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PubMed1984

Genital warts and cervical cancer. V. The tissue basis of colposcopic change.

Histologic differences between subclinical papillomaviral infection and cervical intraepithelial neoplasia are quantitative rather than qualitative. Both entities are characterized colposcopically by acetowhite epithelium and aberrant surface capillaries. This study correlates five new colposcopic signs (variations in contour, thickness, color, vascular patterns, and iodine staining) with 12 histologic signs of human papillomaviral infection and 12 features of premalignant change. Acetowhitening and capillary abnormalities in minor colposcopic lesions are attributable to human papillomaviral disturbance of cell growth and maturation, seen histologically as parabasal layer proliferation, papillomatosis, koilocytosis , and dyskeratosis. Alteration in cell ploidy is usually minimal. Major colposcopic abnormalities reflect extensive disorganization of cell phenotype and tissue architecture, increased DNA content, and aneuploid stem cell populations. Intermediate colposcopic patterns generally denote polyploid lesions in which tissue changes are a composite of two reciprocal events: the extent of benign warty expression and the severity of premalignant change.

Animals↗
PubMed1984

Genital warts and cervical cancer. IV. A colposcopic index for differentiating subclinical papillomaviral infection from cervical intraepithelial neoplasia.

Five colposcopic signs (thickness, color, contour, vascular atypia, and iodine staining) were graded into three objective categories representing (1) subclinical papillomaviral infection, (2) lower-grade dysplasia, and (3) grade 3 cervical intraepithelial neoplasia. Seventy-two colposcopically different biopsy specimens (25 of subclinical papillomaviral infection and 18 of grade 1, 18 of grade 2, and 11 of grade 3 cervical intraepithelial neoplasia) were collected from 52 women and interpreted by validated, quantitative histologic analysis. Attempts to grade lesions by the prominence of the acetowhitening reaction or the mere presence of aberrant surface capillaries were unsuccessful. In contrast, each of five new colposcopic criteria were significantly correlated with histologic severity. Differences in color, vascular atypia, and iodine staining were more predictive than those of thickness and contour. Combined into a weighted index, these colposcopic features were 96% correct in forecasting approximate histologic findings. Because this method relies upon critical analysis rather than pattern recall, the use of this colposcopic index greatly simplifies the learning of colposcopy.

Animals↗
PubMed1991

Colposcopic analysis of genital human papillomavirus infections during an 8-year prospective follow-up.

A long-term prospective follow-up program has been conducted for genital human papillomavirus (HPV) infections in 532 women in Kuopio since 1981. By regular examinations (at 6-month intervals) using colposcopy, cytology and/or punch biopsy, 426 of these women have been followed up for the minimum of 48 months (mean 71 +/- 19 months). These 426 women were included in the present report. The colposcopic data of all women at the first and the latest visits were recorded from the colpophotographs, analysed and correlated with cytology, histology, HPV DNA detection and clinical behavior (i.e. prognosis) of the disease. Colposcopic abnormalities were found in 313 (73.5%) women at the first visit and in 138 (32.4%) patients at the latest visit. HPV infections were diagnosed in 368 (86.4%) women at the first visit and in 75 (17.9%) at the latest visit on light microscopy (i.e. biopsy and/or PAP smear). CIN was found in 54.7% of the women at the first visit. HPV DNA was detected by in situ hybridization in 38.2% of the biopsies assayed. Colposcopical multicentric lesions were found in one third of the women upon examination of the entire lower genital tract. The majority of the lesions were situated within the transformation zone. HPV infection and CIN were most frequently encountered in women with multiple lesions. Progression to CIN III was most frequent in large lesions (28.6%). No colposcopic pattern was able to distinguish HPV infections from CIN lesions, or predict the progression of the former. The results implicate that: (1) colposcopy is an essential method to disclose abnormalities due to CIN and HPV infections, but histological changes cannot be predicted on a single colposcopy; (2) HPV infection is a multicentric disease, making the careful examination of the entire lower genital tract mandatory on every colposcopy; and (3) the HPV progressors cannot be predicted on the basis of the colposcopic patterns.

