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PubMed1983

An in-service registrar-training programme in colposcopy at Groote Schuur Hospital. Reliability and results.

A scheme for the in-service training of registrars in colposcopic techniques was evaluated in a prospective study. The colposcopic interpretation was satisfactory in 79% of the 721 patients examined, and inappropriate treatment was avoided by utilizing the specified protocol of management. The value of cytological screening of the population is emphasized by the fact that in 95,7% of patients referred for colposcopy the pre-invasive cancer was not suspected on the basis of symptoms or the results of clinical examination.

Colposcopy↗
PubMedDate not supplied

Comparative evaluation of abnormal cytology, colposcopy and histopathology in preclinical cervical malignancy during pregnancy.

The results of a two-and-a half-year study on cytodetection of preclinical cervical malignancy during pregnancy are presented. Of 3,534 pregnant women, 125 (3.5%) had cytologic diagnoses of dysplasia, carcinoma in situ or microinvasive carcinoma of the uterine cervix. These results are compared with those obtained from colposcopy and from tissue diagnosis following biopsy, cervical conization and hysterectomy. They are also analyzed in relation to the patients' age, parity and age at first sexual intercourse. The management of these patients during pregnancy is discussed, especially with regard to the authors' experience in dealing with patients from very poor socioeconomic and cultural backgrounds.

Adolescent↗
PubMed1982

Screening with colposcopy in a prepaid health center.

The early detection of cervical cancer by widespread application of the Papanicolaou (Pap) smear has produced a decrease in U.S. mortality rates from this disease. Colposcopy is a useful adjunct in evaluating patients with an abnormal Pap smear. The author's five years of experience using the colposcope for primary screening detected 146 patients with cervical lesions, 30 with moderate dysplasia or worse and 116 with minimal or mild dysplasia. Estimated incidence by type of appointment showed the highest incidence of significant pathology (approximately one lesion per 115 patients) in patients who were seen without appointments. In 19 patients their disease would have been missed by routine Pap smear but was detected by the colposcope. Gynecologists who are trained in the use of this instrument should use it in conjunction with the Pap smear to help detect pathology in new patients.

Carcinoma in Situ↗
PubMed1980

[Diagnostic colposcopy of adenocarcinoma of the cervix uteri (author's transl)].

Although frequency rate of adenocarcinoma of the cervix is about 5% or over in cervical carcinoma, colposcopical studies of this lesion have never been reported systematically. We observed the colposcopic findings of 52 cervical adenocarcinoma cases. Resemblances in the findings between colposcopy of the lesion and hysteroscopy of corpus carcinoma were examined in order to confirm diagnosis. And the points differentiating the lesion from other lesion with similar findings were noted. In early cases, papillary findings (Cad), transformation-like findings (Tad), mixed findings, granulation-like findings (Gr), columnar epithelium (C) and atypical vessels (aV) were observed. The lesion tended to bleed and secrete mucus. Glomerulus and tendrilous vessels were seen in the papillaries, and roo-like, wastethread-like, tendrilous and corkscrew-like vessels outside the papillaries. In advanced cases, the lesions tended to necrotic mass and the surface collapsed. White epithelium, mosaic and punctation were not observed in the pure adenocarcinoma cases but were observed in some adeno-squamous carcinoma cases. These surface and capillary characteristics resembled the hysteroscopic findings of corpus carcinoma. The papillary findings resembled some squamous carcinoma findings, papilloma and columnar epithelium. We differentiated the lesion by color, luster, degree of alteration after application of acetic acid, shape of papillaries, nature of bleedings, secretion of mucus, formation of necrotic mass, surface degeneration and vessel types.

Adenocarcinoma↗
PubMed1980

Cytology and colposcopy in the diagnosis and management of outpatients with cervical intraepithelial neoplasia.

One hundred consecutive outpatients seen in the colposcopy clinic of a private hospital had one or more Papanicolaou smears that suggested cervical atypia, dysplasia or carcinoma in situ. Of these 100 patients, 7% underwent a diagnostic cervical cone biopsy; 11% more had therapeutic conization. The accuracy of colposcopic examination with directed cervical biopsy within one level (under or over) of histologic findings was 88%; the cytologic accuracy within one level of histologic findings was 83%. The study showed that patients with cervical atypia at cytologic examination had dysplasia and carcinoma in situ at subsequent colposcopic cervical examination with directed biopsy.

