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PubMedDate not supplied

Colposcopy, cervicography, speculoscopy and endoscopy. International Academy of Cytology Task Force summary. Diagnostic Cytology Towards the 21st Century: An International Expert Conference and Tutorial.

ISSUES: The colposcope was developed in 1925 and is well established in clinical gynecologic practice for defining and delineating cytologically detected lesions mainly of the cervix but also the vagina and vulva. Additionally, various endoscopic procedures in gastroenterology, pulmonary and urologic lesions enhance the cytologic detection and histologic verification of precancerous and cancerous lesions. The cost-effectiveness of all these devices and their applicability, particularly in countries with a limited health budget, is a major issue. This task force considered aspects of the present state of the art and the challenges in the 21st century. CONSENSUS POSITION: Automated cytology can interface with colposcopic examination in a number of significant ways. Automated cytologic analysis of conventional cervical smears can potentially direct colposcopic examination by predicting the nature of a lesion, assist in determining which patients should receive colposcopy and, in some settings, thereby reduce the number of colposcopies. Potentially, various combinations of automated cytology and colposcopy may be used to generate screening protocols that might result in more effective and inexpensive screening. The role of cervicography, or high-resolution cervical photography, as a screening device remains to be defined. Sensitivity for high grade lesions is generally no greater than that in cytology, and specificity appears lower. The interpretation of cervical photographs in triage of mildly abnormal cytology may prove to be useful in countries with established cytology programs. In areas of the world where cytology screening programs are not in place, the interpretation of cervical photographs may have its most dramatic effect. Cost-effectiveness analyses are needed. There are, at present, insufficient data for the evaluation of speculoscopy, a procedure using chemiluminescent illumination of the cervix for visualization of acetowhite areas. Basic training in colposcopy should be integrated into the residency programs of obstetrics and gynecology. Criteria for the adequate training of colposcopists should be developed. Continuing education programs in colposcopy should be developed when they are not already in existence. The cost-effectiveness of integrating colposcopy as a primary screening technique should be evaluated. Following a high-grade squamous intraepithelial lesion (HSIL) cytology result, colposcopically directed punch biopsy should be taken with or without endocervical curettage. This generally should precede the loop electrosurgical excision procedure (LEEP); however, in certain circumstances direct LEEP may be indicated. LEEP under colposcopic vision is an efficient way to treat an HSIL lesion of the cervix because the histologic extent and margins can be determined, unlike with laser surgery or cryosurgery. It is also more cost-effective than cold knife conization because general anesthesia and an operating room are unnecessary. Following LEEP, the endocervical canal should be examined colposcopically for any evidence of involvement. Lesions in the endocervix can then be removed with a different-shaped loop. Further research into Raman spectroscopy as a diagnostic aid in cervical pathology is needed, as is the use of micrococolpohysteroscopy for in vivo cytologic analyses, especially of the endocervical canal and transformation zone. Hysteroscopy is the most direct method for the diagnosis and treatment of intrauterine diseases. Hysteroscopic endometrial biopsy is more accurate than conventional biopsy methods. Cervical invasion of endometrial cancer can be detected by hysteroscopy. The depth of invasion, however, is more accurately determined by magnetic resonance imaging or computed tomography. ONGOING ISSUES: Many topics for ongoing research and/or implementation are mentioned under "Consensus Position," above. (ABSTRACT TRUNCATED)

Automation↗
PubMed1999

[Critical review of colpo-histological results in cervix pathology].

BACKGROUND: The objective of this paper was to evaluate the role of squamous metaplasia in the determination of certain colposcopic appearances. METHODS: One thousand four hundred and six infertile outpatients, attending assisted reproduction techniques, underwent a "first level" colposcopy. Two hundred fifty nine abnormal transformation zones were biopsied and the histologic diagnoses were subdivided as follows: squamous metaplasia, squamous metaplasia + koilocytosis, isolated koilocytosis, condyloma, CIN + HPV, cervicitis. RESULTS: Two hundred forty seven cases out of 259 biopsied colposcopic findings (95.4%) were colposcopically classified as grade 1 abnormal transformation zone (thin white epithelium, regular mosaic and punctuation). The correlation between 247 grade 1 abnormal transformation zone colposcopic patterns and histologic diagnosis revealed 105 (42.5%) histologic findings described as squamous metaplasia that resulted immature in 63% of these samples. Between 132 (53.4%) cases that presented a pattern of human papillomavirus infection (condyloma, squamous metaplasia + koilocytosis or isolated koylocitosis), quite two thirds (62%) were described as condylomas, one third (31%) as squamous metaplasia associated with koylocitosis and only 7% as isolated koylocitosis. In conclusion, 42.5% of target biopsies performed on low grade abnormal transformation of the cervix revealed squamous metaplasia, more than half of them revealed one of HPV infection forms, while only 2% represented cervical intraepithelial neoplasia. CONCLUSIONS: Among the low risk female population, one out of two cases of colposcopically low grade pattern should be considered indicative of squamous metaplasia. The results obtained confirm that colposcopic evaluation is unable to distinguish between immature metaplastic transformation of the epithelium and metaplastic epithelium with initial neoplastic transformation.

