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PubMed1993

Quality, access, and clinical issues in a nurse practitioner colposcopy outreach program.

From 8/89 to 7/92 a NP-colposcopist performed 593 colposcopy examinations including cervical biopsies, endocervical curettages, and Pap smears. Procedures were performed in selected health departments in north-central Florida. This portable outreach program expanded services to a primarily rural, medically indigent population. Specimen results were 21.1% negative, 5.6% human papilloma virus (HPV) only, 37.3% CIN I, 17.4% CIN II, 11.9% CIN III, 2.4% CIS, 0.3% carcinoma, and 4% other. Many CIN lesions also included HPV, yielding an overall incidence of HPV at 62.7%. Using the Bethesda system, 42.8% were low grade lesions, 32.1% high grade. Fourteen cases of CIS and two of carcinoma (one invasive, one microinvasive) were found. An 87.7% colposcopic diagnostic acumen level is favorable compared with published physician studies. One third of undercalls were due to occult canal lesions. Significant risk factors were smoking (48.6%), first coitus at < 18 years old (74%), history of HPV (49.6%), and life-time sexual partners > 2 (61.3%). Holistic prevention enabled 209 non-colposcopy problems.

Adolescent↗
PubMed2001

When to suspect squamous cancer at colposcopy.

Advanced practice nurses are increasingly using colposcopy to investigate abnormal cervical cytology. Specific colposcopic features can lead the clinician to suspect squamous cancer. This article discusses vascular pattern study, examination evaluation, lesion grading, and correlating colposcopy with histology and cytology to aid in identifying squamous cancer.

Carcinoma, Squamous Cell↗
PubMed2003

Chlamydia trachomatis, herpes simplex virus 2, and human T-cell lymphotrophic virus type 1 are not associated with grade of cervical neoplasia in Jamaican colposcopy patients.

BACKGROUND: A few recent studies have suggested that other sexually transmitted infections may increase the likelihood of a human papillomavirus (HPV) infection progressing to high-grade cervical neoplasia and cancer. GOAL: The goal was to assess whether exposures to Chlamydia trachomatis, human T-cell lymphotrophic virus type 1 (HTLV-I), and/or human simplex virus type 2 (HSV-2) are greater in colposcopy patients with cervical intraepithelial neoplasia grade 3 or cancer (CIN3+) than in patients with low-grade cervical neoplasia (CIN1). STUDY DESIGN: Sequential patients (n=447) attending a colposcopy clinic in Kingston, Jamaica, a country with high cervical cancer rates and high HTLV-I prevalence, were tested for (1) HPV DNA by L1 consensus primer (MY09/11) polymerase chain reaction assays, (2) C trachomatis DNA by ligase chain reaction, (3) C trachomatis antibodies by both microimmunofluorescence and a peptide (VS4) enzyme linked immunosorbent assay (ELISA), (4) HTLV-I antibodies by ELISA confirmed by western blotting, and (5) HSV-2 antibodies by a recombinant HSV-2-specific ELISA. Odds ratios and 95% confidence intervals were estimated with use of multinomial logistic regression models. RESULTS: HPV DNA detection was associated with grade of cervical neoplasia but other evaluated sexually transmitted infections were not. CONCLUSIONS: HTLV-I, C trachomatis, and/or HSV-2 were not associated with severity of cervical neoplasia in Jamaican women.

Adult↗
PubMed1979

Colposcopy in gynecologic practice.

We review the role of colposcopy in the setting of a private gynecologic practice and present the data regarding 418 patients. The practicality and propriety of using colposcopy to evaluate patients with abnormal results of cytology, gross cervical lesions with or without postcoital bleeding, or a history of intrauterine exposure to diethylstilbestrol are discussed. The follow-up of small groups of patients treated with cryosurgery for intraepithelial neoplasms is presented.

Adult↗
PubMed2005

Default from colposcopy and loop excision electrocautery procedure appointments in a military clinic.

