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PubMed1988

Value of colposcopy in genitourinary departments.

During 18 months 237 colposcopies were performed on 227 patients in the department of genitourinary medicine, Sheffield. Histological evidence of cervical intraepithelial neoplasia was found in 118 patients (52%), of whom 104 (88%) were aged under 35, 93 (79%) under 30, and 64 (54%) under 25. Most were treated with local destructive treatment, only five (4%) requiring cone biopsy. Colposcopy in a genitourinary department has an important part to play in detecting cervical intraepithelial neoplasia, particularly in younger women. Early diagnosis may often facilitate using local destructive treatment, thereby reducing the numbers of patients needing cone biopsy.

Adolescent↗
PubMed1991

Assessment of psychiatric morbidity in patients attending a colposcopy clinic situated in a genitourinary medicine clinic.

OBJECTIVE: To determine the adverse psychological implications of referral for colposcopic screening within a genitourinary medicine clinic. DESIGN: Cross sectional survey. SETTING: A colposcopy clinic held within a genitourinary medicine clinic. SUBJECTS: 160 consecutive women referred to the clinic were assessed for psychiatric morbidity using the General Health Questionnaire (GHQ-28). Women were referred to the colposcopy clinic because of one or more of the following: abnormal cervical cytology, condylomata acuminata, HIV antibody positivity. A history of prior local ablative therapy to the cervix was also included in the analysis. RESULTS: There was no difference in psychiatric morbidity, as detected by the GHQ-28, in women referred to the clinic because of abnormal cervical cytology or condylomata acuminata. The total GHQ-28 scores indicated a significant increase in psychiatric morbidity, with increased sub-scores indicating social dysfunction, anxiety and somatic symptoms, in women who had had prior laser therapy to the cervix. Women with HIV infection attending the clinic were noted to have an increase in GHQ-28 sub-scores indicating social dysfunction and depression. CONCLUSIONS: Women who have undergone laser therapy to the cervix may benefit from psychological evaluation and supportive measures if they develop further genital lesions which require colposcopic evaluation. Women with HIV infection need further psychological evaluation prior to planning intervention and preventative strategies.

Anxiety Disorders↗
PubMedDate not supplied

Clinical value of repeat Pap smear at the time of colposcopy.

OBJECTIVE: To determine the clinical value of a repeat (second) Pap smear at the time of colposcopy in the management of patients with recent cytologic abnormalities. STUDY DESIGN: A study of paired Pap smears and their corresponding cervical biopsies during a two-year period, commencing in June 1996, was undertaken. Pap smears and cervical biopsies from 614 patients were evaluated in the Department of Pathology, Royal Darwin Hospital, Northern Territory, Australia. To maintain uniformity, the cytologic and histologic findings were assessed according to the Bethesda System. RESULTS: The original (first) Pap smears included 288 high grade and 326 low grade lesions. The second smears showed 200 high grade, 221 low grade, 167 normal and 26 unsatisfactory cases. Punch biopsies revealed 242 high grade, 300 low grade and 72 inflammatory/reactive lesions. The changes noted in the second Pap smears and in the punch biopsies in the group originally diagnosed as having high grade disease were generally less advanced. The second Pap smears and corresponding cervical punch biopsies showed more advanced changes in the group originally diagnosed as having low grade disease. Removal of part of the abnormal epithelium during the first Pap smear and the desire of the colposcopist not to damage the surface epithelium prior to performing a cervical biopsy may account for some of these findings. Sampling errors and morphological misinterpretation may explain some of the findings. CONCLUSION: In the second smears, new cases of high grade abnormality were discovered mainly in patients with low grade changes on the first smears. Therefore, a second Pap smear at the time of colposcopy is justifiable in the group with low grade changes on the first smear.

Biopsy↗
PubMedDate not supplied

Screening colposcopy in genitourinary medicine.

