specialists whose information was contradictory to that which they had obtained themselves. We recognize that the Internet has a positive and potential power in partnership with medical professionals to educate patients, helping them to overcome their disease. Nevertheless, we suggest the need to take an active role in identifying the Web sites containing accurate medical information and evaluating their quality.

Colposcopy↗
PubMed1999

[Colposcopy screening for prevention of uterine neck neoplasms].

Cervical cancer, throughout the world, is the second most common neoplasm among women. In Europe approximately 22,000 new cases of cervical cancer are diagnosed each year. This study assessed colposcopy as a screening method in the detection of pre- and early neoplastic lesions. This retrospective study analysed 3264 women hospitalized or treated on an outpatient basis at the Gynaecology and Oncology Clinic of CMUJ from 1995 to 1997. Among 81.2% patients the unsuspected colposcopic pictures were found which were histologically verified. In 5.9% of all examined patients the colposcopic pictures suggested lesions of CIN and early invasive cancer. In these cases the colposcopy presented false positive pictures in 2.6%. From this analysis the colposcopy is a method of good concordance with histologic examination result. This allows to eliminate unnecessary punch biopsies and even diagnostic conisation in significant percentage.

Adult↗
PubMed1999

[The role of colposcopy in evaluation of the cervix for unexpectedly positive pap smears].

The cervical cancer is still one of the most common malignancies of female low genital tract (LGT). Pap smears is a widely used screening procedure. Colposcopy with punch biopsy verifies positive Pap smears. Clinical material were 133 women aged 34-75 yrs diagnosed and operated in the Chair and Department of Gynecology and Oncology CM Jagellonian University. In all cases cytology and colposcopy were performed. Their results were compared to each other and to histology results. The concordance of cytologic and histology results reached 92.5% while of colposcopic and histology--98%. Colposcopy is an useful method of Pap smears verification because it limits to minimum false negative results percentage.

Adult↗
PubMed1998

[The evaluation of computer cytological test with colposcopy for the diagnosis of cervical lesions].

OBJECTIVE: To assess the value of computer cytological test (CCT) with colposcopy for the diagnosis of early cervical diseases. METHODS: 3,016 cervical pap smears have been done in our hospital from March 15, 1995 to March 15, 1996. The CCT smears were analyzed first, then cytologist made the final reports, cervical biopsies under the guidance of colposcopy were taken in 56 cases with abnormal findings. RESULT: We found 375 (12.4%) abnormal pap smears out of 3,016 cases, in which cervical squamous cancer 5 cases, endometrium adenocarcinoma 1 case. The low grade squamous intraepithelial lesion (LSIL) and human papilloma virus (HPV) infection most frequently happened at the younger patients. There are 59 cases (2.0%) of LSIL, among which HPV infection accounted 79.7%. We use CCT for primary selection, its sensitivity is 98.9% specificity is 90.9%. CONCLUSION: Sexually transmitted diseases is closely related to cervical early disease. CCT should be done in the younger women, especially high-risk patients. Positive cases of CCT must be examined by colposcopy and pathological biopsy, this is the best way to diagnosis cervical disease.

Adolescent↗
PubMed2000

Does a family physician who offers colposcopy and LEEP need to refer patients to a gynecologist?

BACKGROUND: Many family physicians perform colposcopy and provide treatment when biopsy reveals dysplasia. Before the adoption of loop electrical excision procedure (LEEP) gynecologic referral following colposcopy was required for a small percentage of women--most commonly for cold cone procedures. The use of LEEP and LEEP cones may obviate the need for cold conization, so we sought to assess the pattern of gynecologic referral in the practice of family physicians skilled in this procedure. METHODS: We reviewed the referral practices of a family medicine residency practice that routinely provides LEEP for biopsy-proven cervical intraepithelial neoplasia requiring treatment. Colposcopy and, when indicated, LEEP were performed primarily by the senior author or by residents under close faculty supervision. The computerized clinic log was reviewed for all patients from its 1993 inception through November 1999, and all treatment decisions were evaluated. RESULTS: During the study period, 283 women were seen in the clinic, and 26 individuals (9%) were referred by the family physician colposcopist to a consulting gynecologist. CONCLUSIONS: Despite use of LEEP, a minority of patients continues to need gynecologic referral. Large acetowhite lesions extending onto the vaginal fornix accounted for the majority of referrals, and some patients were referred exclusively for cold cone biopsy. Although LEEP can allow family physicians to manage cases previously requiring referral, we urge that this procedure be employed only by those with the technical and decision-making skills required for safe and effective treatment.

Ambulatory Care Facilities↗
PubMed2002

An observational study of women with positive HPV-DNA tests and normal cytology and colposcopy.

