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PubMed1989

Colposcopy, biopsy, and cytology results in women with chlamydial cervicitis.

Colposcopy and biopsy were carried out at diagnosis and at follow up of 222 women. Of 322 cervical biopsy specimens taken, 174 were from women with chlamydial cervicitis (patients) and 48 from control women (both at diagnosis) and 100 from 76 patients and seven controls at follow up. Of the 174 patients with chlamydial cervicitis, 158 (91%) had erythema compared with 9/48 (19%) controls, and 140 (81%) had "follicles" and lumps compared with three (6%) controls. The cervical polymorphonuclear leucocyte (PMNL) count in a high power (x 1000) field (HPF) was 85 in patients compared with 47/HPF in controls. Cervical ectopia was found in 154 (89%) patients compared with 32 (67%) controls. After treating the 174 patients, we found erythema in nine (5%) and "follicles" in 16 (9%); both conditions were disappearing. Lymphocytic germinal follicles were found on histology in only 5/165 patients compared with none in controls or in patients at follow up examination (after treatment for chlamydial cervicitis). Inclusions were found in 6/165 patients compared with none in controls or patients at follow up. Chlamydiae were found on electron microscopy in slides from seven out of 159 patients compared with none from controls or 81 subjects at follow up. Estimating numbers of inflammatory cells and measuring vascularity showed diffuse increases in lymphocytes and plasma cells and increases in vascularity in both endocervical and exocervical tissue of patients with chlamydial cervicitis. These increases were lessened by treatment.

Adolescent↗
PubMed1989

Recognising covert disease in women with chronic vulval symptoms attending an STD clinic: value of detailed examination including colposcopy.

A vulval colposcopy clinic was established in the sexually transmitted diseases (STD) clinic of St Mary's Hospital, London, to investigate patients with chronic symptoms (mean duration 3 1/2 years). Fifty patients with a mean age of 33 were studied for 12 months, and a specific diagnosis was established for many of them. Forty complained of pruritus vulvae, 33 of dyspareunia, and 30 of vulvodynia. One or more macroscopic abnormality was seen in 29 of the women, the most common being erythema, papules, plaques, and fissures. Colposcopic abnormalities, however, were identified in 45 of the women, the most common being acetowhite epithelium in a flat, papillary, or cobblestone pattern. Biopsy specimens were obtained from 33 of the patients, and all had abnormal histological features. Those of human papillomavirus (HPV) infection were the most common, and were found in 27 specimens; evidence of vulval intraepithelial neoplasia was seen in seven and that of dermatoses in 10. Further work is required, however, before concluding that HPV was necessarily responsible for the chronic symptoms.

Adult↗
PubMed1991

Anal human papillomavirus infection: a comparative study of cytology, colposcopy and DNA hybridisation as methods of detection.

OBJECTIVE: To compare anal cytology, colposcopy and DNA hybridisation as methods of detecting anal HPV infection. SUBJECTS AND DESIGN: Patients attending: (1) a genitourinary medicine (GUM) clinic with ano-genital warts; (2) a surgical out-patient department with anal fissure or haemorrhoids were examined for evidence of anal HPV infection. RESULTS: Considering GUM clinic attenders, 17% (38/225) and 40% (90/225) had perianal or anal canal warts respectively. Colposcopic examination revealed anal acetowhite lesions without warts in 28% (63/225). Cytological evidence of HPV infection was found in 98%, 83%, and 90% of patients with anal canal warts, perianal warts and acetowhite lesions respectively. Anal intraepithelial neoplasia (AIN) was documented in 22% of patients with anal canal warts compared with 6% with perianal warts (p less than 0.01). HPV DNA was detected from the anal brushings of 71%, 50%, 32%, and 29% of patients with anal canal warts, perianal warts, acetowhite lesions and a normal anal examination respectively. HPV type 6/11 was detected in the majority of HPV positive samples. Considering surgical out-patient attenders with no history or signs of anal warts, 25% showed cytological evidence of anal HPV infection and HPV DNA was detected from anal brushings in 3% (2/71). CONCLUSION: Anal examination with the colposcope is a useful method for detecting subclinical HPV infection. Anal cytology may prove helpful for detecting AIN, however, since koilocytosis was rarely seen, the specificity of the cytological criteria for anal HPV infection in the absence of AIN is uncertain. DNA analysis of anal brushings proved only moderately sensitive.

