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PubMed1998

One-step management of cervical lesions.

OBJECTIVE: To test the value of diagnosing and treating cervical lesions at the first colposcopic visit using large loop excision of the transformation zone (LLETZ) based on abnormal colposcopic findings as compared with punch biopsies followed by subsequent therapy accordingly. PATIENTS AND METHODS: Among 1255 patients with a clinically suspicious cervix, 119 patients with abnormal and satisfactory colposcopy were divided into two groups. In group A (53 patients) multiple cervical punch biopsies were taken. In group B (66 patients), LLETZ under local paracervical anesthesia was done. RESULTS: Cervical intraepithelial neoplasia was diagnosed in 25 and 29 cases, condyloma acuminatum in seven and six cases, granulomatous cervicitis including tuberculous and bilharzial cervicitis was diagnosed in two and four cases in groups A and B, respectively. Endocervical adenocarcinoma was diagnosed in two cases in group B whereas microinvasive squamous cell carcinoma was diagnosed in one case in each group. Histopathologic assessment of the specimens obtained in group B revealed minimal coagulation artifact, adequate biopsies and free margins in all but three cases (4.5%) who needed further treatment by hysterectomy. In group B, only one case was complicated by a second hemorrhage and the overtreatment rate was 30.3%. On follow-up visits 20 patients (38%) and 59 patients (89%) were satisfied with the procedure in both groups, respectively. Further treatment was required in 29 cases in group A (55%) after initial assessment of punch biopsies and in three cases in group B (4.5%). Persistent abnormal colposcopic findings at follow-up visits 3 months after diathermy coagulation were seen in five patients (9.4%) in group A. CONCLUSIONS: LLETZ at the first colposcopic visit is a practical and fast method of treating most cervical lesions with limited complications and has the advantage of eliminating a second session of treatment. These advantages, particularly in developing countries, may outweigh the high overtreatment rate of this procedure. Many cervical lesions can be properly treated using large loop excision of the transformation zone at the first colposcopic visit. This may help save time and resources, especially in developing countries.

Adult↗
PubMed1998

Evaluation of atypical and low-grade cervical cytology in private practice.

OBJECTIVE: To evaluate the adequacy of cytology alone for diagnosis of grade of cervical intraepithelial neoplasia (CIN) and to study performance of cytology, human papillomavirus (HPV) testing, and colposcopy in the evaluation of cytologic findings suggesting low-grade squamous intraepithelial lesions (SIL), or atypical squamous (ASCUS) or atypical glandular (AGCUS) cells of undetermined significance. METHODS: Standard gynecologic and cytologic evaluation and colposcopic inspection as an additional screening approach were performed on women with no prior hysterectomies screened in a private practice between January 1, 1993, and August 1, 1995. Among these 7651 women, 367 had ASCUS, AGCUS, or SIL cytology or clinically or colposcopically visible cervical lesions. Sensitivity, specificity, and relative risk of CIN in the 367 women were compared by colposcopic, cytologic, histologic and virologic diagnoses. RESULTS: The sensitivity of all non-negative Papanicolaou smears for CIN 2-3 and cancer was 92%, combined cytologic categories of high- and low-grade SIL were 59%, and high-grade SIL alone was 22%. Colposcopy was performed in all 367 patients, and positive findings led to biopsies in 48%. Colposcopy of patients with ASCUS increased detection of CIN 2-3 by 32% and CIN 1 by 48%. Cervical cytology was false negative in 8% of patients with CIN 2-3 and in 14% of those with CIN 1. These cases of CIN were detected by screening colposcopic inspection. High-risk HPV DNA was positive in 41% of women with CIN 2-3, and in 25% of those with CIN 1. The positive predictive value of ASCUS cytology increased from 5% to 42% for CIN 2-3 and from 30% to 85% for all grades of CIN in patients carrying high-risk HPV DNA. Virologic studies did not add to an increase in the sensitivity for CIN 2-3 among women in the low- and high-grade SIL cytology groups. CONCLUSION: Because of the limited sensitivity of the high-grade SIL cytologic category for CIN 2-3, we recommend that all women with ASCUS, AGCUS, low- or high-grade SIL cytology be recalled for colposcopy, with biopsy only when indicated by colposcopic findings.