Adult↗
PubMed1985

Pathology of colposcopic findings in 2635 diethylstilbestrol-exposed young women.

An analysis of 6055 colposcopically directed biopsy specimens from 2635 diethylstilbestrol (DES)-exposed women and 445 biopsy specimens from 277 nonexposed women was undertaken to correlate microscopic findings with colposcopic patterns. All examinations were performed using a standardized protocol which required that each participant have colposcopy, cytologic smears, and biopsy of abnormal colposcopic lesions. The findings of colposcopic "columnar epithelium, gland openings, and Nabothian cysts" correlated most often with glandular epithelium in the biopsy specimen. "White epithelium," which includes three related colposcopic patterns, mosaicism, punctation, and white epithelium, was associated most frequently (82-93% of cases) with squamous metaplasia, but occasionally with dysplasia and carcinoma in situ (CIS)(0-6%). The presence of dysplasia or CIS in any individual biopsy specimen occurred most frequently with the observation of higher graded lesions by colposcopy or a prior diagnosis of dysplasia.

Carcinoma in Situ↗
PubMed1991

Histological differences between colposcopic-directed biopsy and loop excision of the transformation zone (LETZ): a cause for concern.

Colposcopic examination and biopsy were performed on 100 patients with abnormal cervical cytology. All were suitable for ablative therapy but were treated by loop excision of the transformation zone (LETZ) as outpatients. Histological comparison between the colposcopic biopsies and LETZ samples showed poor agreement with only 43% of cases illustrating identical degrees of dysplasia. The dysplasia was underestimated by colposcopic biopsy in 16% of cases and overestimated in 41% of cases, when compared to the LETZ specimen. Microinvasive carcinoma was diagnosed in 3 cases on the LETZ histology, having been missed by the preceding colposcopy and colposcopic biopsy. The disparity between histological findings is of great concern and would not have been detected if the patients were treated by ablative therapy. It is the authors' view that LETZ should replace ablative therapy in the treatment of localized cervical dysplasia and that it may avoid the need for pretreatment colposcopic biopsy. LETZ limits the possibility of inadequate treatment and also provides a method of audit for the colposcopist.

Adolescent↗
PubMed1993

Comparison between colposcopic, cytologic, and histologic findings in women positive and negative for human papillomavirus DNA.

Little is known about the role of detection of human papillomavirus (HPV) DNA in exfoliated cells of the cervix in aiding the colposcopic diagnosis of cervical lesions. The purpose of our study was to compare the colposcopic findings of young women who were positive and negative for HPV DNA. Eighty-four women aged 13-22 years attending family planning clinics were examined colposcopically with the aide of acetic acid and Lugol's solution and without knowledge of HPV DNA status. Lesions identified were given scores based on the severity of observed colposcopic changes. Samples for cytology and HPV DNA testing, which included types 6, 11, 16, 18, 31, 33, and 35, were obtained at the time of the examination. Biopsies were performed on women with significant lesions identified on examination or with cytology suggestive of neoplasia. Students t-test and chi 2 analysis were performed to compare colposcopic variables and HPV DNA type. Of the 84 women examined, 17 were positive for HPV DNA; 9 had type 16/18. The average length of sexual activity was 2.7 years. Women with HPV 16/18 had a mean of 1.7 lesions visible at colposcopy compared to 0.7 lesions visible in those negative for HPV 16/18 (this included HPV DNA negative women and women positive for HPV types 6, 11, 31, 33, and 35) (p < 0.001). Women who were positive for HPV 16/18 also had higher lesional scores than the HPV 16/18-negative group (3.4 versus 1.0, respectively, p < 0.001). All four women who had dysplasia either on cytology or histology were positive for type 16/18.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

Genital warts and cervical cancer. VII. An improved colposcopic index for differentiating benign papillomaviral infections from high-grade cervical intraepithelial neoplasia.

