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PubMed1997

The value of repeat Pap smear at the time of initial colposcopy.

OBJECTIVE: The objective was to determine if repeating a Pap smear at the time of an initial colposcopy has sufficient clinical benefit to justify its clinical and financial costs. METHODS: The records were reviewed of all patients who had an initial colposcopy at Queens Hospital Center between 1984 and 1995. Data were gathered regarding the referral cytology, the cytology done at the time of colposcopy, and the results of any biopsies which were taken. The terminology for cytology and histology done prior to 1989 was adjusted to the Bethesda classification system. A repeat Pap smear was defined as clinically valuable if it would have changed the patient's management, i.e., if it suggested more advanced disease than the referral Pap and that the disease was not identified on the colposcopically directed biopsy. RESULTS: Two thousand nine hundred sixty-nine records were reviewed. In 139 cases, no Pap smear was repeated at the time of colposcopy. Of the remaining 2830 women, only 1347 (47.6%) showed exact correlation between their referral Pap smear and the Pap done at the time of colposcopy. In another 1016 (35.9%), the Pap at colposcopy was within one grade of the referral Pap. In 312 women, the Pap at the time of colposcopy was a higher grade than the referral Pap. However, in 236, the higher grade of disease was detected by the colposcopically directed biopsy. Of the remaining 76 women, 58 had a normal biopsy, but their Pap at the time of colposcopy showed low-grade squamous intraepithelial lesions (44) or high-grade squamous intraepithelial lesions (HGSIL) (14). Seventeen others had a biopsy showing low-grade dysplasia while the Pap at the time of colposcopy showed HGSIL. In 1 patient, the repeat Pap showed malignant cells while the biopsy showed a high-grade lesion. Based on the triage protocols at our institution, this means that a repeat Pap at the time of colposcopy would have indicated a cone biopsy in 31 patients (1.1%) and more careful follow-up of another 44 patients (1.6%). Skipping the repeat Pap smear would not have resulted in any missed cancers. In our series of 2830 patients, the cost savings of skipping the repeat smear would have been $68,580 or $24.23 per patient. On a national level, skipping the repeat smear would save more than $24,000,000 annually. CONCLUSION: Using current triage protocols at our institution, repeating the Pap smear at the time of an initial colposcopy would have changed the management in 2.7% of patients and indicated a conization in only 1.1% of patients. It is doubtful that this justifies its cost and the potential detrimental effects on the colposcopic examination.

Adolescent↗
PubMed2003

The use of music to reduce anxiety for patients undergoing colposcopy: a randomized trial.

OBJECTIVE: The goal of this work was to investigate the impact of music on women's anxiety and perceived pain during colposcopy examination. METHODS: This was a prospective randomized study. Two hundred and twenty women referred for colposcopy for the first time were recruited. They were randomized to either the music or no-music group. Before colposcopy examination, each subject completed a Chinese version of the state anxiety questionnaire (STAI) and assessed the anticipated pain for colposcopy with a visual analog scale (VAS). Slow-rhythm music was played during colposcopy examination in the music group. Subjects in the no-music group were examined in the same setting without music. After colposcopy, each subject completed the STAI form again and assessed their pain during examination by the VAS. RESULTS: Women in the music group experienced significantly less pain (mean VAS 3.32 [95% CI 2.86-3.78] vs 5.03 [4.54-5.52], P<0.001) and lower anxiety (mean STAI 39.36 [95% CI 37.33-41.39] vs 44.16 [41.82-46.49], P = 0.002) during colposcopy examination than women in the no-music group. On linear regression analysis, the factors significantly affecting anxiety during colposcopy were anxiety score at enrollment, pain score during colposcopy, and whether or not the women had listened to music during the colposcopy examination. The factors significantly affecting the pain scores were whether the women had listened to music during the procedure and the final anxiety scores. CONCLUSIONS: Music is a simple, inexpensive, and easily used strategy to minimize anxiety and pain during colposcopy examination.

Adult↗
PubMedDate not supplied

Access to colposcopy services for high-risk Canadian women: can we do better?