Adolescent↗
PubMed1999

Colposcopy in pregnancy: directed brush cytology compared with cervical biopsy.

OBJECTIVE: To evaluate colposcopically directed brush cytology as a substitute for directed biopsy of acetowhite lesions identified during pregnancy. METHODS: Pregnant patients eligible for the study were referred for colposcopic evaluation for either newly diagnosed abnormal cervical cytology or follow-up of a previously diagnosed squamous intraepithelial lesion (SIL). All patients with acetowhite lesions underwent colposcopically directed brush cytology followed by directed biopsy. RESULTS: Of 81 pregnant patients referred, 50 paired samples of colposcopically directed brush cytology and directed biopsies were evaluated from 49 patients. One patient was sampled in the first and third trimesters and one patient's brush cytology was unsatisfactory for interpretation because of clumping artifact, leaving 49 brush-biopsy pairs that were satisfactory for examination. One patient in the study group had an intrauterine fetal death of uncertain cause, remote from the time of biopsy. Compared with the corresponding biopsy, the directed brush caused significantly less blood loss (P < .001). For all diagnostic categories, directed cytology demonstrated a good degree of correlation with biopsy (kappa = 0.73). The brush technique correctly identified 12 of 14 cases (86%) of biopsy-proved cervical intraepithelial neoplasia II-III as high-grade SIL. If one considers "atypical squamous cells, favor human papillomavirus effect" as a true positive, brush sensitivity was 88 +/- 9% and specificity was 74 +/- 12%, with an accuracy of 80%. CONCLUSION: In the absence of lesions suspicious for carcinoma, colposcopically directed brush cytology is a safe substitute for directed biopsy in pregnant patients.

Adult↗
PubMed1992

Towards a more rational policy for colposcopy.

The objective of the study was to establish the relationship between the results of positive and abnormal cervical smears and the corresponding colposcopic biopsy results and its relevance to clinical management. A retrospective analysis of linked results was carried out at the Princess Anne Hospital, Southampton. The main outcome measure was the correspondence between a positive or abnormal cervical smear and the related colposcopic biopsy. Colposcopic biopsies were carried out on 1,841 consecutive women. Of these, 1,424 (77.4%) had moderate or severe dyskaryosis on their smears. Of the 1,767 with definitive results on their smear, 1,101 (62%) showed exact correspondence between the cervical smear and the colposcopic biopsy. Ninety-one (26%) of all women with mildly dyskaryotic smears were reported as showing CIN II or CIN III on biopsy. We conclude that women with moderate or severe changes on cervical smear should not be asked to attend for confirmatory colposcopic biopsy prior to treatment, but those with persistent mild changes should be referred for separate diagnostic colposcopy.

Cervix Uteri↗
PubMed1987

Human papilloma virus infection and associated intraepithelial neoplasia of the cervix, vagina and vulva.

A prospective colposcopic and histological study was performed on 333 patients with cytologically detected human papilloma virus infection (HPV) without cytological evidence of associated intraepithelial neoplasia. The colposcopic changes seen in the cervix, vagina and vulva were documented and target biopsies were taken from abnormal areas in these 3 sites. Colposcopic and histological evidence of HPV infection was found in the cervix of 314 patients (94%), vagina in 274 patients (82%) and vulva in 146 patients (44%). Histologically proven cervical intraepithelial neoplasia was found in 94 of 333 patients biopsied (28%), vaginal intraepithelial neoplasia in 3 of 333 patients biopsied (0.9%) and vulval intraepithelial neoplasia in 9 of 146 patients biopsied (6.2%). This study identified the colposcopic changes of HPV infection to be widespread throughout the lower female genital tract. The diagnosis of intraepithelial neoplasia undetected by cytology in 28% of patients with HPV infection indicates that such patients require colposcopy and target biopsy according to the colposcopic findings.