Carcinoma in Situ↗
PubMed1994

Effects of coping style on psychological reactions of low-income, minority women to colposcopy.

Patterns of coping and adjustment in 36 low-income, minority women with positive cytologic smears were assessed prior to diagnostic follow-up examination (colposcopy). Subjects were divided into high monitors (who attend to threatening cues) and low monitors (who avoid threatening cues) on the basis of their scores on the Miller Behavioral Style Scale, a well-validated measure of coping style. Multivariate analysis of variance showed that high monitors worried more about the seriousness of their condition, expressed more concern about the immediate sensory and procedural aspects of the diagnostic examination and felt more responsible for the onset and course of their disease as compared to low monitors. However, they were no more likely to be concerned about the overall importance or long-term consequences of their abnormal smears. Finally, high monitors displayed greater symptoms of intrusive and avoidant ideation in relation to their medical status. These results were independent of sociodemographic and medical confounding variables. Consistent with results in other populations, the findings suggest that it may be useful to assess attentional coping dispositions in minority populations with high-risk gynecologic conditions and to target psychosocial interventions accordingly.

Adaptation, Psychological↗
PubMed1994

Colposcopy, colpocytology and the vaginal ecosystem. Oncological, bacteriological and hormonal evaluation in a series of 400 women.

The Authors retrospectively considered colpocytological and colposcopic findings in a series of 400 women, aged 16 to 83 years, presenting for the first time at the Oncological Gynaecology Unit of the Institute of Gynaecology and Obstetrics of Padua University between 1991 and 1992. In addition to oncological evaluation, the bacteriological profile and hormone status of cytological samples were formulated in all cases. The most common oncological finding was a cell morphology within normal limits (67%), followed by reactive and reparative changes (19%) and low-grade squamous intraepithelial lesions (SIL, 12%). Histological findings correlated well with the cytological diagnosis, though low-grade SIL was over-estimated. As for the bacteriological profile, a mixed flora was most frequent (56.7%) followed, especially in fertile age, by Döderlein's bacillus (20%) and vaginosis (15.5%). Colposcopy most frequently revealed ectopia and/or a normal transformation zone (50.7%) and dystrophic mucosa (21%). An abnormal transformation zone was more common among women with a moderate-to-abundant flora. Fifteen male partners were also checked: cellular changes typical of human papilloma virus infection were found in 40% and colposcopic findings compatible with said virus were observed in 26.6% of cases. These results confirm that colpocytology provides a complete and simultaneous evaluation not only of cell morphology, but also of the bacterial population and hormones in the vaginal ecosystem. It is therefore the method of choice in screening for cervical and vaginal neoplasms and an effective means for simultaneously evaluating vaginal flora and hormone status.

Adolescent↗
PubMed1994

Cytologic-histologic discrepancy in human immunodeficiency virus-positive women referred to a colposcopy clinic.

OBJECTIVE: To evaluate the rate of discrepancy between cytology and histology in a referral-based population of human immunodeficiency virus (HIV)-positive women compared to HIV-negative women and women whose HIV status was unknown. METHODS: From January 1, 1990 to December 31, 1993, approximately 830 women underwent evaluation at Women and Infants' Hospital colposcopy clinic. Women who had histologic diagnosis and recent cytologic evaluation during this interval (N = 678) were selected for study. Forty-one HIV-positive women were compared to 228 HIV-negative women and 409 women whose HIV status was unknown. RESULTS: Of the 41 HIV-positive women, seven (17%) were noted to have a discrepancy between cytologic and histologic findings. In HIV-negative and HIV-unknown women, 15% (34 of 228) and 22% (91 of 409) were discrepant, respectively. Using HIV-negative women as the reference group, the relative risk of cytologic-histologic discrepancy was 1.1 (95% confidence interval [CI] 0.51-2.41) for HIV-positive women and 1.5 (95% CI 1.04-2.14) for women whose HIV status was unknown. CONCLUSION: Human immunodeficiency virus-positive women referred for colposcopic evaluation have no more cytologic-histologic discrepancy than HIV-negative women or women whose HIV status is unknown.

Cervix Uteri↗
PubMed1993

Screening for cervical cancer: experience from the Colposcopy Clinic at Harare Hospital.

A study was carried out to determine the prevalence of cervical intra-epithelial neoplasia (CIN) among women referred to Harare Hospital Colposcopy Clinic with a history of an abnormal smear. During the period, 132 patients were seen and 79 (60 pc) had colposcopic findings suggestive of CIN and 17 (13 pc) had inflammatory changes and 36 (27 pc) had normal findings. Electrocautery was used to treat low grade CIN lesions, cone biopsy was performed for higher grades of CIN and a selected group underwent hysterectomy.