A prospective study of new female patients attending the Genitourinary Medicine Department in Doncaster was carried out to look at the value of colposcopic examination at their first attendance. Of the 100 randomized patients studied 41 showed evidence of colposcopically detected cervical abnormality. Twenty-seven patients had colposcopically directed biopsies. These showed evidence of cervical intraepithelial neoplasia (3 cases), flat condyloma (16 cases), exophytic wart (2 cases), chronic inflammation (2 cases) and normal epithelium (4 cases). Colposcopic cervical abnormalities were significantly associated, with a history of anogenital warts, sexual contact with anogenital warts and the presence of anogenital warts at presentation. Despite this, less than half the group showing colposcopic abnormalities had an association with anogenital warts. Demonstration of cervical abnormalities by colposcopy resulted in a greater patient compliance during follow-up. Screening or primary colposcopy may be incorporated into a genitourinary screen at the first visit. The procedure is both acceptable and beneficial to the patient, facilitating the detection of a range of cervical disease and enhancing the doctor-patient relationship.

Adolescent↗
PubMed1998

A comparison audit of a genitourinary medicine colposcopy service against nationally agreed quality standards.

The National Health Service Cervical Screening Programme (NHSCSP) recently published their document Standards and Quality in Colposcopy outlining recommendations for standards in the service provided by colposcopists. In this first audit of colposcopic practice measured against these agreed UK national guidelines, the authors discuss the standards, their attainability, and their relevance to genitourinary medicine (GUM) colposcopy services.

Adolescent↗
PubMed1978

The diagnostic accuracy of combined colposcopy, cytology, and target biopsy of carcinoma in situ of the uterine cervix.

The results of cytology, colposcopy and target biopsy in 91 cases diagnosed by conization as uterine cervical carcinoma in situ and 39 cases diagnosed as microinvasive carcinoma were compared. Lesions limited to the ectocervix could be identified by colposcopy, and those identified as carcinoma in situ by cytology or target biopsy were all included in the group diagnosed as carcinoma in situ by conization. Among the 29 cases of carcinoma in situ limited to the ectocervix, 19 (66%) were similarly diagnosed by both cytology and target biopsy, allowing for us to avoid conization. For cases diagnosed as microinvasive carcinoma using target biopsy, conization must also be performed in order to determine the depth of invasion. Even in cases diagnosed as dysplasia or carcinoma in situ by target biopsy, when it is thought that the lesion may extend into the cervical canal or in cases where agreement with the cytological results is not found, conization is necessary.

Adult↗
PubMed1989

Comparison between abnormal cytology, colposcopy and histopathology during pregnancy.

During a 3 year period, 35 pregnant woman with grade III or IV cytological changes found at pregnancy control were followed during pregnancy and up to 4 years after delivery. These 35 patients constitute 0.35% of all the pregnant women admitted for antepartum consultation. Complete regression of dysplasia was seen in one third of the patients. The patients were followed with colposcopy and sometimes punch biopsy and the decision regarding final treatment was postponed until 8 weeks after delivery. No invasive lesion was found, and no recurrences or invasive lesions were found at follow up. It is concluded that cytology and colposcopy with punch biopsy on suspicion of early invasion is an adequate control procedure during the pregnancy at intervals of 2-3 months.

Adult↗
PubMedDate not supplied

Colposcopy: an evidence-based update.

Colposcopy is a diagnostic procedure, most commonly used in the diagnosis of cervical intraepithelial neoplasia and lower genital tract carcinoma. In this article, evidence-based management strategies are updated with discussion of the 2001 American Society for Colposcopy and Cervical Pathology Consensus Guidelines. Practice management issues include methods to improve cervical cancer screening rates, coding and billing, and telemedicine. Textbooks, CD-ROMs, and courses are listed for new learners and experienced providers who want to update and sharpen their skills.

Colposcopy↗
PubMed1998

Follow-up of a decentralized colposcopy program for the investigation and management of cervical intraepithelial neoplasia in the central Canadian Arctic.

Cervical intraepithelial neoplasia (CIN) is the second leading cause of cancer in Canadian Inuit women, and the incidence ratio in this population is 3.1 times the Canadian average. In 1993 a program was developed in a regional northern health center (Churchill) to provide colposcopy and loop electrosurgery for women in the Keewatin District of the central Canadian Arctic. Data collected prospectively over the following 2.5 years are presented. One hundred and forty-six women were seen in 341 visits. Indication for referral included CIN I on Pap smear (54.1%), CIN II (34.9%), CIN III (9.6%), and carcinoma of the cervix (1.4%). Large loop excision of the transformation zone was performed at a rate of 9.7 procedures per 100 patient visits. Estimated travel cost-savings attributable to this northern program are $299,200 (Canadian). Use of portable colposcopy in patients' home communities is presently being considered in order to provide enhanced accessibility and further cost-effectiveness.