BACKGROUND: Despite overall decreasing mortality from cervical cancer, selected groups of Canadian women continue to have suboptimal access to diagnostic and treatment interventions for cervical cancer. In this paper, we present an evaluation of a colposcopy program developed to improve attendance for colposcopy in a lower socio-economic and immigrant population. METHODS: All women attending the North Hamilton Community Health Centre (CHC) who required colposcopic assessment and were referred to a newly developed colposcopy program based at the CHC were evaluated. Attendance rates for consultation, follow up and treatment in women referred for colposcopy were compared retrospectively for the CHC-based colposcopy program and concurrently with the regional colposcopy clinic (RCC). RESULTS: Women referred to the CHC colposcopy program had a significant reduction in their no-show rate after the introduction of the locally based colposcopy program (17.2% vs. 1.3%, p<0.01). Comparing the same time periods, there was no significant reduction in the default rate at the RCC (2.5% vs. 3.3%, p=0.21). Despite serving a population of women who were at higher risk for non-attendance, patients at the CHC had a default rate for appointments similar to that of the RCC (1.3% vs. 3.3%, p=0.55) after the introduction of the local colposcopy program. CONCLUSIONS: Lower socio-economic status and immigrant women receiving care from a CHC-based colposcopy program had a significant decrease in their no-show rate for colposcopic evaluation after the introduction of the on-site program. Consideration must be given to locating diagnostic colposcopy programs in settings more accessible to women who require these services the most.

Adolescent↗
PubMedDate not supplied

Colposcopy practice and training in family practice residency programs.

BACKGROUND: The potential growth of colposcopy as a family medicine procedural skill is directly related to the training currently offered to family practice residents. To define whether these skills are being adequately offered to physicians who want to perform this procedure for their patients, a study was designed to investigate the current status of colposcopy practice and training in family practice residency programs. METHODS: A 16-item survey sent to 356 family practice residency directors in the United States included items concerning colposcopy practice, training, educational programs and strategies, colposcopy coordinator educational background, and colposcopic resource materials and equipment. RESULTS: Surveys were returned from 204 (57 percent) family practice residencies. Colposcopy was performed at 45 percent of the residencies that responded. Ninety-six percent of the respondents who did not perform colposcopy believed colposcopy is a procedure that should be performed by family physicians. Clinical teaching and supervision was the most common method of resident training (74 percent). Colposcopy training coordinators were usually family physicians (72 percent), primarily trained by gynecologists. Assistance with implementing a colposcopy training program was requested by 85 percent of those programs presently not performing colposcopy. CONCLUSIONS: This study indicates that there are opportunities for further development of colposcopy practice and training in family practice residencies.

Attitude of Health Personnel↗
PubMed2006

The role of colposcopy in the follow up of women treated for cervical intraepithelial neoplasia.

OBJECTIVE: To determine the effect of colposcopy on the sensitivity and specificity of follow-up procedures in the detection of residual or recurrent disease after treatment for cervical intraepithelial neoplasia (CIN). DESIGN: A retrospective study of information held in a colposcopy database. SETTING: A teaching hospital colposcopy clinic. POPULATION: A total of 2244 women treated in Hammersmith Hospital for histologically confirmed CIN between 1 January 1988 and 31 December 2002. METHODS: Data from the records of women treated with some form of local conservative therapy for CIN1-CIN3 between January 1988 and December 2002 were extracted from the colposcopy database. Women with histological confirmation of post-treatment disease were identified. MAIN OUTCOME MEASURES: The sensitivity and specificity of cytology alone was compared with the sensitivity and specificity of the combination of colposcopy and cytology. RESULTS: Colposcopy improved the sensitivity of cytology for the detection of high-grade disease from 64 to 91% but reduced the specificity from 95 to 88%. With a 3% rate of post-treatment high-grade disease, colposcopy detected 8 extra cases per 1000 women but resulted in 88 more false alarms per 1000 women. Among women in whom the treatment margins were involved or uncertain, colposcopy detected 13 extra cases per 1000 women but resulted in 12 fewer false alarms per 1000 women because the prevalence of post-treatment disease was higher. CONCLUSIONS: Colposcopy does improve the detection rate of post-treatment disease but at a cost of additional false alarms. The benefit of colposcopy will be greater in high-risk groups of women with higher rates of treatment failure.

Adult↗
PubMed1996

Consequences of current patterns of Pap smear and colposcopy use.