OBJECTIVE: To determine the extent of nonadherence and impediments to care in a military colposcopy and loop excision electrocautery procedure (LEEP) clinic. MATERIALS AND METHODS: The nonadherence rate for colposcopy and LEEP appointments was determined for a 6-month period at Walter Reed Army Medical Center. Nonadherence was defined as failure to keep an appointment or cancellation within 24 hours of the scheduled time. A nurse coordinator telephoned all nonadherent women. Women who agreed to participate were administered a structured survey to elicit their reasons for default from their appointments. RESULT: Sixty-one (15%) of 405 women were nonadherent. Of the 61 nonadherent women, 55 (90%) agreed to participate, 4 (7%) were unable to be contacted, and 2 (3%) declined participation. The average age of participants was 30 years. Beneficiary status of the 55 women was as follows: dependent, 27 (49%); active duty, 25 (45%); retired, 2 (4%); and veteran, 1 (2%). The most common reasons for default overall for 55 women were onset of menses (15 [27%]), unplanned family or personal event (9 [16%]), forgetting (8 [15%]), and work conflict (7 [13%]). Leading reasons for 25 active duty women included work conflict (7 [28%]) and menses (6 [24%]). Leading reasons for 27 dependent women included menses (9 [33%]), unplanned family or personal event (6 [22%]), and forgetting (5 [19%]). CONCLUSIONS: Despite unrestricted access to care in the military clinic, the default rate was similar to rates reported for civilian clinics. Previsit interventions likely to improve compliance include sending informational packets to patients, better attention to scheduling around the time of expected menses, and initiating an appointment reminder system. To decrease the high percentage of nonadherence attributable to work conflicts for active duty women, supervisors need to be better informed about both medical and deployment implications of an unevaluated abnormal Pap smear.

Adult↗
PubMed2006

Number of cervical biopsies and sensitivity of colposcopy.

OBJECTIVE: To examine the influence that type of medical training and number of biopsies have on sensitivity of colposcopically guided biopsies. METHODS: Among 408 women with an adequate enrollment colposcopy and a diagnosis of cervical intraepithelial neoplasia (CIN) 3 or cancer (CIN 3+) over 2 years in the Atypical Squamous Cells of Undetermined Significance/Low-Grade Squamous Intraepithelial Lesions (ASCUS-LSIL) Triage Study, we evaluated factors influencing the sensitivity of the enrollment colposcopic procedure. We used contingency table analysis to examine confounding variables and chi(2) tests to ascertain statistical significance. RESULTS: Overall, 69.9% of women with a cumulative diagnosis of CIN 3+ had a "true-positive" enrollment colposcopically guided biopsy result of CIN 2 or worse (CIN 2+), the threshold that would trigger excisional therapy. The sensitivity of the procedure did not vary significantly by type of colposcopist. However, the sensitivity was significantly greater when the colposcopists took two or more biopsies instead of one (P<.01), a pattern observed across all types of colposcopists. Independent of the severity of the colposcopic impression, the frequency with which colposcopists took two or more biopsies instead of one varied (in descending order) from nurse practitioners to general gynecologists to gynecologic oncology fellows to gynecologic oncologists (P<.01). CONCLUSION: Colposcopy with guided biopsy or biopsies detects approximately two thirds of CIN 3+. Although the sensitivity of the procedure does not differ significantly by type of medical training, it is greater when two or more biopsies are taken.

Adolescent↗
PubMed2007

Preclinic appointment telephone contact: an effective intervention for colposcopy clinic nonattendance.

OBJECTIVE: To assess the impact of preclinic appointment telephone contact with prospective patients on colposcopic clinic default rates. MATERIALS AND METHODS: All women attending the Cornwall Colposcopy Service in Truro, UK, between July and October 2003, were recruited and randomly assigned into two groups. The patients in one group (group A) were contacted by telephone 12 to 24 hours before their clinic appointments to be reminded of their appointments. Confirmation of their attendance was obtained. For patients who indicated their inability to attend, a new date and time was offered. The patients in the other group (group B) were not contacted by telephone. RESULTS: Ninety-one percent of patients randomized to group A attended their clinic appointment compared with 69% of patients in group B (who had no preclinic appointment telephone contact) (chi1=15.74; p=00073). The odds ratio was 4.68 (95% CI=2.8-10.45), thus implying that patients who were contacted by telephone before their clinic appointment are about five times more likely to attend compared with their counterparts who were not contacted by telephone. CONCLUSIONS: Our study shows that preclinic appointment telephone contact of prospective patients attending colposcopy clinic was an effective intervention to reduce clinic nonattendance.

Adult↗
PubMed2005

Measuring service quality in a hospital colposcopy clinic.

PURPOSE: The issues surrounding the measurement and provision of service quality in a health care setting are becoming increasingly important to nursing. This research study aims to apply the SERVQUAL measurement instrument in a Scottish colposcopy clinic. DESIGN/METHODOLOGY/APPROACH: The study involved adapting the SERVQUAL instrument to the colposcopy setting and asking a sample of patients to complete the questionnaire. Patient expectations of service were obtained on first attendance at the clinic. Patient perceptions of service received were obtained on completion of treatment. Perceptions and expectations are then compared to identify where the largest service gaps exist. FINDINGS: Although patient satisfaction with the overall service provided was generally high, the instrument provided evidence of where specific service improvements were needed. The largest service quality gap was for the reliability of service. The research also revealed the need for improved premises. RESEARCH LIMITATIONS/IMPLICATIONS: Although the study has a limited sample size, it does appear that the SERVQUAL instrument has a useful diagnostic role to play in assessing and monitoring service quality in nursing, enabling nursing staff to identify where improvements are needed from the patients' perspective. The study has raised a number of issues which would form the basis for useful further research. PRACTICAL IMPLICATIONS: Service quality from the patients' perspective should be routinely monitored and assessed. ORIGINALITY/VALUE: The findings should be useful to nursing staff seeking to assess, and improve, service quality.