Arctic Regions↗
PubMed1999

Detection of viral and bacterial infections in women with normal and abnormal colposcopy.

Signs and symptoms of sexually-transmitted diseases (STD) do not allow any etiological diagnosis in women. Colposcopic findings are seldom pathognomic. Consequently, the microbiology laboratory with the recent availability of molecular diagnostic tools is required to detect the infectious bacterial and/or viral agents involved in STD. In cervical samples of women submitted to gynaecological screening for past or present signs and symptoms of inflammation and with different colposcopic findings, we searched by molecular approaches Chlamydia trachomatis, Mycoplasma genitalium, herpes simplex virus type 1 and 2, adenovirus and 45 genotypes of papillomaviruses and, by cultural methods Mycoplasma hominis and Ureaplasma urealyticum. Colposcopy permitted us to divide the studied population into three groups: 48 women had negative colposcopic findings, 50 presented signs of flogosis and 100 resulted positive for an abnormal transformation zone (ANTZ) and/or for HPV colposcopic findings. Results obtained by microbiological assays indicated that the prevalence of infectious agents did not always correlate with colposcopy. Double and triple infections were found in groups 2 and 3, with mycoplasmas being the most common microrganisms present in association and quite almost copresent with papillomaviruses.

Adult↗
PubMed2000

Colposcopy, cytology and HPV-DNA testing in HIV-positive and HIV-negative women.

In this study we examined the incidence of colposcopic-colpocytologic findings and analyzed Human Papilloma Virus (HPV)-DNA testing by Polymerase Chain Reaction (PCR) in 104 Human Immunodeficiency Virus (HIV) serous positive women (Group 1) and 218 HIV-negative women (control Groups 2 and 3). The aim of the study was to evaluate the most appropriate and efficacious diagnostic methods for screening programs for cervical cancer in HIV-positive women. For Group 1 we also considered the value of CD4+ T-lymphocytes and morphologic and molecular follow-up from 3 to 6 months. The results showed that the abnormal transformation zone (ANTZ) was present in 66.3% of the cases in Group 1 compared with 31.4% in control-Group 2 (p<0.001), and with 58.93% of the cases in control-Group 3 (p=0.257); intraepithelial squamous lesions (SIL) were found in 50% vs 5.66% (p<0.001) and vs 56.25% of the cases (p=0.433), respectively. In 28.85% of the HIV-positive patients the first cytological screening exam was not evaluable due to inflammation but in 56.67% of the cases colposcopy revealed ANTZ. The subsequent colpocytological checkup after therapy showed 10 cases (30%) of low risk squamous intraepithelial lesions (LSIL) and two cases (6.6%) of high risk squamous intraepithelial lesions (HSIL). HPV-DNA testing by PCR was positive in 53.8% of the cases in Group 1, in 6.6% in control-Group 2 and in 42% in control-Group 3. In HIV-positive patients multiple HPV genotypes were simultaneously present in 21.43% of the cases and high risk genotypes were present in 70% of the cases of HSIL. In Group 1, 36.61% of the cases had lesions of the lower genital tract. The value of CD4+ T-lympocytes was <200 cells/ml in 30% of the cases of HSIL. Our data, like those of other Authors, confirm a high incidence of HSIL, abnormal colposcopic findings, and HPV infections in HIV-positive women with respect to control-Group 2, while there was not much difference between Group 1 and control-Group 3. Such frequency again suggests that an integrated morphological diagnostic approach with colposcopy-colpocytology in the screening of immunosuppressed subjects would be worthwhile.

Adult↗
PubMed2002

Correlation between atypical colposcopy findings and detection of human papillomavirus (HPV) infection of the uterine cervix.

