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PubMed2004

A mobile system for postmortem genital examinations with colposcopy: SART-TO-GO.

The interpretation of genital findings in the deceased is a vital and timely issue. A paucity of information exists on the nature and appearance of the anogenital tissues in the postmortem interval. The traditional postmortem genital examination consists of gross visualization, which may preclude detection of the subtler trauma that usually constitutes injury in sexual assault. The mobile system grew out of a need to bring the examiner to the patient, e.g., in jurisdictions that lack a centralized morgue. The theoretical framework of the methodology lies in the sexual activity that culminates in the death of the sexual homicide victim. This sequential methodology was based on the Sexual Assault Response Team (SART) model, with adaptation to the autopsy milieu. Colposcopy is well-established for the medical-legal investigation of living sexual assault victims. During the author's initial rape-homicide examinations, only gross visualization was available. It soon became apparent that a system that facilitated detailed scrutiny of the anogenital tissues at various postmortem intervals was needed. Colposcopy was selected as the examination method because of its magnification, photodocumentation, and peer review potential. The sequential protocol was developed and refined during an ongoing accumulation of baseline cases. The role of the forensic nurse examiner is described within a defined scope of expertise and as a collaborative member of the homicide investigative team.

Body Fluids↗
PubMed2004

Factors affecting the reproducibility and validity of colposcopy for product development: review of current literature.

Colposcopy has been adapted from cervical cytology screening as a tool to assess the tolerance of vaginal products in development for anti-infective and contraceptive indications. As the vagina is poorly enervated, symptoms do not correlate well with visual findings, which increases the importance of secondary assessment. Dysplasia screening has used biopsy liberally to verify the colposcopic diagnostic impression. The few studies that include correlative biopsy with colposcopy performed for product development are reviewed. A recent study of the reproducibility of two observations at a single visit by a single or two different physicians is discussed. The review points to magnification and experience of the observer as factors in improving the agreement between observations. Observers are more likely to agree on areas greater than 1 cm in diameter. Variation is reduced when fewer observers are used and they report findings as dichotomous or categorical data.

Anti-HIV Agents↗
PubMed2004

Illumination, optics, and clinical performance of a hand-held magnified visual inspection device (AviScope): a comparison with colposcopy.

OBJECTIVE: Colposcopy is the reference standard for a visual inspection device in terms of illumination, optics, and clinical performance. A hand-held magnification device such as the AviScope, developed as an alternative to naked eye visual inspection with acetic acid, is also of interest as a low-cost, more portable alternative to a colposcope in low-resource settings within the context of cervical cancer prevention programs and for microbicides research. DESIGN: A performance comparison of the AviScope, visual inspection with acetic acid, and three colposcopes. METHODS: An analysis was carried out of the optics and illumination of the colposcopes and the AviScope prototype and of the evidence for the reproducibility and clinical accuracy of visual methods for histologically confirmed high-grade cervical intraepithelial neoplasia. Using the findings, the feasibility of increasing the performance and reducing the cost of a hand-held scope was examined. RESULTS: Published studies have found the AviScope to have slightly higher sensitivity than visual inspection with acetic acid (60.7 versus 55.7%, P < 0.05) without loss of specificity. Despite the variability among the colposcopes, the field of view, resolution, depth of field, magnification, and quality of the illumination beam pattern and spectral output exceeded that of the AviScope. The clinical sensitivity and specificity of colposcopy were higher than that of the AviScope. The availability of improved materials for optics and illumination suggests that a hand-held scope with enhanced performance is feasible. CONCLUSION: Although the performance of the AviScope prototype was suboptimal compared with the colposcopes, it appears possible to design a hand-held magnification device at a reasonable price with better optics and illumination.

Colposcopes↗
PubMed2006

What is the appropriate management for a patient with CIN1 on colposcopy?

Of the different strategies available for managing cervical intraepithelial neoplasia grade 1 (CIN1), testing for high-risk subtypes of the human papillomavirus (hr-HPV) DNA at 12 months has the highest sensitivity for predicting the development of CIN2 or CIN3 and leads to the lowest rate of referral to repeat colposcopy. If the hr-HPV DNA test result is negative at 12 months, then the patient may return to routine cytology screening. If the hr-HPV DNA test result is positive, the patient should undergo repeat colposcopy.