Biopsy↗
PubMed2001

[Evaluation of cervical conization in diagnosis and management of cervical intraepithelial neoplasia].

OBJECTIVE: To determine whether cervical conization can be instead of colposcopic multiple biopsies and to evaluate the clinical value of cervical conization in diagnosis and management of cervical intraepithelial neoplasia. METHODS: Fifty four patients with cervical intraepithelial neoplasia (CIN) diagnosed and treated at Peking Union Medical College hospital were retrospectively analyzed focusing on the comparative study in pathology between cerical conization and colposcopic multiple biopsies. RESULTS: Of the 54 patients, there was a correlation in pathology between cervical conization and colposcopic multiple biopsies in 22 cases (40.7%), but there was not much correspondence between cervical conization and colposcopic multiple biopsies in 32 cases (59.3%). In 31 cases conization performed for ruling out invasive cancer, there was a correlation in pathology between cervical conization and colposcopic multiple biopsies in only 13 cases (41.9%). After conization radical hysterectomy was performed in 2 cases (3.7%) because of early invasive carcinoma and simple hysterectomy was performed in 13 cases (24.1%) because of CINIII involved the gland and microinvasive carcinoma of the cervix. 39 cases (73.2%) were closely followed-up postoperatively with preservation of fertility. During the mean follow-up time of 18.3 months, no cytology abnormality was detected and 3 patients had pregnancy and delivery. Postoperative hemorrhage was main side effect for conization. CONCLUSIONS: Cervical conization plays a very important role in diagnosis and treatment of CIN and it can not be instead of colposcopic multiple biopsies. Cervical conization is a good choice for patient with CINIII and desired childbearing.

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↗
PubMedDate not supplied

Should smears in a colposcopy clinic be taken after the application of acetic acid?

Conventionally, cervical smears obtained during a colposcopic examination are taken before the application of acetic acid. However, this occasionally precipitates bleeding and removes epithelium from the cervix, particularly in the presence of cervical pathology, making colposcopic evaluation difficult. This study examined the possibility of deferring the smear until the end of the colposcopic examination. In the first part of the study, the cytologic results on cervical samples taken from the same patient before and after the application of acetic acid were compared. In the second part of the study, only one smear was taken per patient (either before or after colposcopic assessment) to eliminate the possibility that the taking of the first smear affected the quality of the second. The results of both parts of the study showed that deferring the smear until after the application of acetic acid leads to an unacceptably high rate of unsatisfactory and falsely negative smears. Thus, deferring the taking of the cervical smear until after the colposcopic evaluation results in a poor cytologic evaluation, although it might facilitate the colposcopic examination in some patients.

Acetates↗
PubMed1981

Cervical intraepithelial neoplasia associated with exposure to diethylstilbestrol in utero: a clinical and pathologic study.