OBJECTIVES - To describe age specific frequencies of Pap smear and colposcopy use in the Australian Capital Territory (ACT) and to estimate the cumulative effects of current patterns of use. SETTING - Frequencies of Pap smear and colposcopy use were estimated for the financial year from 1 July 1989 to 30 June 1990. Eligible women were between the ages of 15 and 74, living in the ACT. METHODS - Data collected from a 10% sample of subjects enrolled with Medicare and from the only public pathology laboratory in the ACT were used to estimate age specific frequencies. The expected number of deaths from cervical cancer in the ACT in the absence of a screening programme was estimated by applying Australian age specific mortality rates for cervical cancer between 1960 and 1964 to the 1989 ACT population. A life table approach was used to simulate the cumulative risk of colposcopy - given current age specific rates - on a hypothetical cohort of 1000, 15 year old women. RESULTS - Forty four per cent (95% confidence interval (CI) 42.9 to 44.9) of women had a Pap smear and 2.5% had colposcopy (95% CI 2.4 to 2.6). Two and a half percent of 15 to 24 year old women had colposcopy (95% CI 1.9 to 3.1). The ratio of women having Pap smears to women having colposcopy was 17-8:1 (95% CI 17.7 to 17.9). An estimated 247 women had colposcopy for every cervical cancer death; in the 15 to 24 year old age group this ratio was 47900:1. A 15 year old woman exposed to current rates of colposcopy (adjusted for hysterectomy) has a 76.8% chance of having a colposcopy during her life time. CONCLUSIONS - Many more women will have colposcopy than will develop cervical cancer, which undermines the cost effectiveness of Australia's cervical cancer screening programme.

Adolescent↗
PubMed1995

Ability of visual tests to predict underlying cervical neoplasia. Colposcopy and speculoscopy.

OBJECTIVE: To describe the attributes of colposcopy and a low-power, magnified examination that utilizes chemiluminescent illumination (speculoscopy) in the visualization of cervical epithelium in a predefined, high-risk population and to compare how the two tests predict cervical histology. STUDY DESIGN: During this multicenter, prospective study, 395 women who were referred to our colposcopy clinic underwent a repeat cervical smear and speculoscopy followed immediately by colposcopy. Abnormal colposcopic lesions were biopsied and endocervical curettage performed when indicated. Histologic diagnoses were compared with cytology, speculoscopy and colposcopy results. RESULTS: Colposcopy was more sensitive than speculoscopy in the detection of cervical neoplasia (97% vs. 82%) (P < .001) and was superior in visualizing focal lesions and vascular patterns. An antecedent acetowhite abnormality detected during speculoscopy was highly predictive of subsequent abnormal colposcopy (97% positive predictive value). The "overall" rate of acetowhite lesions during speculoscopy was nearly half the rate during colposcopy (P < .001). CONCLUSION: Colposcopy is better suited than speculoscopy to the follow-up of patients with abnormal cervical cytology because it facilitates lesion grading and assists in directing biopsies. Speculoscopy is best utilized as a dichotomous screening test based on the presence or absence of at least one well-demarcated acetowhite lesion and may be more suitable than colposcopy as an adjunct to cervical cancer screening due to its lower overcall rate. The biophysical properties of blue-white chemiluminescent light as it relates to the diagnosis of cervical neoplasia are discussed.

Adult↗
PubMed1994

[Preliminary report on the application of colposcopy in screening of cervical carcinoma].

Four hundred and fifty six women were examined by colposcopy in a high incidence area of cervical cancer from May 1988 to June 1990. In the 330 evaluable cases, colposcopic impression correlated accurately with the histologic diagnosis (including difference of one degree) in 95.2% of the cases, while cytology in 71.2% only. Directed biopsies under colposcopy were compared with surgical specimen of 36 patients and the diagnostic accurate rate was 97.2%. The confirmation rate between colposcopy and endocervical curettage was 89.2%. Among 79 patients with cervical cancer, the results obtained by colposcopy and cytology did not show a statistically significant difference (P = 0.9691). However, colposcopy was superior to cytology with regard to the sensitivity of detection of early cervical cancer (88.5% vs 54.4%). When colposcopy was combined with cytology, the diagnostic accurate rate of cervical cancer was further improved (94.9%). This study demonstrated that colposcopy is another reliable method for the diagnosis of cervical cancer and precancerous lesions. The combination of colposcopy with cytology may not only improve the diagnostic accuracy, but also reduce their false negative rate. We would suggest application of colposcopy plus endocervical curettage combined with histopathological examination as an effective approach to improve the quality of screening of cervical cancers.