Colposcopy↗
PubMedDate not supplied

[Diagnosis of cervicovaginal infection by human papillomavirus. Value of colposcopy, cytology and histopathology as methods of diagnosis].

The authors evaluated 476 patients to determine the accuracy of colposcopy, cytology, and histopathology as diagnostic methods for cervical and vaginal HPV infections. Results were treated by statistical analysis which showed significant disagreement among the methods tested. Colposcopy was positive in 87.8% of the cases. Abnormal transformation zone was the most frequent finding in the cervix, acetowhite epithelium being its main representative. Condylomatous vaginitis was the most frequent feature in the vaginal surface. Cytology was positive in 76.9% of the cases. To increase sensitivity of this method, the authors suggest that not only koilocytosis is important, but other major aspects are also important, such as minimal koilocytosis, dyskeratosis, karyopyknosis, binucleation, and multinucleation. Histopathology was positive in 81.9% of the cases. In conclusion, the three diagnostic methods studied presented statistical disagreement, however, they are supplementary and efficient.

Analysis of Variance↗
PubMed1991

ViraPap: can it help to reduce the need for colposcopy?

Two new tests recently became available for identifying cervical human papillomavirus (HPV). This study investigated the usefulness of the ViraPap and ViraType in the clinical setting. Thirty-six subjects considered to be at risk for HPV infection were examined; had specimens obtained for Papanicolaou smear (Pap smear), ViraPap, and ViraType; and were then referred for colposcopy. Results of these examinations were then compared to the findings of colposcopy and/or colposcopic biopsy. The sensitivity and specificity of the ViraPap in predicting an abnormality being found on colposcopic examination were 61.5% and 70%, respectively. Identifying the specific viral type by use of the ViraType did not prove to be clinically helpful in this population.

Adolescent↗
PubMed1990

Teaching colposcopy and androscopy in family practice residencies.

Addressing the widespread human papillomavirus and genital epithelial dysplasia epidemic requires mastery of colposcopy, androscopy, and cryotherapy. Implementing a family medicine residency training program for these skills requires identifying a faculty facilitator to consider the issues of time, cost, caseload, reimbursement, specialist support, personal training, and office impact related to this training. Experience with teaching these skills in a community-based family practice residency indicates that startup costs range from $10,000 to $20,000. Residents will initially require from 30 to 60 minutes to provide a complete examination. All procedures require precepting by trained faculty and adherence to established protocol. The most frequent indications for these procedures include evaluating the abnormal Papanicolaou smear, visible cervical abnormalities, or evidence of clinical papillomavirus infection in either sex. Experience suggests that over 90% of cervical dysplasia can be managed entirely in the residency outpatient setting. These procedures have become the most common outpatient procedures performed, surpassing all others combined. Referrals to the residency for these procedures are readily available. Strategies for developing curriculum, literature review, learning materials, and training workshops are presented. Colposcopy, androscopy, and cryotherapy are appropriate additions to the training curriculum of family practice residencies.

Colposcopy↗
PubMedDate not supplied

The importance of complementary cytology and colposcopy in a detection program.

Since 1956, we have used cytology and colposcopy routinely as complementary methods and the percentage of positive results has brought us much closer to the ideal 100 per cent. In order to achieve this, it is essential to put to good use the experience acquired by cytologists and colposcopists and to constantly update and improve the technique employed. The population must be made aware of the benefits of the simultaneous use of these detection methods through health education. The possibilities of diagnostic prediction of cytology are already well known. By means of colposcopy, we may classify the findings as follows: 1) normal, 2) with benign pathology, 3) suspicious, requiring additional frequent control, 4) highly suspicious of neoplasm, 5) malignant. Using the combined methodology, we were able to detect the flaws in use of both methods separately. Considering the carcinoma in situ and microcarcinoma, the results amounted to 16.6 per cent of cytologic false negatives and 12.9 per cent of colposcopic false negatives, whereas applying both methods simultaneously, we obtained only 2.7 per cent of false negatives. As we mentioned previously, this percentage of error may be attributable to technical faults, associated pathology and/or anatomic-histologic localization. We emphasize our reference to the simplicity of our method, making it possible to dispense with exaggerated human and material requirements and, at the same time, obtain highly successful results.