The anatomic, colposcopic, cytologic, and histologic findings of the cervix in 300 women exposed to diethylstilbestrol (DES) in utero are reported. Structural cervical abnormalities were found in 51.7% of these patients and an abnormal colposcopic examination was present in 50.6%. The initial interpretation of the pathologic specimens revealed that 26.6% of patients had cytologic or histologic evidence of cervical dysplasia. A uniform pathologic review demonstrated that 10.8% of the cytologic specimens and 37.5% of the histologic specimens had been overread by the initial pathologist. A correlation of the review cytology and histology revealed that the Papanicolaou smear sensitivity for the prediction of abnormal histology was 83.9% and specificity was 86.3%. The probability of an atypical cytologic finding predicting an abnormal histologic pattern was highly significant (P less than .00001). Colposcopic and structural cervical abnormalities were not predictive of an abnormal histologic diagnosis. Of the 18 patients (6%) with histologic evidence of mild-moderate dysplasia, 12 have been followed with no treatment, and cytologic and colposcopic examination has been normal. Marked dysplasia-carcinoma in situ was found in 14 patients (4.7%). Their therapy is summarized. These data strongly suggest that women exposed to DES may be followed safely with Papanicolaou smears and colposcopic examinations provided that both cytopathologists and colposcopists are cognizant of the metaplastic changes in the DES progeny that distinguish them from patients with cervical intraepithelial neoplasia (CIN) who were not exposed to DES. Biopsy should be performed only if indicated by cytologic atypia, colposcopic evidence of advanced CIN, or the presence of an invasive lesion.

Adolescent↗
PubMed1994

Appraisal of the modalities used to evaluate an initial abnormal Papanicolaou smear.

OBJECTIVE: To examine the efficacy of the different modalities used to evaluate an initial abnormal Papanicolaou smear. METHODS: The study population comprised 214 nonpregnant women referred with a Papanicolaou smear diagnosis of cervical intraepithelial neoplasia. Each patient was evaluated by a repeat Papanicolaou smear, colposcopy, and colposcopically directed cervical biopsies. Immediate loop excision was performed to remove the entire transformation zone in all patients. Kappa statistics were calculated to determine agreement among the modalities, and logistic regression was used for determining relative risks (RR). RESULTS: There was 53% agreement between the initial and repeat Papanicolaou smears. When low-grade squamous intraepithelial lesion (SIL) was diagnosed by Papanicolaou smear, there was 89% agreement with the colposcopic impression. However, a colposcopic impression of high-grade SIL was found in only one-third of the women diagnosed with high-grade SIL by Papanicolaou smear. A comparison of the histology of the cervical biopsy and the loop specimen revealed 57% agreement. Univariate analysis indicated that each modality was able to predict the RR of high-grade dysplasia in the loop specimen at a statistical significance level of .05. A colposcopic impression of high-grade dysplasia conferred an RR of 7.43 (95% confidence interval [CI] 2.17-25.49) for high-grade dysplasia in the loop specimen. An initial Papanicolaou smear diagnosis of high-grade SIL did not contribute to the multivariate model for calculating the risk of high-grade dysplasia, as the RR was 1.6 (95% CI 0.68-3.81). CONCLUSION: Patients with an initial Papanicolaou smear showing low-grade SIL would benefit from a repeat Papanicolaou smear and colposcopically directed biopsies before proceeding with loop diathermy. In contrast, patients with a colposcopic impression of high-grade dysplasia combined with high-grade SIL on Papanicolaou smear appear to be candidates for immediate loop excision.

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↗
PubMed2004

[The suitability of digital colposcopy for telematic applications].

Since carcinoma of the cervix is one of the most common cancers in women, screening of the cervix has acquired considerable importance. Colposcopy is a simple diagnostic method of detecting suspicious changes at an early stage. Shortcomings of this method are its low specificity and high inter- and intra-observer variability. A clinical pilot study was therefore carried out to investigate the advantages of a digital colposcopic system comprising a binocular colposcope coupled to a CCD camera and a computer. The aim of the study was to evaluate the reliability of diagnostic findings of the cervix obtained with digital colposcopy in comparison with standard binocular colposcopy, and to assess its suitability for telematic applications (teleconsultation, telediagnostics, treaching). A total of 315 patients were examined and statistically analysed. The patients were first submitted to a conventional colposcopic examination and a diagnosis was established. During the colposcopic examination camera images were stored on a computer, on the basis of which a second physician experienced in colposcopy reviewed the initial diagnosis. The primary and secondary findings of each patient were classified into 4 categories and compared following the Rome classification system. Agreement between the primary and secondary diagnosis was established in 69% of the cases (kappa = 0.60 +/- 0.03). No bias was observed in terms of under- or overrating. The percentage of non-assessable colposcopic examinations was 9.2%. Digital colposcopy is therefore suitable for reproducing diagnostic findings on the computer, given adequate digital image quality and a suitable classification model. The method has clear advantages with regard to follow-up, internal quality control of the diagnosis, and the training and further education of physicians and students. In the future, telecolposcopy may open up new opportunities in gynaecology.