Carcinoma in Situ↗
PubMed2003

Prospective follow-up suggests similar risk of subsequent cervical intraepithelial neoplasia grade 2 or 3 among women with cervical intraepithelial neoplasia grade 1 or negative colposcopy and directed biopsy.

OBJECTIVE: The purpose of this study was to determine the risk of cumulative cervical intraepithelial neoplasia (CIN) grade 2 or 3 according to initial colposcopy and directed biopsy results among women with low-grade squamous intraepithelial lesions (LSIL) or human papillomavirus (HPV) DNA positive atypical squamous cells of undetermined significance (ASCUS). STUDY DESIGN: A 2-year follow-up of 897 cases of LSIL and 1193 cases of HPV DNA positive ASCUS from the ASCUS/LSIL Triage Study was used to simulate American Society for Colposcopy and Cervical Pathology Consensus Conference recommendations. Women with CIN grade 1 or less were followed up for 2 years by semiannual cytologic examination, with universal exit colposcopy. The clinical end point was a cumulative clinical center histologic diagnosis of CIN grade 2 or 3. RESULTS: The cumulative risk of CIN grade 2 or 3 was equivalent for LSIL (27.6%) and HPV positive ASCUS (26.7%). After excluding the women with a diagnosis of CIN grade 2 or 3 at initial colposcopy and directed biopsy (17.9%), the remaining women were at nearly identical risk for subsequent CIN grade 2 or 3 regardless of initial colposcopy result (completely negative colposcopy-11.3%; negative colposcopically directed biopsy-11.7%; and CIN grade 1 biopsy-13.0%). CONCLUSION: LSIL and HPV positive ASCUS are clinically equivalent. Initial colposcopic detection of obviously prevalent CIN grade 2 or 3 reduces risk. However, for the remaining women who have CIN grade 1 or less on colposcopy and directed biopsy, the risk for subsequent CIN grade 2 or 3 (whether missed, prevalent, or truly incident) is approximately 12% over 2 years. This risk does not vary meaningfully by initial distinction of histologic CIN grade 1 from negative colposcopy and biopsy.

Adolescent↗
PubMed2002

Teaching residents humanistic skills in a colposcopy clinic.

OBJECTIVE: The aim of this project is to add formal training and evaluation of humanistic skills for residents in a colposcopy clinic. Medical education of residents in office procedures has generally focused on proficiency in a particular technical skill and acquisition of clinical knowledge regarding management options. The literature supports assessing pattern recognition with visual images and observing a specific number of procedures to achieve proficiency. Little attention has been given to training residents to demonstrate sensitivity during procedures. However, we believe this is a key element, as the procedure involves anxious patients who are fearful of cancer and fearful of pain in their most private body parts. Further, women who have painful or unpleasant colposcopy procedures are less likely to follow up for further evaluation of treatment and may be at higher risk to develop cervical cancer. DESCRIPTION: Colposcopy training for gynecology residents, family medicine residents, medical students, and emergency room sexual assault nurses is provided at a colposcopy clinic that performs more than 400 procedures per year. The majority of women are referred for colposcopy from outside clinics, and more than one third are non-English-speaking. We have added to our traditional didactics and case instruction curriculum a session dedicated to training residents in humanistic skills related to performing colposcopy. Topics of discussion include (1) how to ask sensitive questions regarding risk factors for cervical dysplasia, (2) how to explain the procedure and obtain consent, especially with non-English-speaking women, (3) how to educate patients about human papilloma virus (HPV) and prevention of cervical cancer, (4) how to speak to the patient and the attending physician during the procedure to reduce rather than increase anxiety, (5) how to provide comfort measures during colposcopy (e.g., using a warm speculum, using local anesthesia, hiding instruments from patient view), and (6) how to review findings during and after procedures. The discussion includes errors that previous residents have made and approaches that create effective, culturally sensitive role models. The training session participants are given feedback regarding statements or actions that may make patients anxious or less comfortable during and following clinical procedures. Residents are evaluated at the end of each rotation by faculty who rate their technical skills, visual pattern recognition, knowledge on the subject, and humanistic qualities. DISCUSSION: The training session participants have responded favorably to feedback about observed interactions with patients during procedures. Indications are that this training may improve the quality of care given by providers during colposcopy and other sensitive procedures. To document the curriculum's effect on patient satisfaction and care, we plan to pilot the use of a patient survey regarding physicians' humanistic qualities.