Adolescent↗
PubMed1994

Colposcopy and cervical biopsy educational training models.

BACKGROUND: Realistic simulation models serve meaningful educational purposes. The intent of this article is to review the physical and educational features of three instructional colposcopy models, and to discuss the advantages and implications of the use of models in teaching colposcopic skills. METHODS: Models made from latex, steak, and the bovine cervix were assessed as instructional devices to simulate the uterine cervix and cervical disease. Model construction, preparation, and unique features were critiqued. The models were also evaluated for their potential use in the preclinical teaching of important colposcopic skills. RESULTS: The latex model required minimal assembly but was costly. It was limited in design, which would exclude the training of most colposcopic techniques. The steak model used readily available materials, facilitated colposcopic skill acquisition, and was the least expensive model. The bovine model best simulated human cervical tissue, was intermediate in cost, and enabled teaching a variety of colposcopic procedures. The optional silicone inserts realistically demonstrated the spectrum of cervical disease. CONCLUSIONS: Various cervical biopsy models have different strengths and weaknesses for teaching colposcopic procedural skills. Available models each possess unique features designed to reproduce anatomy, pathology, tissue texture, and technical spatial limitations. The models permit assessment of gynecologic knowledge and psychomotor abilities.

Animals↗
PubMed1993

Colposcopy in the diagnosis of human papilloma virus infection, cervical intraepithelial neoplasia and invasive carcinoma.

Colposcopic diagnosis of 156 different lesions of the cervix was compared with histologic examination of the cervical punch biopsies. Colposcopy showed high degree of sensitivity and specificity (96% and 99.2%) in cases of carcinoma of the cervix. In cervical intraepithelial neoplasia (CIN) it showed a sensitivity of 82.8% and specificity of 49.6%, while in subclinical papilloma virus infection (SPI), it showed high degree of specificity (93.7%) but poor sensitivity (19.7%).

Colposcopy↗
PubMed1994

Should all women with cervical atypia be referred for colposcopy: a HARNET study. Harrisburgh Area Research Network.

BACKGROUND: Clinicians who manage women with Papanicolaou (Pap) smears showing atypical squamous cells of undetermined significance (ASCUS) may miss clinically significant cervical disease by repeating the cytology alone. We evaluated the ability of the human papillomavirus (HPV) screen and the naked-eye examination after a cervical acetic acid wash to enhance the follow-up Pap smear in predicting an abnormal colposcopic biopsy. METHODS: Pap smears were performed on all women (N = 7458) attending six family practice offices for a health maintenance examination from August 1989 through February 1991. Consenting subjects with ASCUS underwent repeat cytological testing, an HPV screen, and a cervical acetic acid wash examination immediately before colposcopy after a 4- to 6-month waiting period. RESULTS: Of the 122 consenting women identified with ASCUS, 67 (55%) demonstrated abnormalities on biopsy, including 26 with condyloma, 26 with cervical intraepithelial neoplasia I (CIN I), and 15 with CIN II to III. The false-negative rate, 58%, of the follow-up Pap smear alone for detecting these cases of condyloma and CIN was significantly decreased (false-negative rate, 27%) with the use of the cervical acetic acid wash as an adjunctive test. There was no additional reduction in the false-negative rate with the use of the HPV screen. Of the 15 subjects with high-grade cervical lesions (CIN II to III), 14 had either an abnormal follow-up Pap smear or an abnormal cervical acetic acid wash examination. CONCLUSIONS: Among women with cervical atypia, a single follow-up Pap smear alone failed to detect one third of the cases of high-grade disease. Ninety-three percent of these cases were detected, however, with a follow-up Pap smear and an acetic acid wash. Our one subject with a high-grade lesion missed with this combination of tests had an unsatisfactory Pap smear. Use of both tests together may reliably guide clinical decisions regarding the management of cervical atypia.

Acetates↗
PubMed1993

Colposcopy of adenocarcinoma in situ and invasive adenocarcinoma of the cervix.