Adult↗
PubMedDate not supplied

Cervical acid phosphatase: a biomarker of cervical dysplasia and a potential surrogate endpoint for colposcopy.

BACKGROUND: In 2000, cervical acid phosphatase (CAP) has been recently described as a biomarker labeling abnormal squamous cells on Pap smears (USPTO #6,143,512). The enzyme activity is presented as a red, granular deposit on a modified Papanicolaou background. This unique property was utilized for development of MarkPap technology intended for cervical cancer screening. MATERIAL/PATIENTS & METHODS: We conduct a multicenter, random assignment, assessor blinded, 2-group (test and control), split-sample designed clinical trial on 1,500 subject/specimens to assess safety and efficacy of the new test, in comparison with the control, for cervical cancer screening in standard Pap test environment. Safety is measured with frequency, severity and relation of adverse events. Efficacy is measured with primary endpoints (portion of positive/abnormal specimens detected, and the false negative rate). At the end of the follow-up period (two years) when the study will be completed, other efficacy endpoints such as accuracy (sensitivity/specificity) and predictive values will be added to the method evaluation. Here we present in interim analysis. RESULTS: In April 2003, the recruitment was completed and the first twelve hundred cases have been evaluated. There was no serious or related adverse event in both groups. Minor, unrelated adverse events were rare and insignificantly distributed in both groups. PRIMARY ENDPOINTS: A: Portion of positive/abnormal specimens detected: Pe (new test) = 0.166, Ps (Pap control): 0.082; Ps' (ACS reported value for US in year 2000): 0.07. Pe >/= Ps + delta, for delta = 0.5Ps. B. False negative rate: Pe = 0.05, Ps' = 0.10. Confidence intervals: 95% CI: Test [0.148-0.193], Pap control [0.068-0.098]. OR = 2.26. chi2 = 40.69101 is greater than the critical value of 3.841 (P < 0.01). CONCLUSION: We concluded that CAP had added to visibility of Pap test and has enabled cytoscreeners to significantly improve the detection of positive/abnormal specimens and reduce false negative rate. We discuss this unique property of CAP with emphasis on using it as a surrogate endpoint for colposcopy and eventual removal of a cervical lesion that, if untreated, could progress into cancer.

Acid Phosphatase↗
PubMedDate not supplied

Repeat cervical cytology at the time of colposcopy. Is there an added benefit?

OBJECTIVE: To determine if repeating the Pap smear (PS) at colposcopy offers added benefit in the detection of cervical squamous intraepithelial lesions (SILs). STUDY DESIGN: Eight hundred fifty-two women were subjects of this study. Patients with cervical SIL were defined as women with SIL on the repeat PS, or SIL on the colposcopic cervical biopsy (bx) or a negative repeat PS and bx but confirmed SIL on both the previous and follow-up PS or bx. The sensitivities of repeat PS and bx in detecting SIL were calculated. The chi 2 test was used to assess statistical significance. The total cost of repeating the PS was calculated by multiplying the total number of patients (852) by the estimated cost of a single PS ($25). RESULTS: The sensitivities of repeat PS, bx and PS/bx combined were .89, .69 and .92 for low grade SIL (LSIL) and .74, .77 and .98 for high grade SIL (HSIL), respectively (P < .0001). Sixteen percent of the HSIL and 28% of the LSIL cases were diagnosed on repeat PS only (negative bx). If repeat PS was omitted, $21,300 would have been saved.

Biopsy↗
PubMedDate not supplied

Contribution of cytology, colposcopy, target biopsy and conization to the early diagnosis of precancerous and cancerous lesions of the cervix uteri.