Colposcopy↗
PubMed1999

Adherence to colposcopy among women with HIV infection.

UNLABELLED: In the general population, nonadherence to the recommendation to have colposcopy in women with abnormal cytologic smears is estimated at 30% to 80%, but studies have failed to identify consistent risk factors for nonadherence. The purpose of this analysis is to assess adherence to colposcopy in a subset of participants in the Women's Interagency HIV Study (WIHS), an ongoing multisite longitudinal study of HIV infection in women in the United States and determine factors associated with nonadherence. Identification of such predictors would be useful in designing strategies to improve adherence in this group. METHODS: Adherence to colposcopy was examined in a cohort of 462 women with, or at risk for, HIV infection with abnormal cervical cytology on entry into WIHS. Adherence was defined as having colposcopy done within 6 months of an abnormal cytology result. RESULTS: Overall adherence to colposcopy was 65% (302 of 462). A multivariate logistic regression model revealed that the odds of adherence were significantly lower for the women who were HIV-infected (p = .011), current crack/cocaine users (p = .040), ever too ill to get medical care (p = .033), not recruited by WIHS study staff (p = .004), and less concerned about the care of their children (p = .037). Among HIV-seropositive women, low CD4 counts, high viral loads, and presence of AIDS-defining illness were not predictive of nonadherence. DISCUSSION: Adherence to colposcopy among WIHS participants was at the upper limit of the reported range in the United States. Chemical dependency and domestic violence may negatively impact on colposcopy adherence whereas supportive study personnel, having health insurance, and concerns about raising one's children appear to be motivators for adherence to colposcopy in this study. HIV infection was a risk factor for nonadherence, but markers of advanced disease were not predictive of nonadherence.

Adult↗
PubMed1992

Survey of colposcopy service provided by genito-urinary medicine in England and Wales.

OBJECTIVE: To investigate the expansion of colposcopy services within genito-urinary medicine (GUM) in England and Wales since 1985. DESIGN: Data collected by postal and verbal communication from 189 genito-urinary medicine clinics in England and Wales in January 1990. SUBJECTS: Consultant and junior genito-urinary physicians practising colposcopy. MAIN OUTCOME MEASURES: Number of clinics providing colposcopy service; indication for colposcopy, treatment facilities available, waiting lists and training opportunities, compared with that in 1985. RESULTS: Of the 189 genito-urinary medicine clinics contacted, 60 provided a colposcopy service and 55 of these returned completed questionnaires. There has been a 67% increase in the number of colposcopies in use and over 50% of clinics have the facilities to treat cervical pathology. Waiting lists were minimal for both examination and treatment. Both men and women are examined with the colposcope for a variety of indications. At present, 52% of career grade GUM physicians practise colposcopy compared to 24% in 1985 and 94% of senior registrars compared with 42% in 1985 were in training or trained in colposcopy.

Colposcopy↗
PubMed2006

A long-term study of women with normal colposcopy after referral with low-grade cytological abnormalities.

BACKGROUND: About 50,000 women are referred annually to colposcopy in England because of a low-grade smear. About 35% of these women have no colposcopic abnormality but are followed up in the colposcopy clinic because of uncertainty about the risk of significant pathology. OBJECTIVE: This study determined the 5-year rate of disease when initial colposcopy was normal and smear was non-dyskaryotic. DESIGN: Retrospective study. SETTING: Colposcopy clinic of an inner city postgraduate teaching hospital. Population Two thousand one hundred and fifty seven women referred between January 1990 and December 2001 with mild dyskaryosis (Low Grade Squamous Intraepithelial Lesion [LSIL]) or borderline nuclear changes (Abnormal Squamous Changes of Uncertain Significance [ASCUS]). METHODS: Information was obtained from the colposcopy clinic database and Open-Exeter. Time plots of the disease-free rates were generated using the Kaplan-Meier method, and statistical comparisons were performed using Cox regression. MAIN OUTCOME MEASURES: Cumulative rates of cytological and histological abnormalities. RESULTS: High-grade or invasive disease was diagnosed histologically in 12.8% of 805 women referred with borderline nuclear changes and in 35.8% of 1352 referred with mild dyskaryosis. Among 620 women with normal colposcopy and a negative or borderline repeat smear, high-grade disease was found after 5 years of follow up in 1.3% of women originally referred with a borderline smear and in 8.5% referred because of mild dyskaryosis. CONCLUSION: Women referred to colposcopy with borderline nuclear changes or mild dyskaryosis whose colposcopy findings are normal and whose repeat smear in the clinic is non-dyskaryotic may be discharged for routine 3-yearly screening in the community because the risk of high-grade disease in the next 5 years is small.