Adolescent↗
PubMedDate not supplied

Screening colposcopy in genitourinary medicine.

A prospective study of new female patients attending the Genitourinary Medicine Department in Doncaster was carried out to look at the value of colposcopic examination at their first attendance. Of the 100 randomized patients studied 41 showed evidence of colposcopically detected cervical abnormality. Twenty-seven patients had colposcopically directed biopsies. These showed evidence of cervical intraepithelial neoplasia (3 cases), flat condyloma (16 cases), exophytic wart (2 cases), chronic inflammation (2 cases) and normal epithelium (4 cases). Colposcopic cervical abnormalities were significantly associated, with a history of anogenital warts, sexual contact with anogenital warts and the presence of anogenital warts at presentation. Despite this, less than half the group showing colposcopic abnormalities had an association with anogenital warts. Demonstration of cervical abnormalities by colposcopy resulted in a greater patient compliance during follow-up. Screening or primary colposcopy may be incorporated into a genitourinary screen at the first visit. The procedure is both acceptable and beneficial to the patient, facilitating the detection of a range of cervical disease and enhancing the doctor-patient relationship.

Adolescent↗
PubMed2002

[Systematic evaluation of the new screen methods of cervical intraepithelial neoplasm].

OBJECTIVE: To evaluate new cytologic screening methods of papnet cytology computer technology (CCT) and thinprep pap test (TPT) on cervical intraepithelial neoplasm (CIN). METHODS: Three hundred and seventy four cases with abnormal cervical cytologic results received colposcopic examinations and multiple biopsies. The results of cytologic screening compared with the results of histologic-colposcopic diagnosis were analysed retrospectively. RESULTS: A total of 374 cases were diagnosed by cytology, 9.1% with inflammations, 43.3% with low grade squamous intraepithelial lesion (LSIL) and 20.3% with high grade squamous intraepithelial lesion (HSIL) and 1.9% suspected with squamous cell carcinoma. However, after examination by colposcopy and multiple biopsies, the situation was different. The percentage of cases with inflammation increased to 53.5%, cervical intraepithelial neoplasm I (CIN I) decreased to 17.9%, CIN II and CIN III and cervical carcinoma in situ (CIS) elevated to 25.4% and invasive squamous cell carcinoma increased to 3.2%. Among cases with atypical squamous cell of undetermined significance (ASCUS), 52.6% (50/95) were with inflammations or negative results, 47.4% (45/95) with CIN I or even greater. Among 374 cases, 188 women were screened by CCT and 186 by TPT. When all cytological findings compared with the histologic-colposcopic results, respectively, the coincidence of TPT with histologic-colposcopic results was significantly higher than that of CCT (P < 0.01). The coincidence rate (79.7%) of screening cases with LSIL or inflammation was significantly higher than that (20.3%) of cases with HSIL or even greater (P < 0.01). But there was no difference between two methods. The incidence of human papillomaviral infection (HPV) infection at colposcopies was 34.0%. The high incidences of HPV and CIN infection were found among women from 20 to 30 years old and from 30 to 50 years old, respectively. CONCLUSIONS: Cases with abnormal cytologic findings should undergo colpscopic examination and multiple biopsies for further diagnosis. Only in this way, cases with CIN or HPV infection could not be misdiagnosed. Women ranged from 30 - 50 years old should receive cytologic screening or colposcopic examination regularly.

Adult↗
PubMed2004

A "See and Treat" approach for high grade squamous intraepithelial lesion on cervical cytology.