A new colposcopic sign (sharpness of peripheral margins) was graded into three objective categories representing subclinical papillomaviral infection, lower grade dysplasia, and grade 3 cervical intraepithelial neoplasia. Colposcopic features were prospectively recorded in 72 women and then correlated with histologic findings. Histologic diagnoses were evenly spread within the disease spectrum: 18 patients had subclinical papillomaviral infection without associated dysplasia; 15 had grade 1, 16 had grade 2, and 23 had grade 3 cervical intraepithelial neoplasia with or without koilocytotic atypia. Differences in the pattern of the peripheral margin were discriminatory throughout the entire diagnostic range. Predictive accuracy of this new colposcopic sign (79%) compared favorably with that of color (72%), vascular atypia (81%), and iodine staining (72%). Each criterion was independent of the other three. Hence, combining these four individual signs into a colposcopic index was 97% correct in forecasting approximate histologic findings. Because formulation of the colposcopic index is based on critical analysis rather than pattern recall, the use of this method will greatly simplify the otherwise arduous task of learning colposcopy.

Carcinoma in Situ↗
PubMed1997

Colposcopic regression patterns in high-grade cervical intraepithelial neoplasia.

OBJECTIVE: To evaluate the serial changes in colposcopic and cervicographic findings of women with cervical intraepithelial neoplasia (CIN) II and III enrolled in a phase III randomized comparison of oral beta carotene and placebo. METHODS: All subjects treated with beta carotene or placebo for at least 6 months were included if they met the criteria of persistent or progressive disease (no change or worsening of CIN grade) or disease regression (improvement of two grades or more). These two groups were compared for changes in colposcopic and cervicographic patterns. Colposcopically directed biopsies and cervicography were done at enrollment and after 6 months. Quarterly Papanicolaou smears and colposcopic assessments also were performed. Findings of mosaic pattern, punctation, and white epithelium were graded and diagrammed at colposcopic examinations. Cervicographic measurements of the centripetal movement of metaplastic epithelium were recorded. Data were analyzed by chi 2 analysis and Fisher exact tests. RESULTS: Data were available for 23 subjects with regression and 16 with persistent lesions. Small lesions were significantly more likely to regress than large ones. Lesions without coarse punctation were significantly more likely to regress than lesions with coarse punctation, and lesions with mild acetowhite changes were more likely to regress than those with dense white epithelium. A pattern of centripetal movement of the metaplastic epithelium toward the cervical os was noted in lesions that regressed, but not in those that persisted or progressed. CONCLUSION: This study describes the centripetal growth of metaplastic squamous epithelium associated with the regression of CIN II and III. This observation contributes to our understanding of the process of disease regression in CIN and may be useful in identifying individuals for conservative management. Failure to identify this pattern correlates with persistent or progressive disease.

Adult↗
PubMed1990

Use of the colposcope in childhood sexual abuse examinations.

The addition of the colposcope to the armamentarium of the medical investigator of childhood sexual abuse has many advantages. The ability to accurately record anatomic findings has implications for the medical community, the judicial system, the accused, the victim, and the family. Through the use of the photographs produced by this instrument, examiners can inspect physical findings without the time constraints imposed by the short attention span of the young child. If necessary, colleagues can be consulted and interpretations discussed. The availability of these photographs to the courts has reduced the need to re-examine the child for another opinion. The colposcopic photograph has also proved to be an excellent teaching and research tool. As an aid to teaching, the photographs and slides produced by this instrument help the instructor demonstrate anatomic findings while allowing the student time to ask questions. As a research tool, this instrument has opened up a myriad of possibilities for medical examiners. It has facilitated the collection of clinical data, it has allowed the standardization of examination techniques, and with the help of computers it has made possible the sophisticated analysis of the information collected. The colposcope has limitations. Aside from its cost, it is a difficult instrument to use in the examination of the young child. The time required for an examination can increase substantially as the examiner attempts to maneuver the scope into a proper position. During this procedure, the maintenance of the child in a suitable state of relaxation, while avoiding further emotional trauma, can be a challenge. The reality that the photograph is two dimensional and represents only the findings at that moment will always be a limiting factor in its use as a means of assessing a child's anatomy. Even the multimethod approach employed to offset this problem may compound the situation by further increasing the length of the examination. Most of these and other dilemmas encountered in the use of the colposcope can be solved by additional experience with this instrument. Despite the improvements brought about by the introduction of the colposcope, more advanced technology may be needed to help solve some of the problems currently plaguing medical examiners. The use of video tape could provide a solution to the documentation of the changes that occur in the soft tissues as the child moves or becomes more or less relaxed. The potential of the computer appears unlimited, and its application to the problem of the interpretation of findings could make a significant contribution to the field.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1976