Adult↗
PubMed2004

Illumination, optics, and clinical performance of a hand-held magnified visual inspection device (AviScope): a comparison with colposcopy.

OBJECTIVE: Colposcopy is the reference standard for a visual inspection device in terms of illumination, optics, and clinical performance. A hand-held magnification device such as the AviScope, developed as an alternative to naked eye visual inspection with acetic acid, is also of interest as a low-cost, more portable alternative to a colposcope in low-resource settings within the context of cervical cancer prevention programs and for microbicides research. DESIGN: A performance comparison of the AviScope, visual inspection with acetic acid, and three colposcopes. METHODS: An analysis was carried out of the optics and illumination of the colposcopes and the AviScope prototype and of the evidence for the reproducibility and clinical accuracy of visual methods for histologically confirmed high-grade cervical intraepithelial neoplasia. Using the findings, the feasibility of increasing the performance and reducing the cost of a hand-held scope was examined. RESULTS: Published studies have found the AviScope to have slightly higher sensitivity than visual inspection with acetic acid (60.7 versus 55.7%, P < 0.05) without loss of specificity. Despite the variability among the colposcopes, the field of view, resolution, depth of field, magnification, and quality of the illumination beam pattern and spectral output exceeded that of the AviScope. The clinical sensitivity and specificity of colposcopy were higher than that of the AviScope. The availability of improved materials for optics and illumination suggests that a hand-held scope with enhanced performance is feasible. CONCLUSION: Although the performance of the AviScope prototype was suboptimal compared with the colposcopes, it appears possible to design a hand-held magnification device at a reasonable price with better optics and illumination.

Colposcopes↗
PubMed1991

Colpophotography systems: a review.

Colpophotography and video colposcopy systems are useful for pathology documentation purposes, patient education, and colposcopy training. A wide variety of colposcopic visual media components are available to enhance routine colposcopy. Colpophotographic systems supplied by eight colposcope manufacturers were critically evaluated by a colposcopist and a medical photographer. Components were independently and objectively analyzed. Photographic examination considered color, illumination uniformity, and coverage of illumination at all possible colposcopic magnifications. Photographs were developed by a standardized technique. The investigation results clearly demonstrated variability between different colpophotographic systems. Quality colpophotography is dependent on certain colposcope features and potential modifications. Colpophotography and video colposcopy systems complement the standard colposcopic procedure.

Colposcopes↗
PubMed1995

Operator variability in disease detection and grading by colposcopy in patients with mild dysplastic smears.

BACKGROUND: To determine interoperator variability in the colposcopic evaluation of patients with mild dysplastic smears, retrospective comparison of colposcopy and biopsy results in 856 patients examined by 11 colposcopists in the Outpatient Colposcopy Clinic of "L. Mangiagalli" Institute, Milano, was performed. METHODS: The patients underwent a complete colposcopic assessment and target biopsy on suspect areas if a screening smear showed mild dysplasia. Colposcopic findings and disease detection rate for each operator were compared. RESULTS: There was no significant (P > 0.05) difference in the recording of abnormal colposcopic findings. Significant differences were found, however, in abnormal transformation zone grading (P < 0.001), biopsy rate (P < 0.05), and squamocolumnar junction visualization (P < 0.005). There was no significant difference in overall disease detection (P > 0.5) but there was a statistically significant, inverse relation (r = -0.6, P < 0.01) between the high grade (cervical intraepithelial neoplasia grades 2 and 3) and low grade (human papillomavirus/cervical intraepithelial neoplasia grade 1) detection rate for each operator. CONCLUSIONS: High grade disease detection in patients with mild dysplastic smears is influenced the subjectivity of the colposcopic examination. This should be considered when planning optimal management for patients with mild dysplasia.

Adolescent↗
PubMed2002

Vaginal dysplastic lesions in women with hysterectomy and receiving radiotherapy are linked to high-risk human papillomavirus.