OBJECTIVE: To examine the final histologic findings as well as to correlate colposcopic and histologic findings in patients who had a high-grade squamous intraepithelial lesion (HGSIL) on the Pap smear and underwent colposcopy followed by LEEP on the "See and Treat" basis without intervening colposcopically directed biopsy. MATERIAL AND METHOD: The medical records of patients with HGSIL on cytology who underwent LEEP without prior cervical biopsy at Chiang Mai University Hospital over a 5-month period were reviewed. The authors summarized the final LEEP histologic results and correlated colposcopic and histologic findings in these patients. RESULTS: Of 55 patients who had a see-and-treat LEEP, 53 patients (96%) had a high-grade intraepithelial lesion or higher. There were 11 patients (20%) who had invasive squamous cell carcinoma. Of 4 patients with a low-grade lesion on colposcopic examination, all had a high-grade lesion or higher on final histology. Forty-four patients (96%) with high-grade impression on colposcopy had high-grade or more severe lesion on the final histologic diagnosis. CONCLUSION: For patients with a high-grade lesion on the Pap smear, LEEP according to the "See and Treat" approach appeared to be a reasonable alternative to conventional colposcopically directed biopsy, especially in low resource settings.

Adult↗
PubMed1991

Detection of human papillomavirus DNA in gynaecological swabs by filter in situ hybridization.

Gynaecological smears from the endo- and ectocervix of women with and without cytological and colposcopic abnormalities of the epithelium were investigated for human papillomavirus (HPV) types 6, 11, 16, and 18 by filter in situ hybridization (FISH). The data were compared with cytological, colposcopic, and histological findings. Of the 266 gynaecological smears, HPV DNA was detected in 84 (32%); of 101 cytologically and colposcopically HPV negative cases, HPV DNA was found in 10%. Of 56 women, cytologically and colposcopically positive for HPV infection, HPV DNA was detected in 68%. The sensitivity of the method was controlled by comparing the results of FISH with those of Southern-blot analysis of five cervical tumour biopsies. The data presented demonstrate the necessity of FISH for identification of the HPV type that might be of prognostic value in cervical pathology. Cytological and colposcopic positivity is a reliable sign in about 70% of the cases where HPV infection was proved by FISH.

Adolescent↗
PubMed1985

Colpohistologic correlations. A computerized study.

Data from 300 colposcopic cases were computerized to study the correlations between the colposcopic observations and the histologic and other data. Colposcopy was shown to be most useful in women under 35 years of age. Use of oral contraceptives (the Pill) seemed to relate to a higher level of successful colposcopic visualization and may even prevent the need for conization, based on a higher incidence of negative endocervical curettages. Although 14.5% of the cases were colposcopically undergraded and 17% overgraded when compared to the histopathology, the histologic predictability of the colposcopic observation of white epithelium and vascular changes (punctation and mosaicism) was excellent. Colposcopy remains an essential technique in the appraisal and management of cervical intraepithelial neoplasia.

Adult↗
PubMed1988

Endocervical brush cytology. An alternative to endocervical curettage?

The usefulness of an endocervical brush for cytologic sampling was studied in 288 consecutive women attending a colposcopy clinic. One hundred sixty had initial colposcopic examinations with directed biopsies and endocervical curettage (ECC). One hundred twenty-eight had follow-up examinations that included Papanicolaou smears and ECC some time after evaluation and/or treatment for cervical dysplasia. Within an established protocol for the evaluation and management of abnormal Papanicolaou smears, the endocervical brush was compared to ECC. When the combination of colposcopy and cervical conization showed that dysplasia was confined to the endocervix, the endocervical brush was significantly more sensitive than ECC in detecting this endocervical disease (P less than .05). In follow-up evaluations and in patients with unsatisfactory colposcopic examinations, endocervical brush cytology could replace ECC without affecting clinical management. In patients with a satisfactory colposcopic examination, ECC may be required only when endocervical brush cytology is abnormal. Endocervical brush cytology is less costly and painful and could prove to be a reasonable alternative to ECC for the initial evaluation of the endocervix. Endocervical brush cytology shows promise as a safe adjunct to the colposcopic evaluation of pregnant women, whereas ECC is contraindicated in such women.

Adenocarcinoma↗
PubMed1993

Presence of human papillomavirus infection of the uterine cervix as determined by different detection methods in a low-risk community-based population.