Adult↗
PubMedDate not supplied

Comparing two modalities of management of women with cytologic evidence of squamous or glandular atypia: early repeat cytology or colposcopy.

Early repeat cytology is recommended in most screening programs for cervical cancer in subjects with squamous or glandular abnormalities not amounting to neoplasia (atypical squamous cells of undetermined significance, ASCUS), but immediate colposcopy is also recommended in some countries, especially those where there is easy access to colposcopic facilities. We evaluated the cost-effectiveness of the two procedures in a prospective study of women with cytologic ASCUS, invited to cytocolposcopic assessment after 6 months. Colposcopy-directed biopsy was assumed as the gold standard, and the accuracy of colposcopy at 6 months was assumed to be equal to that of immediate colposcopy. Out of 874 compliers, punch biopsy was performed in 303 cases (34.7%), and 19 CIN2+ lesions were detected (CIN2 = 12, CIN3 = 6, microinvasive carcinoma = 1). Detecting 13 CIN2+ lesions at colposcopy required 874 colposcopies and 303 directed biopsies: the cost per CIN2+ lesion detected with the procedure was 2,749 US$. Detecting 15 CIN2+ lesions at repeat cytology required 874 cytologic examinations, 137 colposcopies, 64 directed biopsies, and 6 diagnostic large-loop resections, the latter being performed in subjects with high-grade squamous intraepithelial lesion and less severe lesions at punch biopsy: the cost per CIN2+ lesion detected with the procedure was 1,961 US$. The policy of repeat smear was more cost-effective than immediate colposcopy. According to such results, the protocol of the Florence screening program has been modified since October 1996.

Adult↗
PubMed1999

[Integrated colposcopy and phase contrast microscopy for diagnosis of squamous intraepithelial lesions and invasive cervical neoplasms].

Colposcopy or cytology examinations alone allows to obtain diagnostic concordance with histopathological examination between 74-89% and 68-86%, respectively in SIL and cervical cancer detection. Both methods used simultaneously allow increase concordance with histopathology up to 95-100%. Cytological examination may be used simultaneously with colposcopy when Ph microscopy is used. The aim was to estimate benefits of conjunction of colposcopy and Ph cytology in SIL and cervical cancer detection in daily gynecological practice. Integrated colposcopy and cytology examinations were performed in 200 patients. Cervico-vaginal smears were obtained from the patient before Acetic-Acid Test and Lugol-Solution-Test were performed. Wet smears (Ph) were made. Results of integrated colposcopy and cytology were verified by histopathological examination. Diagnostic specificity, sensitivity, and Youden's value were estimated for Ph cytology, H-E cytology, and colposcopy alone and for integrated colposcopy and Ph cytology. Simultaneous colposcopy and Ph cytology reveal specificity 97.1% sensitivity 94.6% and Youden's value 91.8% thus provide fast, reliable and comprehensive information for accurate diagnosis in daily gynecological practice.

Carcinoma, Squamous Cell↗
PubMed1999

[Long term progress of low-grade intraepithelial lesions after a smear and colposcopy, directed biopsies and/or normal endocervical curettage].

Low-grade squamous intraepithelial lesions and atypical squamous cells of undetermined significance are the most frequent cytologic abnormalities. Their management is still highly controversial because of the many uncertainties associated with them concerning their histology and their natural history. Cervical smears HPV testing were proposed as an alternative to colposcopy. Neither have a sensitivity equivalent to that of colposcopy. The diagnosis of these abnormalities could be delayed, and a severe lesion may even remain undetected because the cytologic surveillance is frequently omitted, smear sensitivity is far from being perfect and correlation is poor between cytology and histology. The combination of smears with the detection of high risk HPV types increases the triage sensitivity before colposcopy to the detriment of specificity and predictive value, and, therefore, of cost. With colposcopy the histologic diagnosis is rapidly reached and therapeutic management becomes easier because the size and location of the lesion are precisely known. However, the long-term outcome of patients with a normal colposcopy is very poorly known. Our study including 212 patients with a mean follow-up of 79 months, showed an incidence of lesions similar to that found in a control group; 12 CIN (5.7%) were identified, but no cancer. The prevalence of CIN was significantly lower in patients whose initial colposcopy was normal or became normal within the first six months that in patients whose control smear was normal or became normal within six months (1/81 = 1.2% versus 8/143 = 5.6%; P > 0.05). No lesions were observed in patients whose colposcopy and control smear were normal. These results confirm the reliability of colposcopy in patients with minor cytologic abnormalities.