Colposcopy↗
PubMed2005

The performance of a new scoring system for colposcopy in detecting high-grade dysplasia in the uterine cervix.

OBJECTIVE: To construct a simple scoring system for colposcopic examination that can facilitate education of colposcopists and increase the accuracy of evaluation. DESIGN: Prospective clinical study. SETTING AND POPULATION: Two hundred ninety-seven examinations of women referred for colposcopy in western Sweden. METHODS: Five variables were scored: acetowhiteness, margins and surface, vessels, lesion size, and iodine staining. Each variable could be assigned one of three ordered values. Multiple logistic regression was used in order to assess the ability of each single score to predict high-grade lesions (HGL) in histology (cone or biopsy). MAIN OUTCOME MEASURES: Histopathology. RESULTS: All five variables independently predicted for HGL. The analysis resulted in an 'ideal' weighted scoring system, which showed good sensitivity and specificity. Rounding off of each weight gave a more useful and simpler scoring system with values of 0, 1, or 2 without any significant change in performance. The possible total score was then 0-10. A score of > or =5 points identified all HGL and > or =8 points had a specificity of 90%. CONCLUSIONS: The scoring system safely identified a group of patients with low-grade lesions or normal findings, thus allowing 17% to be followed only by colposcopy or cytology. Furthermore, it could select women for see-and-treat with only 10% of cases having less than HGL. With this strategy, only approximately 50% of the cases would have needed biopsy in the evaluation.

Adult↗
PubMed1981

Colposcopy in pregnancy. A twelve year review.

In a 12-year period, 195 patients with abnormal cervical cytology in pregnancy had colposcopy, of whom 73 had Grade IV cytology. Colposcopic findings in pregnancy correlated closely with the postpartum colposcopic assessment and this in turn predicted the ultimate histological diagnosis. Wedge biopsies were taken in two women in whom invasive disease could not be excluded colposcopically. Cone biopsy was avoided in all patients. No frank or occult invasive disease was missed but one patient was ultimately found to have a small focus of microinvasive disease six months post partum. Postpartum cytology gave a reasonable guide to the ultimate histology, although postpartum colposcopy was found to be of value even where cytology had by then reverted to normal.

Biopsy↗
PubMed1988

A prospective study of colposcopy in women with mild dyskaryosis or koilocytosis.

Colposcopy was performed in 91 women who had cervical cytology suggesting mild dyskaryosis or showing koilocytosis, all previous cytology having been normal. The final histological diagnosis was CIN III in 22%, CIN II in 18%, CIN I in 31%, koilocytosis alone in 14% and no abnormality in 15%. These results indicate that even with mild cytological atypia, a high proportion of patients will have more advanced disease when colposcopy-directed punch biopsy is performed.

Adult↗
PubMed1990

Unsatisfactory colposcopy and the response to orally administered oestrogen: a randomized double blind placebo controlled trial.

Thirty-six women with dyskaryotic cervical smears and unsatisfactory colposcopy were randomly allocated to receive either 30 micrograms ethinyl oestradiol or placebo daily by mouth for 10 days. Thirty-four women were available for review (17 women in each of the two groups), full colposcopic inspection of the transformation zone was possible in a significantly greater proportion of the oestrogen treated group (70% versus 23%, P less than 0.01). As most diagnostic conizations are currently performed on the basis of unsatisfactory colposcopy, the use of oestrogen medication followed by colposcopic reassessment should permit a reduction in the number of patients subject to operation.

Adult↗
PubMed1993

The value of cytology and colposcopy in the follow up of cervical intraepithelial neoplasia after treatment by laser excision.

OBJECTIVE: To determine the value of colposcopic assessment in the follow up of cervical intraepithelial neoplasia (CIN) treated by laser excision. DESIGN: Retrospective analysis of case records of women with CIN treated by laser excision over the period 1986 to 1990. SETTING: A colposcopy clinic in a district general hospital. SUBJECTS: Five hundred-forty consecutive patients with either CIN or microinvasion diagnosed on laser excision specimens. RESULTS: Of 452 patients followed up for 10 months, 14 were diagnosed as having persistent CIN. Eleven of these were detected at the first follow up visit at four months using both colposcopic and cytological assessment. Elimination of colposcopic assessment in follow up would have reduced the number detected to five patients. CONCLUSION: For patients undergoing laser excision for CIN involving the endocervical canal, a normal initial, post-treatment colposcopy is necessary before surveillance may be reduced to cytology alone.

