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PubMed1981

Colposcopy and cytology in young women up to the age of 20: an analysis of 401 cases research for a new screening programme.

The Authors have observed by colposcopy and cytology, 401 patients under the age of 20 and have compared the results obtained with those of a similar control group with ages ranging from 20 to 25. They observed the incidence of normal cervix and of other colposcopic reports. From the comparison between the colposcopic and cytologic data emerged that the cytopathologic diagnosis does not put the cervical alterations of inferior level than dysplasia in evidence, in a large number cases as colposcopy does. There is a very close relation between the incidence of pathologic cervical lesions and sexual activity. Correlation between cervical pathology and use of hormonal contraceptives and presence of cervico-vaginal phlogosis, was not possible in this type of survey. The Authors therefore propose a new type of mass screening, which should substitute the actual one, that is substantially based on cytology and on early diagnosis rather than prevention.

Adolescent↗
PubMed1982

The value of colposcopy in evaluating cervical intraepithelial neoplasia during pregnancy.

Two hundred eighty-three patients with abnormal Papanicolaou smears of the cervix underwent colposcopic examination during pregnancy. Two hundred fifty-six were biopsied and 27 patients were not. Forty-five patients had cone biopsies done during the postpartum period. Despite previous reports which have shown colposcopy as a safe and accurate method of investigating an abnormal Pap smear during pregnancy, this study advocates colposcopy and biopsy as complementary procedures without serious complications.

Adult↗
PubMed1982

Colposcopy, conization, and hysterectomy practices: a current perspective.

Data from the provincial cytology program has shown a progressive increase in the number of cases of cervical carcinoma in situ detected in the general population and a doubling of disease rate in third decade women, with most of the cases now in the 25- to 29-year-old age group. The introduction of a colposcopy service has led to a significant decrease in the number of diagnostic conizations performed over a 5-year period. Conization was still used for therapy in a substantial number of women despite the availability of cryotherapy and laser surgery. Eighty-five percent of all patients undergoing cone biopsy had sever dysplasia or carcinoma in situ (CIN III) on pathological examination. In 25% of patients, the conization specimen revealed either dysplasia or carcinoma in situ extending to resection margins. During review of 2249 patients, 1174 were spared a conization and were treated by either hysterectomy, cryotherapy, or laser surgery. It would appear that, although colposcopy can reduce dramatically the number of diagnostic cone biopsies, conization will still be required for therapy in a substantial number of patients.

Adult↗
PubMed1978

Colposcopy in anorectal disease.

If used properly, colposcopy will increase the scope of anorectal examination. It will allow for more precise diagnosis and early diagnosis of rectal, anal and perianal neoplasis during dysplastic phase. It is accepted today that, in its natural course, neoplastic lesions progress from dysplasia through intraepithelial neoplasia to invasive cancer as an interrelated function of time and immunologic status. If dysplasia and intraepithelial neoplasia is present for ten years prior to invasion, as has been suggested, the use of colposcopy in the younger aged patients could help reduce the incidence of invasive disease later.

Anus Neoplasms↗
PubMed1981

Colposcopy and cytology in young women up to the age of 20: an analysis of 401 cases research for a new screening programme.

The Authors have observed by colposcopy and cytology, 401 patients under the age of 20 and have compared the results obtained with those of a similar control group with ages ranging from 20 to 25. They observed the incidence of normal cervix and of other colposcopic reports. From the comparison between the colposcopic and cytologic data emerged that the cytopathologic diagnosis does not put the cervical alterations of inferior level than dysplasia in evidence, in a large number cases as colposcopy does. There is a very close relation between the incidence of pathologic cervical lesions and sexual activity. Correlation between cervical pathology and use of hormonal contraceptives and presence of cervico-vaginal phlogosis, was not possible in this type of survey. The Authors therefore propose a new type of mass screening, which should substitute the actual one, that is substantially based on cytology and on early diagnosis rather than prevention.

Adolescent↗
PubMed1980

The essential place of colposcopy in gynaecological practice.

If routine cytoloical examination of a cervical smear reveals an abnormality short of invasive carcinoma, colposcopic examination, plus directed biopsy of the cervix, is the procedure of choice. Cytological examination is a laboratory technique, whereas colposcopy is a clinical diagnostic method. When the latter is used, anaesthesia and hospital admission are not required, and the hazards and limitations of cone biopsy of the cervix are avoided. The technique of colposcopy is a significant advance in gynaecology, and training in this method should be part of the curriculum for a higher qualification in gynaecology.

Biopsy↗
PubMed1980

The role of colposcopy in the management of cervical intraepithelial neoplasia during pregnancy and postpartum.