The study is based on 334 cytologic suspect or positive women observed in the area of Florence. Cytologic diagnoses of dysplasia, carcinoma in situ (CIS), and invasive carcinoma are related to the histologic reports. To the same histologic reports are related the colposcopic aspects. Lastly, diagnoses made by target biopsy are compared with the final diagnoses made by cone biopsy. The 3 diagnostic methods and their diagnostic accuracy are then compared. As regards dysplasia, the diagnostic precision of cytology is 40.2% and for target biopsy in 76.9%. In the diagnosis of CIS, cytology shows a diagnostic accuracy (77.7%) that is a little lower than that of target biopsy (81.7%). In invasive carcinoma, cytology has a good diagnostic precision (88.2%), which becomes 100% if the diagnosis is made by target biopsy. The correlation between colposcopic aspects and histologic reports is not very reliable. We conclude that cytology is a valid test in an extensive mass screening, that colposcopy is essential to execute target biopsy, and that the latter is useful in defining dysplasia and invasive carcinoma diagnoses. On the contrary, in the case of CIS, target biopsy does not greatly increase cytology diagnostic precision.

Biopsy↗
PubMedDate not supplied

Training in colposcopy: experience with a videocolposcopy test.

The authors evaluate the results of a videocolposcopy test (330 total cases, 12 cases of histologically confirmed CIN2 or more severe lesions) taken by 9 accredited and 17 unaccredited colposcopists during 1995. Seven of 9 accredited and 4 of 13 unaccredited colposcopists reached the requested standard (sensitivity > 90%, biopsy rate < 60%). Performance was definitely better when the test was not blind to the cytologic report (4 of 13 reached the requested standard) with respect to blind reading (none of 17). The study confirmed that colposcopy at unaccredited practices is poorly accurate. Colposcopic assessment of patients with abnormal smears should be centralized in accredited practices, which should undergo periodic quality control to guarantee screening efficacy. Tape-recorded videocolposcopy tests are a good, simple, practical and inexpensive method for interobserver quality control of colposcopic performance.

Clinical Competence↗
PubMedDate not supplied

Subclinical human papillomavirus infection of the male lower genital tract: colposcopy, histology and DNA analysis.

In 25 partners of women with genital human papillomavirus (HPV) infection or cervical intraepithelial neoplasia, colposcopic examination revealed the existence of subclinical HPV infection of the male lower genital tract in 22 cases. It manifested either as short papillae tipped with acetowhite changes, or flat acetowhite lesions on the foreskin, glans, periurethral region, scrotum, perineum and/or perianal region. Multiple lesions involving several anogenital areas were common. Some of these abnormalities were small and inconspicuous. Of these 22 cases, 17 had histological evidence of HPV infection. Although Southern blot hybridization detected HPV DNA in only one case, polymerase chain reaction (PCR) analysis revealed HPV DNA in 20 cases. There were 10 cases of HPV 16. Subclinical HPV disease is best identified by colposcopy and confirmed by PCR. In treating HPV disease, colposcopic recognition of subclinical HPV disease forms an essential part of the management plan.

Biopsy↗
PubMed2003

Chlamydia trachomatis infection in a colposcopy unit: an audit of a fast track referral system for infected patients to a genitourinary medicine department and a survey of patients' demography, clinical findings and partner details.

We had previously shown that screening and treating patients for Chlamydia trachomatis prior to termination of pregnancy significantly reduces postoperative morbidity. Our success led us to consider screening women attending our colposcopy unit and this was introduced in 1998. However, it became apparent that a formal protocol was needed for managing women who had positive results to ensure that all patients and their partners were adequately treated. An interdepartmental protocol was devised for fast track referral of infected patients to the Genitourinary Medicine (GUM) clinic Health Advisor who arranged immediate treatment and partner notification. A re-audit, presented here, has shown that the introduction of the protocol has resulted in all infected patients receiving adequate treatment and partner notification with minimal use of doctor time or disruption of routine GUM services. We suggest that our system is effective and could be extended to other clinics where chlamydia screening is carried out.