Adolescent↗
PubMed1987

Management of squamous atypia (borderline nuclear abnormalities): repeat cytology or colposcopy?

A prospective cytological, colposcopic and histological study was conducted in 44 women with cervical cytology showing borderline nuclear abnormalities insufficient for the diagnosis of dyskaryosis. Atypical squamous epithelium was found on colposcopy in 41 patients and cervical intraepithelial neoplasia (CIN) was diagnosed on histology in 33 patients (75%) including 10 with CIN 3. Repeat cytology obtained under colposcopic vision was negative in 12 (33.4%) patients with CIN. The high prevalence of CIN in smears showing only borderline nuclear abnormalities and the high false negative rate of repeat cytology indicate that colposcopy should be the first line of management for these patients.

Adult↗
PubMedDate not supplied

Women in a region with high incidence of cervical cancer warrant immediate colposcopy for low-grade squamous intraepithelial lesion on cervical cytology.

The objective of this study was to determine the prevalence of high-grade histologic diagnoses in women who had low-grade squamous intraepithelial lesion (LSIL) on Pap smear in an area with high incidence of cervical cancer. We conducted a retrospective study of 220 women with LSIL cytology undergoing colposcopic examination in Chiang Mai University Hospital between January 1999 and July 2004. The histologic diagnoses, obtained from colposcopically directed biopsy or electrical loop excision after initial colposcopy, showed that 80 (36.4%) women had histologically confirmed high-grade lesions and 11 (5%) women had microinvasive (9) and frankly invasive (2) carcinomas. Overall, 41.5% of women with LSIL on Pap smear had significant underlying lesions, requiring appropriate treatment. In conclusion, in the region with high incidence of cervical cancer, women with LSIL cytology are at increased risk of having underlying high-grade lesions and invasive cancer. Immediate referral for colposcopy is warranted.

Adolescent↗
PubMed1990

Women's informational needs about colposcopy.

Questions asked by 36 women during colposcopy, a stressful medical procedure, were examined to determine their specific informational needs about the exam and its results. Of the 226 questions posed, 52 percent were exam related--on the sensations experienced, the nature of the procedure and self-care activities; 34 percent were results related and focused on the meaning of the results, treatment options and treatment procedures; 14 percent of the questions were incidental. The present research documents women's need for information about the medical procedure of colposcopy. The implications for nursing practice are outlined.

Adolescent↗
PubMed2005

Using colposcopy in the rape exam: health care, forensic, and criminal justice issues.

In the setting of a forensic examination following rape, colposcopy allows practitioners to identify and photograph genital injury not readily visible to the unaided eye, thereby clarifying the location and extent of injury as well as providing evidence for court proceedings. Since the 1980s, the technique once reserved for victims of child abuse has been used across the lifespan and has been shown to identify genital injury in up to 87% of women who have been raped. The role of colposcopic findings as evidence in court testimony, however, remains controversial. This paper explores the history of colposcopy in the rape exam and describes the epidemiology of genital injury in consensual sex as well as rape.

Colposcopy↗
PubMed1992

Mild and moderate dyskaryosis: can women be selected for colposcopy on the basis of social criteria?

OBJECTIVE: To describe the distribution of cervical intraepithelial neoplasia grades among women with mild and moderate dyskaryosis after a single cervical smear and to determine whether social criteria could help identify women who are at increased risk of grade II or III disease. DESIGN: Cross sectional analysis within a randomised prospective study. Subjects had a repeat smear, a colposcopic examination, and an excision biopsy of the transformation zone. In addition, women were asked to complete a social questionnaire. SETTING: Colposcopy clinic, Aberdeen. SUBJECTS: 228 women with a single smear test showing mild or moderate dyskaryosis. MAIN OUTCOME MEASURES: Histology, age, sexual and contraceptive history, cigarette smoking. RESULTS: 159 (70%) women had cervical intraepithelial neoplasia grades II or III. Among current smokers the prevalence of grade II and III disease was higher in women who smoked greater than or equal to 20 cigarettes a day (84%) than among those who smoked less (66%; p less than 0.04). Women with more than one sexual partner also had a higher prevalence (75%) than women with only one partner (50%; p = 0.0028). Use of oral contraceptives and younger age were not significantly associated. The prevalence of grade II or III disease was up to 66% in the lower risk groups. CONCLUSIONS: Because of the high prevalence of cervical intraepithelial neoplasia grades II and III in both the high and the low risk groups social factors are not useful for selecting women with mild or moderate dyskaryosis for either early referral to colposcopy or cytological surveillance.

Adult↗