Patients undergoing radiotherapy for advanced cervical and endometrial cancer bear a considerable risk of developing vaginal preneoplastic lesions. Radiotherapy itself has been considered to have a role in the pathogenesis of vaginal dysplasia, although human papillomavirus (HPV) involvement has also been suggested. A series of 88 patients who underwent hysterectomy and were irradiated for gynecological cancer, including 43 with postradiation vaginal dysplasia at colposcopy and 45 without vaginal lesions, were included in this study. Detection and genotyping of HPV DNA in vaginal scraping were carried out by a PCR-based method and compared with colposcopic and cytological findings and with other clinical and laboratory data. Forty-two (97.7%) colposcopy-positive subjects and 6 (13.3%) colposcopically-negative patients were PCR-positive for high-risk HPV DNA (P < 0.000001). Twenty-two out of the 43 patients with colposcopic lesions showed an abnormal Papanicolau (PAP) test. Cytologic examination was negative in all colposcopically negative women. Type 16 HPV DNA was more frequent in patients with high-grade squamous intraepithelial lesions and in patients treated with external radiotherapy, whereas other types of high-risk HPV were more common in patients with low-grade lesions and in those treated with brachytherapy. When considering colposcopy as the standard for diagnosing vaginal dysplasia, HPV DNA testing was more sensitive than the PAP test. However, the specificity of the PAP test was higher with no false-positive case. In conclusion, vaginal preneoplastic changes in women post-hysterectomy and receiving radiotherapy for cervical, endometrial, and vaginal cancer represent an HPV-related nosologic entity. Whereas colposcopic examination can detect these preneoplastic lesions, HPV genotyping is a sensitive, inexpensive, and noninvasive method that may complement colposcopy and the PAP test.

Adenocarcinoma↗
PubMed1995

Computerized colposcopy: results of a pilot study and analysis of its clinical relevance.

OBJECTIVE: To evaluate the clinical usefulness of a computer based system that stores and analyzes high-resolution digital colposcopic images. METHODS: Three hundred patients referred to our institutions for evaluation of abnormal cervical cytology underwent colposcopy with development of digital images. The first 70 patients were used to standardize the system. The images obtained from 188 evaluable patients were analyzed and scored by software according to internationally recognized colposcopic criteria. The results were compared with traditional colposcopic diagnoses and with corresponding histology results using kappa statistics for inter-observer agreement and McNemar test for significance. RESULTS: The exact concordance rate between computer-aided impressions and histology (85.1%, kappa = 0.77) was significantly higher (P < .001) than that observed between traditional colposcopic findings and histology (66%, kappa = 0.40). The computer-assisted colposcopy was much more accurate than traditional colposcopy in diagnosing high-grade lesions (91.2 versus 61.8% of exact concordance, P < .001) as well as normal histology (74.1 versus 34.5%, P < .001), but not significantly different when evaluating low-grade lesions (89.6 versus 86.5%). CONCLUSION: The integration of computer imaging and colposcopy can improve the colposcopic diagnostic accuracy. An inexperienced colposcopist may benefit from computerized support to obtain the most appropriate histologic specimen, and eventually access to distant consultation via modem or through on-line services. An additional advantage is the ability to develop a space-saving permanent record of digitized images readily available to review a patient's cervical history or perform effective programs of quality control in colposcopy.

Adolescent↗
PubMed1986

Endocervical curettage: does it contribute to the management of patients with abnormal cervical cytology?

Routine endocervical curettage has been advocated in the colposcopic evaluation of patients with abnormal cervical cytology. To assess the usefulness of this procedure, we reviewed the records of 518 patients referred to the Colposcopy Clinic with abnormal Pap smears. Data was reviewed retrospectively in 411 patients and collected prospectively in 107 patients. Dysplasia was present in 1.4% of ECC specimens obtained in patients with conclusive colposcopic examinations, and in 25.7% of specimens in patients with inconclusive examinations. Invasive cancer was not detected in any ECC specimen. Eighty patients with inconclusive colposcopic examinations underwent conization of the cervix; in this group, the final pathologic diagnosis was CIN III in 51.2%, microinvasive cancer in 2.5%, and invasive cancer in 1.2%. In patients with conclusive colposcopic examinations, the final pathologic diagnosis was CIN III in 17.2%, and no cases of microinvasive or invasive cancer were present. When the colposcopic examination is conclusive, the incidence of positive ECC is low and may not warrant performing ECC in all patients. When the examination is inconclusive, ECC rarely obviates the need for diagnostic conization as ECC rarely yields a diagnosis of invasive cancer.

Biopsy↗
PubMed1987

Human papilloma viruses and cervical intraepithelial neoplasia: the role of colposcopy.