Colposcopic evaluation of patients with abnormal cervical cytology.

Because of suspicious or abnormal smears, 620 patients were referred to the Colposcopy Clinic of the British Columbia Cancer Institute between 1st March 1973 and 31st December 1974; it was possible to make a colposcopic examination in 549 of these patients (88.5 per cent). The colposcopic impression was within one histological grade of a colposcopically-directed biopsy in 476 patients (86 per cent). There were 221 patients who had a cone biopsy after a colposcopically-directed biopsy and in 192 of these (87 per cent) the two biopsies were within one histological grade of each other; but there were two patients with occult invasive carcinoma in a cone biopsy and only carcinoma in situ in a directed biopsy. In the same group of 221 patients the colposcopic evaluation and final diagnosis (the most advanced histological lesion seen in biopsy) agreed in all but seven patients.

Adult↗
PubMed1982

Cervical intraepithelial neoplasia and 'wary' atypia: a study of colposcopic, histological and cytological characteristics.

Colposcopic, histological and cytological characteristics of 168 consecutive patients attending a colposcopy clinic were reviewed. A group of patients demonstrated a cluster of histological features previously related to possible human papilloma virus infection of cervical epithelium, including particularly koilocytosis, double nucleation and dyskeratosis. These patients had a significantly greater occurrence of colposcopic 'finger-like' lesion outline and colposcopic impression of warty change, but not of other specific colposcopic features. Over two-thirds of patients with histological warty features did not show these colposcopic changes. Cytological changes previously related to warty lesions did not occur commonly, and appeared to underestimate the histological occurrence of such changes. Histological changes considered to represent CIN were uncommon in patients who said that they had begun sexual activity less than 10 years ago, whereas patients with warty characteristics on histology showed no such bias.

Cervix Uteri↗
PubMed1994

Digital imaging colposcopy, image analysis and quantification of the colposcopic image.

OBJECTIVE: To investigate the use of a digital imaging system for colposcopy, its use for image analysis and quantification of the colposcopic features that may predict histological outcome as defined by large loop excision of transformation zone. DESIGN: Prospective programme study of all patients undergoing colposcopy for cytological abnormalities. SETTING: Dudley Road Hospital, Birmingham. SUBJECTS: Fifty consecutive patients having cytological and colposcopic abnormality treated with large loop excision of transformation zone formed the study group. MAIN OUTCOME MEASURES: Pretreatment and colposcopic features correlated with histological diagnosis of excised transformation zone. RESULTS: Index cytology and current smoking status are the most important variables for prediction of histological diagnosis. Other important variables are focality of lesion, surface pattern, intercapillary distance and degree of acetowhiteness. CONCLUSION: Digital imaging colposcopy allows image capture, processing and objective analysis. This methodology holds advantages for basic and clinical research, teaching, diagnostics and clinical audit. The system can act as a quality control tool for colposcopy units. This system should prove invaluable for further quantitative studies, for natural history studies and for those patients with deferred treatment of their cytological and colposcopic abnormalities. The statistical models described may be incorporated into the system and can aid the colposcopist in management of the woman with abnormal cervical cytology and colposcopic abnormality.

Adolescent↗
PubMed1997

An analysis of the factors involved in the diagnostic accuracy of colposcopically directed biopsy.