We made a colposcopic study of 149 pregnant patients with suspicious or positive Papanicolaou smears. Characteristic changes in the colposcopic images were noted to be physiologic eversion of the squamocolumnar junction, glandular hypertrophy and decidual reaction. Fourteen percent of the patients with suspicious Papanicolaou smears were normal by colposcopic examination. Sixteen percent of colposcopic interpretations of the pregnant cervix suggested CIN when in fact none was present on tissue specimens obtained by directed biopsies. There was a good correlation between colposcopic clinical diagnosis and directed tissue biopsies (79%). Furthermore, there was a strong correlation between colposcopically directed tissue biopsies and subsequent cone and hysterectomy specimens (29 cases). All cases with suspicious cytology and CIN based on colposcopic findings (130 patients with satisfactory colposcopic examinations) were managed conservatively. No invasive neoplasia was subsequently detected in this group. Morbidity for colposcopically directed biopsies in pregnancy was negligible. No massive hemorrhage, premature labor, abortion or infection occurred. Treatment for CIN was accomplished following the puerperium by cryocauterization (101 cases), conization (8 cases) or hysterectomy (21 cases). Colposcopy cannot be a substitute for histologic diagnosis. However, it supplies enough data to avoid unnecessary cone biopsies. Only 19 diagnostic cone biopsies were performed during pregnancy with the indication of positive cytology and unsatisfactory colposcopy.

Adolescent↗
PubMed1976

The respective roles of cytology and colposcopy in obstetric and gynecologic practice.

The use of cytology in evaluating the state of the uterine cervix is well recognized and accepted in the United States. The role of colposcopy has not been completely defined although its acceptance is slowly gaining ground in many clinics. It is the purpose of this article to compare the two methods and to discuss the relationship of these methods to each other. Most attention will be directed to cytology and colposcopy of the cervix. However, the applications of both methods to evaluation of the vulva and vagina will also be considered.

Cervix Uteri↗
PubMed1995

An investigation into the default rate at the Fife colposcopy clinic: implications for target setting.

BACKGROUND: High default rates have been reported from the Fife colposcopy clinic in recent years. However, it was felt that this rate was misleading, as many patients who defaulted initially attended subsequent appointments. It was therefore decided to determine the default rate of a cohort of new patients given appointments at the clinic. The objective of the study was to determine the attendance rates for these new patients, between the dates they were first invited to their various appointments and the dates that their notes were subsequently examined as part of this study in September 1992. METHODS: A retrospective cohort study of new patients invited to the Fife colposcopy clinic was undertaken. The notes of 200 new patients who had been invited during the eight-month period January-August 1991 were selected by systematic sampling. The dates that they had attended for their new patient assessment/treatment, first follow-up and second follow-up appointments were recorded. Attendance rates were then calculated using an incomplete life-table method. Patients were censored if they failed to attend their assessment/treatment or review appointments by 1 October 1992. RESULTS: The study demonstrated that 96 per cent of patients attended their first treatment appointment within six months of their appointment date, 91 per cent of first review patients attended within six months, and 88 per cent of second review patients attended within four months. CONCLUSIONS: These findings suggest that there are two distinct groups of defaulters: those who default initially but subsequently re-attend, and those who default completely. We have named these type A and type B defaulters, respectively. This means that attendance within a certain period of time should also be used to monitor clinic attendance in addition to simple mean attendance rates. As patients who default completely may be more likely to have a severe histological lesion, further work is required to identify factors associated with this type of patient.

Adult↗
PubMedDate not supplied

[Role of colposcopy in high-grade CIN (CIN II-III)].

We have considered the colpo-cytologic characteristic of 83 patients with CIN II-III histologic lesions over 900 colposcopic biopsies carried out at our Department from 1990-1992. In particular 38 cases were classified as CIN II of which 23 associated with HPV cytopathic feature, while 45 cases were, classified as CIN III, of which 13 associated with HPV c.f. 29% of CIN II were evident in women under 30 years of age; in this group the age decreased with the presence of HPV. 31% of CIN III were present in women under 35. A good correlation between cytologic and histological analysis on the same patient was observed particularly in CIN with the higher grade. Also a good correlation between colposcopy grading and CIN was observed. In CIN II, grade I images were present, while in CIN III, punctuation and white epithelium were the most common features. Our study shows also the impossibility of distinguishing between the images of simple viral infection and their related CIN morphologic patterns. Colposcopy represents a basic test for the definition of CIN, particularly for those with higher grade, and a complementary test for the definition of the topography of the lesions with the correct choice of the therapeutic treatment.

Adult↗
PubMed1994

Detecting premalignant cervical lesions. Contribution of screening colposcopy to cytology.