To evaluate the reliability of colposcopy for distinguishing flat condyloma from cervical intraepithelial neoplasia (CIN), 211 patients with abnormal cytology, colposcopical evidence of an atypical transformation zone (ATZ), and a histological diagnosis of flat condyloma or CIN were studied. Colposcopic evidence of surface abnormalities, the presence of satellite lesions, and an irregular Lugol's uptake were tentatively considered to be features of condyloma. Histologically, koilocytotic lesions with a disorganized cytologically atypical basal/parabasal layer and with atypical mitotic figures (AMFs) were considered to be CIN cases, and designated as CIN with koilocytosis (CIN K). At least two colposcopic features of condyloma found in 98 of 99 flat condylomas, were also found in 89 of 112 CINs. When colposcopic features were matched with histology for every directed biopsy site, they correlated strongly with koilocytosis, regardless of the degree of atypia in the lesion. Moreover, these features often occurred at the periphery of poorly differentiated or undifferentiated, high grade CINs, in areas histologically indistinguishable from flat condyloma. Thus, colposcopic features are not of predictive value in distinguishing flat condyloma from CIN, do not show correspondence to the lesional degree of atypia and cannot be fully related to the biological characteristics of the cervices in which they are found. These findings confirm that colposcopy cannot be considered to be a diagnostic method.

Acetates↗
PubMed2004

Treatment of high-grade squamous intraepithelial lesions: a 2- versus 3-step approach.

OBJECTIVE: The purpose of this study was to determine whether colposcopically directed biopsy is a necessary step in the evaluation of patients with high-grade squamous intraepithelial lesions. STUDY DESIGN: A retrospective analysis was conducted of the correlation between the high-grade squamous intraepithelial lesion Papanicolaou test and the colposcopically directed biopsy and the correlation between the high-grade squamous intraepithelial lesion Papanicolaou test and the loop electrosurgical excisional procedure. RESULTS: Of 72 patients with high-grade squamous intraepithelial lesions on Papanicolaou test, 48 patients had a pathologic diagnosis on cervical biopsy of CIN II or greater, which provides a 67% correlation between the Papanicolaou test and the colposcopically directed biopsy. Fifty-six patients had a pathologic diagnosis on loop electrosurgical excisional procedure of CIN II or greater, which provides a 78% correlation between the Papanicolaou test and the loop electrosurgical excisional procedure. The median interval between the Papanicolaou test and the definitive treatment was significantly longer (P <.001) when colposcopically directed biopsy was performed before the loop electrosurgical excisional procedure. CONCLUSION: The colposcopically directed loop electrosurgical excisional procedure after a high-grade squamous intraepithelial lesion Papanicolaou test may reduce the time interval between diagnosis and treatment; furthermore, it offers equal correlation when compared with traditional treatment.

Adult↗
PubMed2004

An analysis of 84244 patients from the British Columbia cytology-colposcopy program.

OBJECTIVE: To determine the diagnostic correlation between referral cytology, initial biopsies and colposcopic impression in patients assessed in a provincial cytology screening program. METHODS: A retrospective review of the computerized cytology screening database for British Columbia (BC), to identify all patients having their first colposcopy between 1986 and 2000 in 24 participating clinics constituted the study population. 84244 patient records were identified for analysis. Colposcopies were performed mainly by 37 general gynecologists as part of a province-wide colposcopy program. Correlation of cytology, colposcopic impression and directed biopsies was performed. RESULTS: The colposcopic impression correlated with the referral cytology within one degree in over 90% of cases. Colposcopists felt cytology underestimated disease in 1.5% and overestimated disease in 8.3%. Cytology-histology correlation within one degree occurred in 82%. Cytology underestimated the result of the biopsies in 2.3% and appeared to overestimate disease in 16.1% of patients. Patients with HSIL cytology had corresponding lesions in 77%, with a further 4.9% having LSIL disease. The predictive accuracy of colposcopy increased with advancing severity of disease expected. As the degree of cytological abnormality worsened, the predictive accuracy of colposcopic diagnosis increased. CONCLUSIONS: Both cytology and colposcopy have high sensitivity but low to moderate specificity. Colposcopy is most accurate in identifying high-grade diseases. Colposcopic impression correlates closely with the cytology diagnosis and combining the two produces optimum results.

Adult↗