Adolescent↗
PubMed1991

The histopathology of biopsies taken from women attending a New Zealand colposcopy clinic.

Analysis of the histopathology of biopsies taken from 1371 women attending the Dunedin Hospital Colposcopy Clinic during the period 1982-1988 showed that CIN3, either alone or in conjunction with human papillomavirus (HPV) infection, was the most commonly encountered abnormality. Women under the age of 29 years accounted for 58.3% of the CIN3 lesions. There was also a dramatic increase in the number of women with evidence of HPV infection. Several cases of invasive carcinoma were encountered, 3 in very young women. However, there was no obvious age predilection for the various grades of CIN and for HPV lesions. This raises the question of whether or not HPVs in cervical cancer are chance associations rather than being actively involved in lesion information.

Adolescent↗
PubMedDate not supplied

Colposcopy.

Colposcopy is a method of examination of the cervix using an optical magnifying instrument. Tracy Smith discusses the assessment process, the cervical screening programme, management for patients who have abnormal smears, patient counselling and the role of the nurse colposcopist.

Aftercare↗
PubMedDate not supplied

Quality in colposcopy.

This article analyses the colposcopy service, which is a crucial part of the National Health Service Cervical Screening Programme (NHSCSP), to assess how quality is measured and delivered. It highlights the role of the nurse colposcopist and discusses where improvements to the service could be made.

Anxiety↗
PubMed1999

Colposcopy and microcolpohysteroscopy qualification for large loop excision of the transformation zone (LLETZ) in the management of cervical intraepithelial neoplasia.

OBJECTIVE: Large loop excision of the transformation zone is more and more often used as a treatment for cervical intraepithelial neoplasia. There is still debate as to whether this method should be performed in cases when the lesion extends into the cervical canal. Some colposcopists consider loop excision equal to cone biopsy, while others confine its application to satisfactory colposcopy findings. The purpose of the study was to compare the effectiveness and morbidity of LLETZ performed due to CIN in patients with and without extension of the lesion into the cervical canal. DESIGN: Prospective study of 143 women treated by LLETZ due to cervical intraepithelial neoplasia. METHODS: A series of 143 patients cytologically and colposcopically suspected of cervical intraepithelial neoplasia received outpatient treatment by large loop excision of the transformation zone (LLETZ). Microcolpohysteroscopy examinations of the cervix were performed on all patients. Depending on the involvement of the endocervix the material was divided into two groups. Group A comprised 83 women with a colposcopically visible upper margin of the lesion. Group B consisted of 60 patients with the lesion ranging in the endocervix, but not exceeding 10 mm from the external os. Chi square analyses of indication, morbidity and recurrence of the lesions in the two groups were done. Results were considered significant at p less than 0.05. RESULTS: Minimal thermal damage of excised tissue did not interfere with histological examination in either group. In 139 cases (97.20%) histology examination confirmed the presence of CIN. There were no significant differences between the two treatment groups with respect to mean age, mean parity and indications for LLETZ. The women in the group with an entirely visible lesion experienced less perioperative blood loss. There was no significant difference in secondary haemorrhage, infection, stenosis, incomplete excision of the lesion, visibility of neosquamocolumnar junction and residual disease between the two groups. CONCLUSIONS: On the basis of the results obtained it can be stated that LLETZ performed with colposcopic guidance complemented by microcolpohysteroscopy constitutes a valuable method in the treatment of CIN and it may in selected cases replace cone biopsy.

Adult↗
PubMed1975

Colposcopy: a prerequisite for cone biopsy.

Colposcopy should be an integral part of the diagnostic investigation of all patients with cervical neoplasia demonstrated by Pap smear. If a cone biopsy is necessary, the surgery can be directed. This will improve diagnostic accuracy as well as reduce morbidity, expense and disability.

Adult↗
PubMed2000

[Colposcopy in human papilloma virus infections of the distal uro-ano-genital tract].