OBJECTIVE: To compare the results of colposcopically directed biopsy with the final diagnosis established by the analysis of the surgical specimen, and to determine the clinical and colposcopic factors on which the reliability of biopsy is based. MATERIAL AND METHODS: Five hundred and sixty-seven women were seen by the same colposcopist who also performed the directed biopsies and/or the endocervical curettage. The final histological diagnosis identified 29 normal aspects (5.2%), 58 low-grade cervical intraepithelial neoplasias (CIN) (10.2%), 448 high-grade CINs (79.0%), 16 microinvasive cancers (2.8%) and 16 occult invasive cancers (2.8%). The influence of several factors--such as age, parity, menopause, pregnancy, history of cervical treatment, site of the squamocolumnar junction, localization, size and severity of the lesions--on the pertinence of the biopsy was studied in a uni- and multifactorial analysis. RESULTS: Colposcopy was satisfactory in 399 patients (70.4%) in whom the colposcopic aspect was consistent with the final histological diagnosis in 81.2% of cases. The global agreement between biopsy diagnosis and final diagnosis was observed in 89.6% of cases. It was 84.2% for low-grade CINs, 95.8% for high-grade CINs, 31.2% for microinvasive cancers and 81.2% for invasive cancers. No clinical or colposcopic factor could be identified as independent factor associated with the diagnostic agreement with the directed biopsy. Conversely, concordance of biopsy was related to the final diagnosis since the only independent risk factors were a high-grade CIN (adjusted risk ratio (ARR)=1.52, 95% CI=1.11-2.08; p=0.006) and a microinvasive or invasive cancer (ARR=0.56, 95% CI=0.39 0.81; p=0.002). CONCLUSION: To ensure that a microinvasive cancer has not been overlooked, the excision of high-grade CINs seems to be justified, whatever the clinical status and the colposcopic aspect.

Adolescent↗
PubMed1975

[Therapeutic results of colposcopically controled collection of cervix tissue in atypical smears of women up to the age of 35 years].

The case series consists of 106 women consecutively collected during 1968 to 1973 from those with a vaginal smear belonging to Papanicolou's groups III and attending the gynaecological department in Umeå. Probably the series is a fair random sample of the population (congruent to 150,000 people) of the area served by the clinic. The extension of the colposcopically delimited atypical transformation zone (with its upper bordèrline against normal cervical villi) in most cases being small, the surgical procedure--a small cone congruet to ring biopsy--was accordingly insignificant. In 9 cases only a large conization was performed. As only a small part of the cervical tissue was usually removed it is probable that the enzymatic and mechanical properties of the cervix as well as its capacity as a sperm reservoir could be preserved. The median of the observation time is 26 months, range 3 months to 5 years. At the follow up the colposcopic and histological picture has so far shown no sign of atypia in 91 subjects. The same applies cytologically to the patients subjected to a large conization. Two women have moved away from the district. A relapse occurred in 4 patients, who after a large conization have remained cytologically negative. Throughout the investigation the term a typia has been used to characterize the cytological, colposcopic and histological changes, the degree and extension of this atypia being taken into considertion. Thus the abstruse nomenclature in common use is avoided. Cytological atypia is cellular in character, while histologically it includes the degree of structural derangement of the epithelial architecture as well. Colposcopically the angioarchitecture and the capillary distance seem to be the most important features. The correlation between the colposcopic and the cytological and histological findings is high when the degree of atypia is marked. It is inferred, therefore, that the descriptive term atypia should replace the superfluos bulk of terms in the fields in question.

Colposcopy↗
PubMedDate not supplied

Improving the sensitivity of cervical cytologic screening. A comparison of duplicate smears and colposcopic examination of patients with cytologic inflammatory epithelial changes.