The combination of parallel cytology and screening colposcopy was found to increase the detection of premalignant cervical lesions from 8.2% in a group of patients (based on cytology alone) to 15.3% in that group (based on the combination). The combination of the two methods used in parallel increased the sensitivity, negative predictive value and efficiency of cervical cancer screening over cytology alone while having only a small negative impact on the positive predictive value of a positive test. The addition of screening colposcopy to cytology produces a significant improvement over current uniphasic screening protocols.

Biopsy↗
PubMed1993

Screening for human immunodeficiency virus and sexually transmitted diseases in an inner-city colposcopy clinic.

Among patients attending an inner-city colposcopy clinic, the prevalence of Chlamydia trachomatis was 22/375 (5.0%), Neisseria gonorrhoeae, 3/375 (0.8%), and seropositivity for syphilis, 10/375 (2.7%). In addition, 13/261 (5.0%) of asymptomatic women agreeing to voluntary human immunodeficiency virus (HIV-1) antibody screening were HIV-1 seropositive. Our data support incorporating screening for and education on sexually transmitted diseases and HIV into the work of our colposcopy clinic.

Adolescent↗
PubMed1993

Women with human immunodeficiency virus infection and abnormal Papanicolaou smears: a prospective study of colposcopy and clinical outcome.

OBJECTIVE: To determine the effect of human immunodeficiency virus (HIV) infection on colposcopic and histologic findings and clinical outcome in women who have abnormal Papanicolaou smears. METHODS: We conducted a prospective study of women with abnormal Papanicolaou smears from among those participating in a longitudinal study of HIV infection, human papillomavirus infection, and genital neoplasia. Women with squamous intraepithelial lesions (SIL) on blindly interpreted Papanicolaou smears were referred for colposcopy and standard gynecologic care. Colposcopic and histologic findings were correlated with cytology, and differences between HIV seropositives and seronegatives were analyzed. RESULTS: Thirty-eight of 48 women referred underwent colposcopy, of whom 36 (94.7%) had colposcopic or histologic findings no more severe than those suggested by Papanicolaou smear. Seventeen of 25 HIV seropositives (68%) had cervical or vaginal condyloma or neoplasia, compared with three of 13 seronegatives (23%) (odds ratio [OR] 7.1, 95% confidence interval [CI] 1.5-33.0). Among seropositives, seven (28%) had cervical intraepithelial neoplasia (CIN) grade II or III; ten (40%) had cervical or vaginal condyloma, CIN I, or both; and eight (32%) had no vaginal or cervical SIL. There was no case of invasive carcinoma. Seven seropositives (28%) had or developed multicentric disease, compared with no seronegatives (P = .07). Follow-up ranged at 3-37 months and showed that all three treated seronegative women and five of ten treated seropositive women had normal examinations. Three seropositive patients had persistent disease without progression, and two had progression of condyloma. No CIN II, CIN III, or invasive carcinoma was seen during follow-up. CONCLUSIONS: Among women seropositive for HIV who had SIL on a Papanicolaou smear, colposcopic and histologic findings were predicted reliably by the cytologic smear. Rapid progression of CIN after standard gynecologic care for early genital lesions was not seen.

Acquired Immunodeficiency Syndrome↗
PubMed1977

Colposcopy and selective biopsy in patients with abnormal cervical cytology.

Patients with atypical or positive findings on cervical cytology should be referred to a special colposcopy clinic as the next step in investigation. Colposcopy complements cytology, and when combined with selective biopsy of the worst-affected area allows a high level of diagnostic accuracy (90,7%). The necessity for diagnostic conization with its risks is markedly reduced. When all three modalities were used in combination, only 0,7% of invasive cancers were missed.

Adult↗
PubMed1997

Validity of colposcopy to identify and grade squamous intraepithelial lesions among Venezuelan women.

To assess the validity of colposcopy to correctly detect and grade squamous intraepithelial lesions (SIL) in Venezuelan women, we did a prospective, nonrandomized and cross sectional study on patients referred with low-grade and high-grade SIL. After a second cervical smear, they were colposcopically evaluated and biopsied. The outcome measures were interobserver variation, sensitivity, specificity, and predictive values. Ninety-nine patients were evaluable. Colposcopy had poor agreement with repeat cervical smears, and moderate to good agreement with conization biopsy (kappa = 0.55; 95% C.I.: 0.45 to 0.65), with a sensitivity of 0.87, a specificity of 0.69, a positive predictive value of 0.85 and a negative predictive value of 0.71 for high-grade SIL. The criterion of colposcopic vascular atypias was accurate enough to detect and grade SIL, showing good agreement with histopathology. Because of the disparity of results in previous reports, only a carefully designed, randomized study will settle this question.