OBJECTIVE: To evaluate the effectiveness of various screening tests for detecting genital human papillomavirus (HPV) in a community-based population and to determine the prevalence of cervical lesions on colposcopically directed biopsies in patients found to have HPV by any screening test. DESIGN: Cross-sectional analysis of 208 female patients screened for HPV by clinical examination, Papanicolaou test, dot blot hybridization test (ViraPap, Digene Inc, Silver Spring, Md), and polymerase chain reaction (PCR) analysis. All persons with abnormal or positive results by any method were offered colposcopic evaluation. SETTING: Two community-based family practice offices in southeastern Michigan. MAIN OUTCOME MEASURES: The presence of HPV as determined by each test and results of colposcopic biopsies (gold standard) in patients who had HPV identified by any test. RESULTS: The prevalence of HPV infection was 20.3% by PCR analysis, 3.1% by ViraPap, 3.0% by the Papanicolaou test, and 0% by clinical examination. Symptomatic patients (those with complaints of vaginal odor, swelling, or itching) were more likely to harbor HPV as determined by PCR analysis than were asymptomatic women (P = .03, odds ratio = 2.65). Human papillomavirus type 16 or 18 was found in 41% of patients with positive PCR analyses and in all patients with positive ViraPap tests that were typed. Colposcopy with biopsy (gold standard for the presence of HPV disease) was performed on 34 of the 41 patients who tested positive for HPV by PCR analysis. Histologic results revealed that 79.4% of these patients had cervical disease: 14.6% had cervical intraepithelial neoplasia, 38.3% had condyloma, and 26.5% had cervicitis. CONCLUSIONS: Human papillomavirus as detected by PCR analysis was present in 20.3% of women in our population and was often one of the higher-risk types (16 or 18). A positive PCR analysis was predictive of cervical disease on colposcopic biopsy. The ViraPap test, Papanicolaou test, and clinical examination were insensitive measures for detecting HPV-related lesions in this population.

Adolescent↗
PubMed2005

Should women with atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion, receive reflex human papillomavirus-DNA testing?

BACKGROUND: The 2001 American Society for Colposcopy and Cervical Pathology Consensus Guidelines recommend that women who have Papanicolaou (Pap) smears diagnosed as atypical squamous cells (ASC), cannot exclude high-grade squamous intraepithelial lesion (HSIL) (ASC-H) should be referred for immediate colposcopic examination. The objective of this pilot study was to evaluate whether reflex human papillomavirus (HPV)-DNA testing performed on smears diagnosed as ASC-H may obviate the need for immediate colposcopic examination. METHODS: All ThinPrep Pap smears that were diagnosed as ASC-H or atypical squamous metaplastic cells (ASMT) between 2001-2003 and that had HPV-DNA testing and subsequent histologic and/or cytologic follow-up were evaluated. Those smears that were diagnosed as ASMT were reviewed and reclassified under the 2001 Bethesda System as either ASC of undetermined significance (ASCUS) or ASC-H. Smears that were diagnosed as ASCUS were excluded from the study. RESULTS: The study included of 48 smears that were diagnosed as ASC-H. All patients with biopsy-proven HSIL had positive high-risk (HR)-HPV results (100% negative predictive value). Approximately 80% of patients with ASC-H who had biopsy-proven, low-grade intraepithelial lesion on follow-up had positive HR-HPV results. Among the patients who had ASC-H with negative follow-up, 50% had positive HR-HPV results, and 50% had negative HR-HPV results. CONCLUSIONS: Among patients with ASC-H, a negative HR-HPV result was found to be an excellent predictor of the absence of HSIL. The results of this pilot study suggested that HPV-DNA testing may serve as a means to better select which patients with ASC-H on Pap smear should undergo colposcopic examination. This approach potentially may reduce medical costs and eliminate the need for routine colposcopic examination among patients with ASC-H Pap smears.

Colposcopy↗
PubMed2006

Endocervical curetting vs. endocervical brushing as case finding methods.

