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Outcome after treatment of high-grade squamous intraepithelial lesions: relation between colposcopically directed biopsy, conization and cervical loop excision.

PURPOSE OF INVESTIGATION: The hypothesis that cold-knife conization performed in women with high-grade squamous intraepithelial lesions (HSIL) and unsatisfactory colposcopy is a better procedure than the loop electrosurgical procedure (LEEP) is tested. METHODS: A retrospective study was conducted in conization specimens of women submitted to LEEP (n = 102) or conization (n = 245) due to HSIL. Age, biopsy, compromised surgical margins in conization, and recurrence were analysed. RESULTS: The frequency of invasion, non-compromised margins, and recurrence in conization and LEEP were, respectively, 7.7% versus 2.9%, 64.1% versus 48% (p = 0.008), and 33.8% versus 24.1%. Eight (42.1%) and five (26.3%) of 19 women submitted to conization where invasion was found in surgical specimens were, respectively, menopausal or had unsatisfactory colposcopy. Twenty-five (96.2%) of 26 and 23 (95.8%) of 24, respectively, undergoing conization and LEEP had recurrence in the first five years. CONCLUSION: We recommend the use of cold-knife conization in cases where the lesion is located deep in the cervical canal.

Adult↗

[Endocervical curettage. Its use in the colposcopic assessment of a patient who has an abnormal cervico-vaginal smear].

Endocervical curettage (ECC) is a simple way of exploring the endocervical canal and is useful for the management of a patient with an abnormal smear. If colposcopy is satisfactory, ECC is usually negative confirming that the canal is free of disease and out-patient treatment can be used. A positive ECC warrants conization. If colposcopy is not satisfactory, ECC is usually positive, confirming extension of the disease in the canal, and sometimes the presence of an invasive lesion requiring a radical treatment right away. An endocervical adenocarcinoma alone or associated with an epidermoid lesion may also be identified. Post cone ECC confirms the absence of residual disease. Follow-up of patients after treatment and/or the menopause with an ECC is helped, especially when the squamocolumnar junction is not seen.

Biopsy↗

Sexually transmitted pathogens and colposcopic findings in asymptomatic HIV-1 antibody-positive blood donors.

Sixteen asymptomatic human immunodeficiency virus (HIV-1) antibody-positive female blood donors were examined for sexually transmitted diseases by lower genital tract microbiological tests and colposcopy. Two donors had generalised lymphadenopathy, and in 13 (81.2%) human papillomavirus was detected on histological examination. In 5 (31.2%) Neisseria gonorrhoeae was cultured. Sexually transmitted pathogens were found in all but 3 subjects and multiple agents were detected in 9. The high prevalence of sexually transmitted diseases coupled with the generally poor response to counselling has a frightening potential for spread of HIV locally.

Adolescent↗

[Abnormal cervical cytology. Management without colposcope].

From 1980 to 1987 we analyzed prospectively 30 cases of abnormal cytology at the Hospital Civil de Guadalajara without colposcopy. We practice cervical biopsy with Schiller test and according to result we practiced cervical conization. The cytologic results analyzed were: class V 20 (66.6%), class IV 6 (20%), persistent class III 2 (6.6%) and class II with clinical lesion suspicious of cancer 2 (6.6%). From all the patients, in 12 (40%) we found invasive cancer so that we didn't practice conization; in 10 patients (33.3%) we found the same results in the biopsies that in the conization, but in 8 patients (26.6%) the conization results were worse than the biopsies. We had one cytology class V false positive.

Adult↗

Cytologic and colposcopic examination in the diagnosis of penile HPV infection.

In this study, the Authors take into consideration 70 male partners of women who showed (after medical and/or surgical therapy) cervical and/or vaginal relapsing and/or persistent lesions associated with HPV infections. Fifty-two (74%) of the male partners resulted "positive" for HPV genital infection by the colposcipc and/or cytologic examination. The histological examination of target biopsy performed on o macular lesion revealed slight-moderate dysplasia associated with HPV atypical alterations. persistent and/or recurrent cervical-vaginal HPV infection. For the therapy to be successful, we cannot overlook a diagnostic and therapeutic course that fits the couple.

Adult↗