Adolescent↗
PubMed1991

Development of a curriculum in colposcopy.

BACKGROUND: Colposcopy for the detection of genital malignancy and disease associated with human papillomavirus, along with cytologic screening and histopathologic correlation, allows for intervention before the onset of invasive disease. Family physicians are interested in learning colposcopy, but there are few reports in the literature on the training of colposcopists. METHODS: A colposcopy curriculum for family physicians was designed with goals, objectives, and instructional strategies selected to enhance learning and quality assurance of the current principles of colposcopic evaluation. During the pilot project, a third-year resident studied a syllabus and reviewed slides, practiced performance skills, and observed colposcopies. After demonstrating competence, the resident evaluated patients with instructor supervision and feedback. RESULTS: Resident performance data from written test scores and a performance checklist indicated an excellent learning curve. High resident satisfaction was reported. Suggestions from expert reviewers were incorporated into the final curriculum product. The evaluation data indicated that, based on this pilot program, family practice residents can effectively learn colposcopy. CONCLUSIONS: Colposcopy is a highly technical skill that can be learned by family physicians through professional training. Competency in colposcopy can provide a new dimension to their practice in the diagnosis and treatment of female lower-genital-tract disease. This colposcopy curriculum is an initial effort in the identification of the content and process required to train family physicians in the use of this diagnostic procedure.

Clinical Competence↗
PubMed1994

Anal colposcopy and the diagnosis of anal intraepithelial neoplasia in high-risk gynecologic patients.

The objective of this study was to define the colposcopic features of the normal anal canal and of anal human papillomavirus (HPV)-associated lesions, including anal intraepithelial neoplasia (AIN), and to correlate the colposcopic impression with the final histopathologic diagnosis. A controled colposcopic screening study of women considered at risk for HPV-associated anal epithelial abnormalities was carried out. All colposcopic assessments included a biopsy with matching histopathologic diagnosis. The study group consisted of 213 women who were considered at risk of anal HPV infection and AIN. A further group of 50 women, who had no previous history of ano-genital HPV infection or AIN and whose recent cervical smear was negative were recruited as controls. Informed consent was obtained from all patients, and the study was approved by the local ethical committee. In the control group of 50 women no AIN was detected. Normal histology was obtained in 45/50 (90%) biopsies where normality had been predicted on colposcopy. Histologic diagnosis in the at-risk group was normal in 143 (67%), subclinical papillomarvirus infection (SPI) in 24 (11%), and AIN of all grades (including three cases of early invasive squamous cancer in a field change of AIN III) in 46 (22%) patients. Nineteen of 24 (79%) cases of SPI were incorrectly predicted as normal on colposcopy, and another one (4%) as AIN I-II. Only four (17%) cases of SPI were correctly predicted at colposcopy. Of the 46 cases of histologically proven AIN, 26 (56%) were AIN I-II, and 20 (44%) were AIN III. Some 50% of AIN I-II were incorrectly predicted as SPI on colposcopy. Of the 20 AIN III lesions, 15 (75%) were correctly predicted by colposcopy. Three (20%) of these lesions contained foci of early invasion, of which in only one case (33.3%) was invasive disease suspected at colposcopy. Some 25% (5/20) of AIN III lesions were incorrectly diagnosed as AIN I-II at colposcopy. As is the experience with colposcopic assessment of the cervix, anal colposcopy predictions correlated well with the final histologic diagnosis, at the normal and high-grade AIN ends of the spectrum. The colposcopic predictive distinction between SPI and low-grade AIN (I-II) was less accurate. It was difficult to distinguish early invasive lesions within a field change of AIN III, from pure AIN III. In these studies there were three cases of early anal squamous carcinoma arising in AIN III lesions, two of which were unsuspected clinically.

Journal Article↗