This paper focuses on the performance of endocervical curettage (ECC) and intensive endocervical brushing (ECB) (comprising two or more brushings of the endocervix with liquid-based cytology and cell-block examination) in the course of colposcopic examination for abnormal gynecological cytology. To assess their relative effectiveness in disease detection, we reviewed the outcomes of 1,824 colposcopic biopsy collections from women who had an index cytology diagnosis of LSIL or higher. Our intent was to gauge the relative success of ECC and ECB as case-finding procedures in relation to (1) the original cytological diagnosis and (2) the highest (most abnormal) histological diagnosis of the colposcopy study. Our purpose was to determine whether ECB could effectively replace ECC. One thousand five hundred and seven cases of LSILs or higher cases included an ECC along with two or more colposcopic biopsies and 317 cases included an ECB. ECBs were collected into a liquid fixative and processed as both cytology and cell-block specimens; whereas, ECCs were processed according to standard histological techniques. We found that intensive ECB recapitulates the highest diagnosis of the colposcopy study about 5-8 times as often as that of ECC. Moreover, when calculating the proportion of positive outcomes, we found that cases examined with biopsy and ECC discovered fewer women with CIN 2 or higher among both LSIL and HSIL index cytologies as compared with those of cases examined with biopsy and ECB (9.2% vs. 16.8% for LSIL and 63.7% vs. 72.2% for HSIL cases); and, more negative outcomes were seen among women evaluated with biopsy plus ECC than those with biopsy plus ECB (11.3% vs. 8.1% for LSIL and 4.7% vs. 1.4% for HSIL cases). Our findings suggest that the colposcopic study is optimized when it is performed in conjunction with ECB as opposed to ECC, and that intensive ECB may be superior to ECC.

Biopsy↗
PubMed2005

Assessing the accuracy of colposcopy at predicting the outcome of abnormal cytology in pregnancy.

OBJECTIVE: To determine the accuracy of colposcopic and cytological assessment at predicting final histological diagnosis in women referred with abnormal cervical smears during pregnancy; to use this data as a basis for a follow up protocol for pregnant patients referred with abnormal cervical cytology. STUDY DESIGN: Retrospective analysis of women referred to Queens Medical Centre, Nottingham, UK with abnormal cytology whilst pregnant between 1994 and 2003. RESULTS: Forty-nine patients in total were included in the study. Colposcopic assessment in the antenatal period had a concordance with final histological diagnosis in 60% of patients and a concordance of 68% when undertaken in the post-natal period. Cytological concordance was lower at 58%. In only six percent of patients was a cervical biopsy undertaken and there were no complications as a result. There was a fall in colposcopically assessed high-grade cervical intraepithelial neoplasia between the antenatal and post-natal period. No cases of invasive cancers were diagnosed antenatally. CONCLUSION: A policy of conservative management of pregnant patients during the antenatal period is supported by this data. A suggested protocol of one colposcopic assessment at the time of the index abnormal smear followed by a post-partum colposcopy, and appropriate treatment is suggested.

Adult↗
PubMed1994

Adolescents and colposcopy: the use of different procedures to reduce anxiety.

OBJECTIVE: Two consecutively occurring studies examined whether using a video colposcope to view this procedure or allowing the female adolescent to watch music videos would reduce anxiety and related body movements. STUDY DESIGN: Female adolescents who underwent colposcopy were randomly assigned to one of two groups, experimental and control. In study 1, 27 female adolescents were randomly assigned either to view the procedure on a television monitor or to be part of a control group (no visual distraction). In study 2, 30 female adolescents were randomly assigned either to a music video group or to a control group. Studies were completed in a consecutive manner and used the same measures, colposcopic equipment, and professional staff, including physician. Multiple measures of anxiety were used (heart rate, behavior observation, and paper and pencil) before, during, and after the procedure. During each colposcopy the subject's behavior across 10 dimensions was observed and coded. Data were analyzed by chi 2, analysis of variance, and Student t tests. RESULTS: Study 1 found no significant differences in body movements and anxiety ratings between the video colposcope group and controls. In study 2, subjects who were allowed to watch the music videos demonstrated significantly fewer body movements indicative of pain, required less physician reassurance, and received fewer procedural explanations (p < 0.05). CONCLUSION: Results suggest that allowing a female adolescent to watch music videos during a colposcopic examination appears to decrease body movements associated with discomfort.