Adult↗
PubMed1989

The role of endocervical curettage in satisfactory colposcopy.

The role of endocervical curettage was studied in women with cervical dysplasia who underwent satisfactory colposcopic evaluation. Among 1130 women seen in the colposcopy clinic of a large city hospital during a 2-year period, 96 with satisfactory colposcopy and positive endocervical curettage constituted the study group. In these patients, the extent of dysplasia in the endocervical canal in cone biopsy specimens was measured using an ocular micrometer. When true-positive endocervical curettage was defined as dysplasia extending 5 mm or more inside the transformation zone, the false-positive rate for endocervical curettage was 81.8%. No patient with mild or moderate dysplasia on endocervical curettage had dysplasia that was more than moderate in degree or that extended more than 4.5 mm inside the transformation zone on histopathologic examination of the cone biopsy specimen. Because of the high rate of false-positive endocervical curettage, patients with mild and moderate dysplasia and selected women with severe dysplasia in endocervical curettings could be treated by local cervical ablation, with follow-up by endocervical curettage.

Adult↗
PubMed1989

Contraceptive practices of patients referred for colposcopy with an abnormal cervical smear.

This study examined the contraceptive practices of 100 patients referred for colposcopy because of an abnormal cervical smear. At presentation 49% were using oral contraception but 94% had taken the pill at some time. Eight of the 10 patients using barrier methods were relying on condoms: in at least seven of the eight cases an abnormal cervical smear preceded condom usage. Thus, the method of contraception used when cervical neoplasia develops may differ from the method used when the patient presents for colposcopy. Although consistent with previous studies suggesting that the incidence of cervical neoplasia is increased in women using oral contraception, the risk of neoplasia is more likely to be explained by the degree of exposure of the cervix to an infectious carcinogen or to the immunosuppressive effects of seminal plasma. We suggest that future studies of the epidemiology and natural history of cervical neoplasia should include a detailed contraceptive history.

Adolescent↗
PubMed1988

[Colposcopy of adenocarcinoma of the cervix].

Colposcopic findings of 17 cases of adenocarcinoma of the cervix are analyzed with cytology and patho-histology. One of the highly differentiated mucinous adenocarcinoma of the cervix is presented in detail for the knowledge of colposcopy of that cancer. The colposcopic findings of this tumor are characterized by increase and abnormal distribution of gland openings on the surface and high grades of its white surrounding rings. In addition, abnormal vascularization may be present. It is pointed out that these findings should be considered during colposcopy of adenocarcinoma of the uterine cervix.

Adenocarcinoma↗
PubMed1988

Endocervical curettage in the evaluation of cervical disease in patients with adequate colposcopy.

The purpose of this study was to investigate the importance of endocervical curettage in the outpatient management of women with cervical neoplasia. From 1975-1985, 1500 patients were evaluated in our colposcopy clinic. Endocervical curettage was done routinely, even when colposcopy was adequate; 122 patients with abnormal cytology, an adequate colposcopic examination, and dysplastic epithelium in the endocervical curettings underwent conization. Of these 122 patients, 111 (91%) had cervical intraepithelial neoplasia on cone, one had microinvasion, and none had invasive cancer. In this group, there were 11 patients with abnormal cytology, normal coloposcopically directed biopsies of the ectocervix, and positive endocervical curettages. Nine of these 11 had dysplasia confirmed by conization, which would have been missed if endocervical curettage had not been performed.

Biopsy↗
PubMed1987

Evaluation of colposcopy in the screening of pre-malignant and malignant lesions of uterine cervix.

In an attempt to evaluate the effectiveness of colposcopy in screening pre-malignant and malignant lesions of uterine cervix, one hundred cases of atypical colposcopical findings were cytologically and histologically analysed along with one hundred individuals with typical colposcopical appearance. It was observed that moderate dysplasia, severe dysplasia and malignant lesions of uterine cervix reveal certain distinct changes in the colposcopic "Transformation Zone" which are well related to the cytological and histological findings. The results suggested that colposcopy might be undertaken as a rapid, reliable and complementary tool for cancer screening in a vastly populated country like India.