PURPOSE: High risk human papillomaviruses (HPV) are implicated in the aetiology of malignant cervical disease. The usefulness of HPV DNA tests in identifying women at risk of cervical cancer as an adjunct to cervical cytology is under evaluation. PATIENTS AND METHODS: This is a retrospective analysis of 47 women positive for high risk HPV but with negative cytology and negative colposcopy at the start of the study. Women were observed for three years or more (in 96% cases) using six-monthly combined HPV DNA tests, cytological and colposcopic evaluation. RESULTS: At the end of follow-up, 29/47 (62%) women were still positive for high risk HPV, 45/47 (96%) women had normal cytology and 47/47 (100%) women continued to have normal colposcopy. CONCLUSIONS: Normal colposcopy has an excellent negative predictive value for HPV positive women with normal cytology. These women can be safely screened cytologically on a three-yearly basis.

Adult↗
PubMed1992

Colposcopy in family practice: pilot studies of pain prophylaxis and patient volume.

In a family practice office with volume representative of an average one-person practice, the implementation of colposcopy services was studied. During six months, 257 patients received Papanicolaou (PAP) smears. These patients represented 16.2% of the total 1,585 female patient visits for ages greater than 16. Of the 257 cytology specimens, 10.1% (26) revealed dysplasia or evidence of Human Papilloma Virus (HPV), indicating the need for colposcopic examination. Pathology reports of all biopsied cases confirmed the presence of dysplasia or HPV. These results suggest that the average family physician might reasonably anticipate about 100 colposcopy sessions per year, assuming each patient receives a diagnostic and a therapeutic colposcopic evaluation. In the course of colposcopy services in a family practice, 46 patients underwent 67 colposcopic examinations with cervical biopsy and/or cryotherapy in the office. Some patients received nonsteroidal anti-inflammatory medication 30-60 minutes before the procedure, with selection according to physician preference. All patients rated the pain experienced during the procedure on a 10-point visual-analog scale. Pain scores were significantly lower in those who received medication. Overall, patients tolerated the procedure well and there were no reported complications. Because of the possibility of such factors as the placebo effect influencing these results, a randomized, placebo-controlled, double-blind study will be needed to verify the findings.

Adolescent↗
PubMed1992

Colposcopy findings of CIN and cancer-like lesions of the cervix in pregnancy.

In the course of routine colposcopy evaluation of the cervix in all the cases examined and treated in our clinic we pay attention to the cervical lesions accompanying pregnancy, which are macroscopically and/or colposcopically, and even frequently histologically suspected of CIN and/or cancer. These lesions include findings connected with HPV-infection, i.e. fully developed papillomas, subclinical forms of this infection, as well as the decidual ectopy of the cervix. Fully developed papillomas estimated not only macroscopically and colposcopically, but sometimes also histologically yield falsely positive pictures of cancer, and the decidual transformations on the cervix can be misinterpreted as non-epithelial malignant changes. The incidence rate of cervical papillomas is about 1% in non-selected material; one half of these cases occurs in pregnancy. Decidual ectopy was diagnosed in our material in 6.2% of pregnant women, chiefly between 21 and 30 years of age, and only in single cases in non-pregnant women. On the basis of our routine colposcopy examinations of the cervix in pregnancy conducted for over 30 years, the authors present the colposcopy-clinical signs of these CIN and carcinoma-like changes of the cervix in pregnancy. These observations are colpophotographically documented and allow us to differentiate between these changes and pre- and neoplastic lesions of the cervix in pregnancy.

Carcinoma in Situ↗
PubMed1992

Correlation of colposcopy and histology in cervical biopsies positive for CIN and/or HPV infection.

The purpose of our study was the investigation of colposcopic findings in 108 patients with histologically proved CIN and/or HPV infection in colposcopically directed cervical punch biopsies. The chi square test with Yates' correction was used for the statistical analysis. In 82 cases there were histological changes suggestive of HPV infection, 91 cases showed CIN while in 65 cases CIN was superimposed on HPV infection. The sensitivity of colposcopy was 89% for the detection of CIN and 61% for HPV. In 45% of CIN cases colposcopy underdiagnosed the CIN level, especially in more severe lesions (level II or higher, P < 0.001). We have also observed that the HPV-related colposcopic findings significantly increased the probability of underdiagnosing CIN (P < 0.05). Our results suggest that biopsy is always necessary in order to establish the diagnosis and determine the severity of CIN, especially if the colposcopist suspects HPV infection. We have also shown that many cases of HPV infection are not detected by colposcopy, because they are masked by the coexisting CIN.

Colposcopy↗
PubMed2004

A second Pap smear during colposcopy: is it really worth it?