Adolescent↗
PubMed2003

Human papilloma virus testing in patient follow-up post cone biopsy due to high-grade cervical intraepithelial neoplasia.

OBJECTIVE: We evaluated the contribution of the human papilloma virus (HPV) load in planning follow-up and management of women post cone biopsy for high-grade cervical intraepithelial neoplasia (CIN2-3). METHODS: Ninety-six suitable women were followed-up by Pap smears: two consecutive abnormal smears dictated referral for colposcopy-directed biopsy. Before colposcopy, HPV tests determined high-risk HPV DNA type and load (Hybrid Capture System type I). Patients histologically diagnosed with CIN1 or CIN2-3 underwent repeat conization or hysterectomy for residual disease. HPV load was compared to cytology for the detection of residual disease. RESULTS: At follow-up, 20/89 (22.4%) studied women had positive cytology reports of either low- (n = 11) or high-grade (n = 9) squamous intraepithelial lesion (SIL). Colposcopic biopsies diagnosed 9 CIN1 and 8 CIN2-3 cases. Residual disease was corroborated in 16/17 (94.1%) women and the status was readjusted based on cone biopsy/hysterectomy: CIN2-3 in 9 and CIN1 in 7. The positive prediction values for CIN2-3 residual disease with high-grade SIL, CIN2-3 on colposcopic punch biopsy, and high HPV load were 89, 100, and 100%, respectively. For CIN1 residual disease with low-grade SIL, CIN1 on colposcopic punch biopsy, and low and borderline HPV load, they were 54.5, 77.7, and 100%. The HPV load was a more accurate predictor for CIN1 or CIN2-3 on the cervical specimen in cases with low-grade SIL or CIN1 on colposcopic biopsy. CONCLUSIONS: Evaluating HPV loads after a positive cytology report may assist in triaging women post conization biopsy for CIN2-3 to appropriate treatment. Its high positive predictive value, specificity, and sensitivity for CIN1 and CIN2-3 and supplementary information could be especially pertinent for clinical management of low-grade SIL cases.

Adolescent↗
PubMed2002

Management and evolution of cervical intraepithelial neoplasia during pregnancy and postpartum.

OBJECTIVE: To investigate the evolution of cervical intraepithelial neoplasia (CIN), and to evaluate the safety of cytological and colposcopical surveillance of women with CIN during pregnancy. STUDY DESIGN: Ninety-eight women with antenatal cytological and/or colposcopical impression of CIN were followed up during pregnancy with cytology and colposcopy every 2 months. A cytological and colposcopical reevaluation 2 months postpartum was done, and large loop excision of the transformation zone (LLETZ) was performed if appropriate. Punch or loop biopsies were only taken if there was suspicion of microinvasion. RESULTS: In 14 of 39 (35.9%) and in 25 of 52 (48.1%) women with antenatal impression of CIN I and CIN II-III, respectively, there was postnatal impression of regression. Seven women with findings suspicious of microinvasion underwent small loop biopsies during pregnancy, but early stromal invasion (< 1 mm) was seen in just one case. There was one more case of microinvasion (1.5 mm) diagnosed postnatally in which the antenatal impression was of CIN III. 84.6% of the women with regression compared to 67.3% of the women with stable disease or progression had a vaginal delivery (P = 0.057). CONCLUSION: There is a considerable regression rate of CIN after pregnancy possibly attributable to the loss of the dysplastic cervical epithelium during cervical ripening and vaginal delivery. Frequent cytological and colposcopical evaluation seems to be safe. Small loop biopsies are recommended in cases of possible microinvasion.

Colposcopy↗