HPV infections fall within the STDs and certain high-risk types have a significant role in the cancer genesis of the distal genital tract. The infection results can be clinically evident or be subclinical and in this latter case they are revealed by a highly-sensitive colposcopic examination after acetic acid application at 3% followed by Schiller's test with Lugol solution in weak iodine concentration. Indeed, the distal districts of male and female uroano-genital tracts takes advantage of the colposcopic diagnostics although complementary analysis like histology or DNA tests for HPV typing have sometimes to be performed to confirm the results or to evaluate the prognosis. HPV subclinical lesions, above all at cervical and vaginal level, are those mostly involved with the cancer genesis: the bright-white acidophilia often combined with irregular surface, atypical vascularization and discrete iodine caption represents a colposcopic indication to complementary diagnostic analysis aiming at choosing the most suitable therapy for which colposcopy can show the lesion topography and its frequent plurilocalizations.

Anus Neoplasms↗
PubMed1992

[The significance of colposcopy in surgical gynecologic emergent situations].

There has been described the case of coexistence of ruptured extra-uterine cysts and cancer of cervix uteri diagnosed by preliminary colposcopic examination confirmed by cytology and the directed biopsy specimen what enabled simultaneous surgical treatment. The presented paper is sufficient example that the colposcopy protects a woman requiring surgical treatment caused by the emergent gynecologic reasons from further surgical interventions in cases of simultaneous malignant changes of cervix uteri.

Adult↗
PubMed1992

Colposcopy staging and treatment of papillomavirus infection of the cervix.

The specificity of colposcopy findings in HPV infections allows the colposcopic differentiation of these lesions. In all of these colposcopically selected cases, additional tests included cytology with immunoperoxidase reaction (IPR), and, recently, virus typing with the use of ViraPap HPV DNA Detection test and ViraType HPV DNA Typing test became also available. When needed, histological examination of the specimen was carried out. In 202 detected and treated cases of HPV infections in females, and in 5 in males, four groups of lesions have been colposcopically distinguished. Group I contains early and fully developed, unsuspected typical papillomas; Group II--atypical papillomas which are usually colposcopically suspected of CIN and/or cancer; Group III--the so-called subclinical forms, i.e. cases with secondary diminution of epithelial transparency, i.e. acetic acid white epithelium, secondary simple punctuation and/or mosaic (flat condylomas) that are visible only in colposcopic magnification and usually suspected of CIN; and Group IV--the so-called latent lesions without any colposcopic findings and only with positive IPR. CIN 3 (including CIS) was determined histologically in five cases of Group II, and CIN 1-2 in ten cases of Group III. HPV virus type 16/18 was found only in cases of CIN 3. The cases of atypical papilloma (Group II) and recently those containing HPV virus type 16/18 were treated by means of surgical conisation or cryosurgery. The remaining cases (Groups I, II, IV) were treated with orally administered Tetracycline and Vitamin A. The effectiveness of this antibiotic/vitamin therapy in the group of typical papilloma and subclinical HPV lesions amounted to 75%.(ABSTRACT TRUNCATED AT 250 WORDS)

Colposcopy↗
PubMed1992

Abnormal Papanicolaou smears. Comparison of cytology, colposcopy and cervical swab DNA hybridization.

Cervical swab sampling for DNA hybridization was performed on 89 women attending a colposcopy clinic. In situ hybridization studies for human papillomavirus (HPV) types 6/11, 16/18 and 31/33/35 were performed on the specimens. Biopsy specimens were obtained from 65 patients. The cytologic, colposcopic and histologic results were classified into five groups and assigned a score of 0-5, depending upon the diagnosis. An increasing score correlated positively with the presence of HPV, especially types 16/18 and 31/33/35. A comparison was made of the sensitivity, specificity, and positive and negative predictive values for the standard method of colposcopic evaluation versus the standard method combined with DNA cervical swab sampling. No significant changes in the parameters were found when the DNA cervical swab was added.

Colposcopy↗