The aim of this study was to determine whether the clinical value of a second Pap smear during colposcopy outweighed its cost-effectiveness and reliability parameters. We studied retrospectively 569 cases focusing on A) The initial Pap smear, B) The smear performed during colposcopy, C) The colposcopic findings, and D) The histopathological reports of the cases where biopsy sampling was performed. In 380 patients (67%), the second Pap smear corresponded to the first one. In 13% of the patients, the cytological lesions were worse (particularly in 2% of the patients staging increased from HPV-associated reactive cellular changes to CIN II, or from CIN I to CIN III), and in 20% slighter than the initial. In 79% of the cases revealing more serious lesions in the second smear, the histological result of the biopsy corresponded to that of the initial smear. Conclusively, only 2% seem to benefit from a second repeat Pap smear during referral colposcopy.

Adolescent↗
PubMed2004

Normal colposcopy following abnormal Pap smear evoking LGSIL: a follow-up study.

The aim of this study was to determine the optimal treatment policy in women presenting with an abnormal Pap smear showing low-grade squamous intraepithelial lesion (LGSIL), who additionally had normal colposcopic findings. We prospectively studied 160 women with LGSIL and normal colposcopy, and divided them into two groups. Group A, consisting of 54 women, was followed-up for a mean period of 42 months and had a new control smear 12 months after the initial one. Group B, consisting of 106 women, was followed-up for a mean period of 44 months and had two consecutive control smears (6 and 12 months after the initial), and a new colposcopy, depending on the findings. At the end of the first year, the lesion persisted in 37% and 39% of the patients in groups A and B, respectively. At the end of the study, regression or persistence of the LGSIL was revealed in 63% and 61% of the women in groups A and B, respectively. Aggravation of the lesions occurred after 16.5 and 15 months, respectively, in groups A and B. Our findings suggest that women with LGSIL and normal colposcopy do not need further therapeutic measures during the first year after the initial smear.

Adolescent↗
PubMed2004

HPV, cervical neoplasia and smoking: knowledge among colposcopy patients.

OBJECTIVE: To assess colposcopy patients' knowledge of human papillomavirus (HPV) infection and the role of smoking in cervical neoplasia and, if patients were current smokers, their willingness to quit smoking. STUDY DESIGN: Between January and June 2001, 250 women seen in a colposcopy clinic for the evaluation of an abnormal Pap smear or previously diagnosed cervical neoplasia participated in a survey designed to evaluate knowledge of HPV infection, smoking and neoplasia. Participants who smoked were questioned regarding their smoking behaviors and readiness to quit. In the analysis, the population was stratified by age (< 25 years versus > or = 25 years) to determine differences in knowledge, perception of risk and behaviors. RESULTS: The study population was in general young and racially/ethnically diverse. Fifty-seven percent (143 of 250) thought that HPV was a risk factor in cervical neoplasia, and 58% (146 of 250) associated smoking with neoplasia. Among smokers who discussed risk reduction with their providers, 75% (50 of 66) were advised to stop smoking. Of the 39% (98 of 250) who were current smokers, 63% (62 of 98) agreed that having an abnormal Pap smear would make them consider smoking cessation, and 58% (57 of 98) reported that they would use medical therapy (nicotine replacement or medication) to aid in that process. There were age-related differences in smoking behaviors and attitudes toward cessation (e.g., younger smokers were less likely to desire nicotine replacement). CONCLUSION: Given the high prevalence of smoking and a demonstrated desire by many of the colposcopy patients to stop smoking in the context of a cervical abnormality, further efforts at encouraging cessation are warranted.

Adolescent↗
PubMed2005

[Intraepithelial cervical squamous lesions: comparison between PAP-test, colposcopy, phase contrast microscopy and histology; usefulness of their synergic use].

AIM: In the last 10 years the tumors of cervix have showed a significant reduction in incidence, while the preneoplastic lesions are increased (linked often to human papilloma virus [HPV] infection), and so it is enhanced the role of early diagnosis. METHODS: The Authors have examined 124 patients at colposcopy showing transformation zone anomalies and/or HPV infections. The patients have submitted to PAP-test, phase contrast microscopy and to biopsy. RESULTS: The analysis of our cases show oneself better sensitivity of colposcopy than cytologic exam, in particular in the diagnosis of low grade intraepithelial lesions (LSIL), corresponding to CIN 1 and HPV lesions. CONCLUSIONS: Phase contrast microscopy, by search of possible preneoplastic elements in the smear, is a complementary technique, and if performed systematically and by qualified operators allows to reduce furthermore false negative rate. The synergic use of tools allows to increase of number of intrecervical neoplasia diagnosis. The following cost's increase cannot be considered an obstacle and it is not should be necessary to counsel always the colposcopy in case of anomalous PAP smear revealed during screening.

Carcinoma, Squamous Cell↗
PubMed2005

Colposcopy vs Hybrid Capture II assay in detection of cervical human papilloma virus infection.