Adult↗
PubMed1998

Ineffectiveness of topical benzocaine spray during colposcopy.

BACKGROUND: Colposcopic evaluation can cause patients to experience pain and anxiety. This study investigated the use of benzocaine spray, a topical anesthetic, and its effects on pain and anxiety associated with colposcopy and colposcopic biopsy. METHODS: The study was a double-blind, placebo-controlled trial of the effectiveness of benzocaine spray applied to the cervix immediately before colposcopic examination, cervical biopsy, or endocervical curettage in patients of a family practice center. Prior to the gynecologic procedure the patient's cervix was sprayed with either benzocaine spray or matching placebo spray. After waiting at least 30 seconds the clinician started the procedure. Pain and anxiety, measured on 10-cm visual analog scales, were determined at the following times: (1) before the start of the gynecologic examination; (2) immediately before using the spray; (3) immediately after using the spray; and, (4) after the procedure was completed. RESULTS: Of 58 consecutive patients who underwent colposcopy, 36 patients were eligible for the trial and were evaluated. Participants were similar to patients not participating with regard to race, gravidity, and parity. Statistical analysis found significant differences in both pain and anxiety scores over time (repeated measures multivariate ANOVA, P < .0001), but no difference between the use of active drug and placebo. Pain scores increased significantly after application of either benzocaine or placebo spray before the start of the procedure (average increase 1.3 cm, P < .0001). CONCLUSIONS: Benzocaine, in a spray vehicle, confers no benefit when used to decrease pain and anxiety in women undergoing colposcopic procedures.

Administration, Topical↗
PubMed1976

Management of cervical neoplasia with colposcopy.

During a 44-month period the introduction of colposcopy to a metropolitan dysplasia clinic resulted in 1, 144 colposcopic examinations on 442 patients. Agreement between colposcopically directed biopsy and final diagnosis was found in 84%, and directed biopsy revealed the most advanced lesion in 42.5%. Satisfactory colposcopy was performed on 93% of patients, and some degree of histologic abnormality was obtained in 86% of patients with colposcopic abnormalities. Undetected invasive cervical cancer occurred in both cervical conization and colposcopic examinations with equal frequency. Endocervical curettage detected two cases of occult invasive cancer, and increased use of this procedure is recommended. Guidelines for management of cervical neoplasia are suggested.

Biopsy↗
PubMed1987

Detection of DNA of human papillomavirus types 6/11 and 16/18 in cell scrapings of the uterine cervix by filter in situ hybridisation. Correlation with cytology, colposcopy and histology.

The application of filter in situ hybridisation (FISH) to detect the presence of the DNA of human papillomavirus genotypes 6/11 and/or 16/18 in cell scrapings of the uterine cervix of 248 women in Western Australia is described. The results obtained by FISH are related to cervical dysplasia as assessed by cytology, colposcopy and histology. The detection of HPV infection was more sensitive and specific by FISH than by either histological/cytological evidence of an HPV cytopathic effect (koilocytosis) or immunohistochemical staining for HPV capsid antigen using antiserum against genus specific antigen of the bovine papillomavirus. Viral DNA was detected by FISH in 65% of women with atypical cytology and of the HPV positive cases, 68% were HPV 16/18, 22% HPV 6/11 and 10% of mixed types. HPV-DNA was detected in the cervical smears of 16 women who also had HPV capsid antigen (HPV-Ag) in their cervical biopsies; HPV 6/11 was found in 4 cases and HPV 16/18 in 12 cases. The relative frequency of the HPV-Ag positive cases decreased markedly from 44% to 4% with an increase in the severity of cervical dysplasia. By comparison, the percentage of HPV-DNA positive cases remained relatively constant between 70% and 80% for all 3 categories of dysplasia. Of these, the percentage of HPV 6/11 positives decreased slightly with an increase in the severity of dysplasia as assessed by either cytology or histology, whereas the percentage of HPV 16/18 positive cases was relatively constant. HPV-DNA was found in cervical smears of 11 of 48 (23%) women who were diagnosed colposcopically to have atypical transformation zone of the cervix. In 138 women with an atypical transformation zone, 96 (70%) were found to have HPV-DNA with HPV 16/18 contributing to 83% of the HPV positive cases. All four genotypes of HPV were found to be associated with the colposcopic morphology of mosaicism (26 cases) but only HPV 16/18 was found in 12 HPV-DNA positive cases associated colposcopically with punctation and an atypical transformation zone. The detection and typing of HPV-DNA in cell scrapings by FISH is a relatively fast and non-invasive procedure which complements cytology, colposcopy and histology and should be useful in further studies of the natural history of different HPV infections and their role in cervical cancer.

Adolescent↗