During a ten-month period, 264 cervical cytologic specimens were submitted in duplicate to two separate cytology laboratories. An attempt was made to perform colposcopy on all 45 patients reported as having an abnormality by either laboratory. All but one patient with a cytologic diagnosis of cervical intraepithelial neoplasia (CIN) underwent colposcopy, as did 68% of the patients with a diagnosis of nondysplastic atypia (inflammatory epithelial changes [IEC]). Five cases of histologically verified CIN were found by colposcopic study of patients with a cytologic diagnosis of CIN; two additional cases were found by colposcopic study of patients with a cytologic diagnosis of IEC. On the assumption that patients not colposcoped were not systematically different from the others with IEC, the screening sensitivities for both laboratories and for cytology followed by colposcopy of IEC cases were estimated. A statistically significant improvement in screening sensitivity was achieved by colposcopic examination of patients with IEC. This conclusion was tempered by a Bayesian analysis that suggested that some of the apparent improved sensitivity could be due to falsely positive biopsy reports. Despite potential benefits, it is premature to recommend universal colposcopic examination of patients with cytologic reports of inflammatory epithelial changes.

Cervix Uteri↗
PubMed1985

The value of endocervical curettage as part of the standard colposcopic evaluation.

Whether to perform endocervical curettage (ECC) as part of a routine colposcopic examination in patients with an abnormal Papanicolaou smear remains controversial. Some studies consider ECC an essential part of a colposcopic examination regardless of the level of the squamocolumnar junction (SCJ); others consider it superfluous in cases where the SCJ can be visualized. Between January 1980 and December 1982, 278 new patients with abnormal Papanicolaou smears underwent colposcopy. Directed biopsies established the degree of cervical intraepithelial neoplasia (CIN) and ruled out invasive disease. ECC was done on every patient. A total of 51 patients (18%) had a positive ECC. Seven patients could not be evaluated because their records were incomplete. Of the 44 evaluable patients, 32 (73%) had satisfactory colposcopy. In the remaining 12 (27%) the upper limit of the transformation zone could not be seen clearly; in that group the degrees of CIN on colposcopic biopsy and ECC were in agreement in two cases; ECC revealed the degree to be less severe in four cases and more severe in six (50%). In the group with satisfactory examinations, 15 had the same degree of CIN on colposcopic biopsy and ECC; ten had less severe and seven (22%), more severe degrees of CIN on ECC. Of greatest clinical importance was that, overall, 11.5% had a positive ECC despite a satisfactory colposcopic examination. This study indicated that ECC provides unique and important information, justifying its inclusion as part of the standard evaluation of every patient undergoing colposcopy for abnormal cervical cytology.

Biopsy↗
PubMed1979

Evaluation of colposcopic accuracy without endocervical curettage.

A study was undertaken to evaluate the accuracy of colposcopic examination when performed without the use of endocervical curettage. It included 763 cases of suspected cervical-vaginal pathology. An additional evaluation of colposcopic accuracy was made for special-case categories of 1) stromal invasion, 2) pregnancy, 3) menopause, and 4) diethylstilbestrol (DES) exposure. Colposcopic accuracy was determined by cytologic and histologic material obtained either at the initial colposcopic evaluation or during follow-up surgery. With the literature as a standard for accuracy, it was concluded that the omission of endocervical curettage from the colposcopic examination did not reduce accuracy. In addition, the diagnostic conization rate was lower than in most reported series. Finally, the rate of missed invasive lesions was not increased by the omission of endocervical curettage.

Adolescent↗
PubMed1993

[Preliminary experience with colposcopic diagnosis of cervical adenocarcinoma].

Colposcopic technique has become a major method in the diagnosis of cervical cancer. Sixteen patients of adenocarcinoma of the cervix were examined by colposcopy from 1984.2 to 1991.6. Transformation-zone-like and papillary finding were common colposcopical appearances of adenocarcinoma of the cervix. The common vascular patterns in 16 cases were root-like vessels and waste-thread-like vessel. Among the 16 cases, cytologic positive rate was only 25% (3/12), while the accordance rate between colposcopic examination and pathology was 84.6% (11/13). The result suggests that colposcopic examination is superior to the cytology in the diagnosis of cervical adenocarcinoma. Based on the above results and the data of literature, we consider that there are obvious differences of colposcopic findings between adenocarcinoma and squamous cell carcinoma of the cervix which may be useful in the early diagnosis of the cervical adenocarcinoma.

Adenocarcinoma↗