PURPOSE OF INVESTIGATION: Considering the relationship between high-risk human papillomavirus types and the presence or subsequent development of cervical high-grade preinvasive lesions, the aim of the study was to determine if the Hybrid Capture II test can be used to triage women with atypical colposcopic findings. METHODS: The study was carried out on 100 patients with suspicious colposcopy findings (suggestive of human papillomavirus infection) who underwent a cervical smear for human papillomavirus testing DNA Hybrid Capture II and direct biopsies for histopathological analysis. RESULTS: Sixteen patients were negative for human papillomavirus. Of the eight patients positive for high-risk HPV type, seven presented an abnormal transformation zone grade 2 (high-grade squamous intraepithelial lesion of the cervix at histopathology). There was a significant positivity of medium-high risk virus types in the cases with more abnormal colposcopy (chi2 = 7.44; p < 0.005). Histopathological findings of high-grade squamous intraepithelial lesions were registered in the patients positive for medium-high risk human papillomavirus types (chi2 = 7.66; p < 0.025). CONCLUSIONS: Based on these results it can be concluded that if a diagnosis of a high-grade squamous intraepithelial lesion has been made on the basis of colposcopic and histopathological findings, there is a high probability that the infection was due to one or more types of human papillomavirus. There are necessary further studies to interpretate both the advantages and disadvantages of intermediate triage procedures, like Hybrid Capture II testing, compared with immediate colposcopy.

Adolescent↗
PubMed2006

[Possibilities of colposcopy in the diagnostics of cervical Chlamydia-mycoplasmatic infections (population prospective study)].

Possibilities of colposcopy in the diagnostics of cervical chlamydia-mycoplastic infections are less investigated. The aim of given work was the study of this problem. Colposcopic examination was performed in 952 women (age - from 16 to 67) asked to clinics for examination and more precise definition of diagnosis because of different complaints. It was revealed specific colposcopic features of chlamydia-mycoplastic genital infections, which were compared with the results obtained from "gold standard" methods - direct immunofluorescence method and bacteriological analysis of cervical smears. High sensitivity (Se) - 0,96, specificity (Sp) - 0,79 and diagnostic effectiveness (De) - 0,93 of colposcopy were established. Authors conclude that the application of colposcopy for diagnostics of chlamydia-mycoplastic genital infection is particularly important: during urgent cases; during the case, when it is impossible to carry out the deep diagnostics of the sexually transmitted infections; for optimization of the diagnostics of the sexually transmitted infections.

Adolescent↗
PubMed2006

[Colposcopy of abnormal transformation zone].

UNLABELLED: The aim of the study was the determination of colposcopic images of the atypical transformation zone and the estimation of their relationship with cervical intraepithelial neoplasia. MATERIAL AND METHODS: 8700 women hospitalized in the Department of Gynaecology and Gynaecologic Oncology of the Municipal Hospital in Kielce between October 1996 and March 2003 were included in this study. In every investigated women the gynaecological examination, PAP smear, vaginal biocenosis, image colposcopy and histological examination were performed. Colposcopic images underwent computer analysis. Patients were divided into two groups. Behind the criterion of the division one accepted the occurrence (group 1) or the lack (the group II) cervical intraepithelial neoplasia in the histological examination. RESULTS: Atypical transformation zone occurred in 3.8% of investigated women. The statistical analysis showed the lack of the correlation between occurrence of flat punctation pattern and negative iodine uptake in women with the atypical transformation zone. Acetowhite epithelium, very white or gray opaque epithelium, flat mosaic, coarse mosaic, flat and coarse leukoplakia, coarse punctation and atypical vessels correlated statistically (p < 0.05) with the atypical transformation zone. CONCLUSIONS: Acetowhite, very white or gray opaque epithelium, coarse punctation, flat mosaic, coarse mosaic, flat and coarse leukoplakia, coarse punctation, atypical vessels are the characteristic colposcopy images of the transformation zone. There is a correlation between acetowhite epithelium and flat leukoplakia and CIN 1. Coarse punctation, coarse mosaic and coarse leukoplakia correlate with the presence of CIN 3. Flat punctation and negative iodine uptake are not characteristic colposcopy images of the atypical transformation zone.

Adolescent↗
PubMedDate not supplied

Colposcopy training in family practice residency programs.

This study investigated colposcopy training in family practice residency programs, using a national survey of all 376 residency program directors. Responses were received from 75% of the directors; 59% provided colposcopy training, and 40% of the programs not providing the training were in the process of developing a training experience. There was a regional difference in programs providing training; those in the northeast were least likely to provide training and were also least likely to be actively integrating training into their curricula. The three most common barriers to colposcopy training were lack of trained faculty, equipment costs, and inadequate patient volume.

Colposcopy↗