Reports on the detection of genome human papillomaviruses (HPV) in genital neoplasia differ to a great extent either in the overall prevalence or in the frequency of certain types. The aim of the study was to determine the correlation between the HPV infection and the occurrence of premalignant and malignant diseases of the uterine cervix and to investigate the ratio between clinical features and infection findings starting from the assumption that infection by human papillomaviruses is a key factor in the occurrence of premalignant and malignant disease of the uterine cervix. The investigation was carried out on 48 patients who formed the study group (Group I). Based on suspicious colposcopy findings, a Papanicolaou (Pap) smear and biopsy were performed and a histopathological analysis of the sample was carried out. A cervical smear was done on all the patients for HPV detection and typing. The patients in whom HPV infection was not found formed a control group (C Group). In spite of certain divergences it has not been proved that the ratio between colposcopy findings and HPV type has any statistical importance (chi2 = 3.305; p > 0.05). The distribution of Pap smear results did not shown a significant difference with respect to HPV type (chi2 = 0.105; p > 0.05). When the data are analyzed the diagnosis of low-grade squamous intraepithelial lesions (LGSIL) is evident in 20% of the HPV cases whereas it is significantly lower with respect to the group where HPV was not detected (42.5%). Histopathological (HP) findings of a high-grade squamous intraepithelial lesions (HGSIL) in both groups are diagnosed in approximately the same percentage while 6.7% of cancer in situ was registered in the group of HPV positive patients. Based on this it can be concluded that if a diagnosis of LGSIL or HGSIL in particular has been made on the basis of HP findings there is a great probability that the infection was due to one or more joined types of human papillomaviruses.

Adult↗
PubMed2002

Comparison of two signal-amplification DNA tests for high-risk HPV as an aid to colposcopy.

OBJECTIVE: To compare Hybrid Capture Tube (HCT) and the second-generation Hybrid Capture II (HC II) test for detection of high-risk human papillomavirus (HPV) DNA at the time of colposcopy. STUDY DESIGN: Colposcopy and HPV testing were performed by HCT and HC II on 1,309 women for evaluation of abnormal Pap smears. Differences in the proportions were tested with chi 2 and 95% CI calculations. RESULTS: When compared to HCT, HC II was more often positive in women with any abnormal Pap smear (44% [95% CI 41-46%] vs. 34% [31-37%], P < .005) and in the subset of women with atypical squamous cells of undetermined significance Pap smears (32% [29-35%] vs. 24% [22-27%], P < .005). HC II was more sensitive in detecting cervical intraepithelial neoplasia (CIN) 2 or worse (93% [88-97%] vs. 78% [70-84%], P < .005) and had a lower rate of undetected > or = CIN 2 in HPV test-negative subjects (1.5% [0.7-2.7%]) vs. 4.3% [3.0-5.9%], P < .005). HC II was also more often positive in women with negative colposcopic evaluations (29% [25.7-32.4%] vs. 20% [17.6-23.5%], P < .005). The specificity of HC II in detection of > or = CIN 2 was lower than that for HCT (63% [60.5-66.2%] vs. 73% [69.5-74.8%], P < .005).

Adolescent↗
PubMed2002

Health literacy, cervical cancer risk factors, and distress in low-income African-American women seeking colposcopy.

OBJECTIVES: To describe the relationship between health literacy, distress, and cervical cancer risk factors in women at high risk for developing cervical cancer. DESIGN: Cross-sectional, prospective cohort design. SETTING: Two university-based gynecological oncology colposcopy clinics and 3 Planned Parenthood community dinics. PATIENTS/PARTICIPANTS: One hundred-thirty English-speaking African-American women > or = 18 years referred for colposcopy following abnormal Pap testing. MAIN OUTCOME MEASURES: Avoidance and Intrusion subscales of the Impact of Events Scale (IES), Rapid Estimate of Adult Literacy in Medicine (REALM), and demographics. RESULTS: Forty-five percent of women had a low level of health literacy (< 9th grade). Low health literacy was related to fewer risk factors (P < .01) and higher levels of distress on the Impact of Events avoidance subscale (P < .05) after controlling for covariates. Forty-three percent of women with low literacy had excessive levels of distress as compared to 25% in women with high literacy (P < .05). CONCLUSIONS: A low level of health literacy is associated with increased levels of distress among women at high risk for developing cervical cancer. To the extent that distress serves as a barrier to treatment, culturally informed, effective interventions are needed.