Colposcopy is most useful in evaluating squamous lesions of the lower genital tract. Its usefulness in evaluating glandular abnormalities of the uterine cervix now are limited. There are abnormal features in invasive adenocarcinoma of the cervix that allow the colposcopist to make that diagnosis with directed punch biopsies. The biopsy specimens should be large enough to allow the pathologist to make the diagnosis of invasion. At the present time, the colposcopic features of adenocarcinoma in situ are not well recognized. It must be stressed that where adenocarcinoma in situ is suspected colposcopically or by cytology, the definitive diagnostic procedure remains cone biopsy.

Adenocarcinoma↗
PubMed1993

Colposcopy in pregnancy.

The management of the abnormal smear in pregnancy remains a challenge to the modern colposcopist. Colposcopy in pregnancy is difficult. Anatomic variants can mimic disease. Significant cytologic overall detection of low-grade squamous intraepithelial lesions demands an increased understanding of physiologic variants in pregnancy. Possible recent increases in cervical cancer incidence in younger women requires comprehensive knowledge of warning signs of early invasion. Modern management approaches must temper the need for accurate exclusion of cancer with the risk of overly aggressive interference in patients without disease or with very minor atypia.

Biopsy↗
PubMed1993

The colposcopy unit. Instrumentation, colposcopic technique, recording of findings, and terminology.

The colposcopy unit is the ideal setting for the triage of patients with lower genital tract disorders, particularly those who have been identified through screening tests to be at potential risk for developing cancer. This article has reviewed the colposcopic method, related instrumentation, and internationally approved colposcopic terminology. This will serve as a basis for the more detailed discussion of colposcopic diagnosis in the articles that follow.

Ambulatory Care Facilities↗
PubMed1995

Human papillomavirus detection in cervical smears and cervical tissue excised by the Loop Electrosurgical Excision Procedure (LEEP). Diagnostic value of cytology, colposcopy and histology.

A study was performed on 176 patients with benign cervical lesions. Human papillomavirus (HPV) structural antigens which were stained with the immunoperoxidase staining were sought for in cervical smears and in cervical tissues excised by the loop electrosurgical excision procedure (LEEP). HPV infection was found in 16.4% of the patients. Furthermore, cytologic screening on Papanicolaou (PAP) smears, colposcopy, and histologic examinations of whole transformation zones excised by the LEEP were performed. The diagnosis of HPV was based on the positive immunoperoxidase staining of either the exfoliated cells or the cervical tissue. HPV was detected on 5.6% of the PAP smears. The reliability of cytologic colposcopic, and histologic diagnosis of HPV was investigated.

Antigens, Viral↗
PubMed1996

Colposcopy as a tool for detection of human papillomavirus infection of uterine cervix in the setting of high prevalence of gynaecologic infections.

A cross sectional study involving 257 women from the Maternal and Child Health Centre (MCH) in Delhi was initiated for screening clinically, cytologically, colposcopically, and microbiologically for several gynaecologic infections. Eighty percent of the women had one or more gynaecologic infections and 31.1% had three or more infections. Cytology revealed changes suggestive of condyloma in 3 (1.2%) women only, while colposcopic examination suggested HPV changes in 117 (45.5%) women. A very high proportion of colposcopically detected lesions (78.6%) had evidence of HPV related changes in histology. The specificity of these lesions were further confirmed by Pan HPV DNA in-situ hybridisation, when 84% of the colposcopy is a valuable tool for detecting subclinical HPV lesions in a setting with high prevalence of gynaecologic infections.

Colposcopy↗
PubMed1997

[Colposcopy images of cervix in women with Gardnerella vaginalis infection].

Among micro-organisms infecting vagina whose dominant genus is GV anaerobic bacteria are often present. There are reports that GV infections of vagina and uterine cervix, apart from their well-known negative role in obstetrics practice can play a role in carcinogenic processes of uterine cervix. The aim of the study was to assess characteristic colposcopy images of cervix in women with Gardnerella vaginalis infection. The research was carried out on 1180 women hospitalised in the period of 14 months. Many observations lead to conclusions that pathognomic clinic feature of Gardnerella vaginalis infection of uterine cervix is visible in colposcope presence of clean, translucent mucus in external cervical os and opaque vaginal contents in the rear vaginal vault. High hydrogen ion concentration in vaginal contents (pH 6.0 and over) correlates with positive "fishy odour test" of this contents. Gardnerella vaginalis infection of vagina and uterine cervix concerns women with existing erosion-type changes of uterine cervix. Visible in colposcopic test restless and "spotted" images visible after Schiller test are pathognomic colposcopic features of Gardnerella vaginalis infection.

Adult↗