Colposcopy↗
PubMed1985

Correlation between cervical cytology and biopsy in an air force colposcopy clinic.

We examined 258 patients in the colposcopy clinic at David Grant USAF Medical Center from January 1980 to December 1982. Two hundred eleven records (82%) were comprehensive enough to be reviewed. Forty-six percent (97 of 211) of the original cervical (Papanicolaou) smears showed only atypia. Forty percent (39 of 97) of them subsequently showed dysplasia on colposcopically directed cervical biopsy. When cervical smears were repeated at the initial colposcopy clinic visit, 36% (75 of 211) were negative. There were no cases of invasive cervical cancer.

Adolescent↗
PubMed1985

[Establishing guidlines for dealing with mild dysplasia through cytology and colposcopy (follow up study)].

230 cases of mild dysplasia, detected in examinations for cancer of the uterus, were followed up cytologically, and colposcopically for more than 2 and a maximum of 10 years, and the following results were obtained: Mild dysplasia resulted in regression in 169 cases (73.5%), persistence in 46 cases (20.0%), and progression in 15 cases (6.5%). Out of the group with progression, 10 cases (4.3%) developed into carcinoma in situ or microinvasive carcinoma. The average period required for the progression was 54.8 months. The combined use of cytology and colposcopy is useful for diagnosis and follow up of mild dysplasia. In the combined use of cytology and colposcopy, it is appropriate to evaluate the outcome (progression or regression) of mild dysplasia 2 years after detection. The transformation ratio at the time of the initial examination was in many cases higher in the progression group than in the regression group. In the progression group an increase in the transformation ratio was noted in all cases, and it appears that it is also necessary to pay attention to changes in the transformation ratio, in addition to the grading of the findings.

Adult↗
PubMed1979

[Combined use of colposcopy and cytology].

The widespread view of the nearly absolute accuracy of cervical cytology in the diagnosis of severe dysplasia, carcinoma in situ and small invasive carcinoma is not correct. The rate of cytologically missed cases computed from the first smear only is more than 10%. Using cytology and colposcopy simultaneously in each single case, the errors of one method will be greatly compensated by the other. Presupposition for the compensation, however, is the independent indication for biopsy. In other words, biopsy must be done based on cytological findings, even when colposcopy is unsuspicious. On the other hand a colposcopically suspected and cytologically unsuspected case must also be biopsied. For the gynecological clinic as well as for the gynecological practice, the additional effort resulting from the combined method is easily realizable. For large screening programs, however, the colposcope can be used only as an instrument for target punch biopsies, indicated by pathologic smears.

Carcinoma in Situ↗
PubMed1979

Colposcopy.

Colposcopy is the ideal method of establishing the site, nature and extent of abnormal areas of the uterine cervix or vagina. Use of the three modalities of cytology, colposcopy and histology will enable an accurate diagnosis to be made. Appropriate, well documented treatment can be planned and confirmed under anaesthesia. Follow-up of treated lesions can also be accurately performed.

Colposcopy↗
PubMed1984

Use of colposcopically directed, four-quadrant cervical biopsy by the colposcopy trainee.

Colposcopically directed cervical biopsies performed by experienced colposcopists have greatly reduced the need for conization of the cervix to evaluate patients with cervical intraepithelial neoplasia (CIN). Because of the subjectivity of the colposcopic technique and variable time required to become skilled, continued reliance on cervical conization is often recommended to validate colposcopic findings for novice colposcopists . We assessed the colposcopic skill of residents in training in obstetrics and gynecology who had received 9-12 months of instruction in colposcopic techniques. Biopsies of each quadrant of the ectocervix were done after the resident recorded his or her colposcopic diagnosis. In 26% of the patients there was overestimation or underestimation of the histologic findings by more than one grade in the cervical quadrant suspected on colposcopy to contain the most advanced CIN lesion. In 30% of patients the histologically most advanced CIN lesion was not identified by the colposcopist . In 11% of patients with histologic findings of CIN both cytology and colposcopy were negative. Only 69% of the histologically confirmed lesions were diagnosed colposcopically by the resident colposcopists . The four-quadrant, colposcopically directed biospy technique is recommended as an effective training method for the beginning colposcopist .

Adolescent↗