Adolescent↗
PubMed1976

Comparison of colposcopy directed biopsies and cold knife conization in patients with abnormal cytology.

One hundred patients with abnormal cytology were evaluated by colposcopy, and histologic material was obtained by directed biopsies, cold knife conization and endocervical curettage. The colposcopy directed biopsies provided the diagnosis in 94 per cent of the patients, and the colposcopic impression was accurate in 89 per cent of the patients. Cold knife conization was performed in 98 patients, since two patients had invasive carcinoma on colposcopic directed biopsy. In 75 patients, the histopathologic finding on cone biopsy was in complete agreement with the directed biopsies. In 11 patients, the directed biopsies were a degree higher than on cone biopsy, and in six patients the histopathologic findings were a degree lower. In six patients the colposcopic directed biopsies missed the diagnosis of dysplasia. No patients with carcinoma in situ or invasive carcinoma were missed by the colposcopic directed biopsies.

Biopsy↗
PubMed1976

Colposcopy in the follow-up of women with lower genital tract or perianal carcinoma.

Colposcopy has gained acceptance in the management of patients with abnormal cytologic smears or visible lesions of the lower genital tract. The well documented potential for the development of multifocal neoplastic disease in these tissues provides the rationale for the suggested use of the colposcope in the follow-up of patients with a previously treated carcinoma of the lower genital or perianal region. The value of colposcopy in such a patient is discussed.

Adult↗
PubMed1992

Human papillomavirus in women. A three-year experience in a county hospital colposcopy clinic.

The human papillomavirus (HPV) has been associated with cervical dysplasia and carcinoma. This report summarizes the authors' experience with HPV-related problems over three years, 1987-89, while managing 1,644 women at a county hospital colposcopy clinic. Probes for HPV DNA were not used, and the diagnoses were made with cytologic and histologic criteria alone. The percentage of patients referred to the clinic with HPV found on routine Papanicolaou smears rose significantly, from 3 in 1987 to 18 in 1989. Fifteen percent of those referred because of HPV on a Papanicolaou smear were found to have cervical intraepithelial neoplasia (CIN) grade II or III after they were evaluated at the clinic. Of the 367 cases of biopsy-proven cervical HPV, only 33 (9%) were recorded on Papanicolaou smears performed immediately before the biopsy, and 140 (38%) also had concomitant, biopsy-proven CIN, grade II or III. Of the 195 instances in which the colposcopic impression was simple HPV without CIN, 46 (24%) had high-grade CIN on biopsy. We conclude that the proportion of patients with HPV-associated problems is increasing, that the Papanicolaou smear is not sensitive in detecting cervical HPV infections, that patients with HPV changes found on Papanicolaou smears should be evaluated with colposcopy and that lesions that appear colposcopically to be simple HPV should undergo biopsy to rule out the presence of high-grade CIN.

Biopsy↗
PubMed1992

[Colposcopy in gynecologic cancers. Retrospective study of 192 examinations].

One hundred and ninety two colposcopic examinations carried out on 183 patients of whom 140 had carcinoma of the cervix, 26 carcinoma of the endometrium and 17 carcinoma of the ovaries were analysed in order to assess the value of colposcopy in patients with gynaecological cancer. The mean distance from the edge of the anus that was looked at was 45 cms--the range being from--130. Out of all the systematic examinations that were carried out before any treatment was started, 103 were for cervical cancer and among these invasion of the rectal mucosa was found in two cases (1.9%). Twelve cases of external pressure on the rectum and 9 cases of recto-colic polyadenomata (8.7%) of which one was malignant. Out of the 14 colposcopies that were carried out for carcinoma of the endometrium one case of rectal invasion was found and one case of external compression. In the 12 cases of cancer of the ovary 2 were found to have recto-colic spread, 1 external compression and 1 malignant polyadenoma. All these cases of spread to the rectum and colon were diagnosed in advanced cases (stage III or IV). In the 63 examinations carried out on follow-up the most common warning sign was a rectal discharge and the most commonly found lesion in the rectum was actinomycotic inflammation of the rectum. The 5 cases of recurrence in the rectum expressed themselves most often by the rectal syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