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PubMed2003

[Intraepithelial cervical carcinoma and HIV. Prevalence, risk factors and prevention strategies].

BACKGROUND: The present study analyses cervical dysplastic lesions associated with HIV infection by means of cytological, colposcopic and histologic examinations, and the diagnostic accuracy of the Pap test. METHODS: Cross-sectional study. We have studied colposcopic and histologic findings of 115 HIV-positive women. In 86 patients a cytological examination was also carried out. The results were compared with those of a control group consisting of 127 HIV-negative women in pre-menopause age. RESULTS: The prevalence of cervical dysplastic lesions present at colposcopic/bioptic examination was 3.2 times greater in HIV+ women than in HIV- women (38% vs 12%, p<0.001) and that of lesions of a higher degree 7 times greater. Compared to non-HIV+ women, patients who were positive presented more severe dysplastic lesions, a higher frequency of HPV-derived lesions and inflammatory pictures. There was also a correlation between high incidence of dysplastic cervical lesions and advanced stage of immunodepression. The negative predictive value of the Pap test was higher in the seronegatives (95%) than in the seropositives (83%, p<0.01). The overall agreement between cytology and colposcopy/histology was greater in the seronegati-ves than in the seropositives (87% vs 74%, p<0.05). CONCLUSIONS: Cervical dysplastic lesions in seropositive patients are more frequent and aggressive than in HIV negatives and are related both to the degree of immunodepression and to the HPV infection. Further, the diagnostic value of the Pap test in association with HIV is reduced. These results suggest that in HIV+ patients careful combined cytological-colposcopic screening should be adopted, together with an attentive cyto-colposcopic follow-up in treated patients.

Adult↗
PubMed2003

[Postoperative verification of cervical intraepithelial neoplasia grade].

UNLABELLED: Colposcopically directed punch biopsy and endocervical curettage is considered to be a "gold standard" in diagnosing premalignant lesions of the uterine cervix. However, in daily routine practice the CIN grade, assessed on the basis of colposcopically directed punch biopsy, sometimes differs from postoperative histopathological evaluation. Such a situation can influence the methods and outcomes of further treatment of women with premalignant lesions of the uterine cervix. OBJECTIVE: The comparison of histopathological diagnoses of punch biopsies to postoperative findings. MATERIAL AND METHODS: The accuracy of punch biopsies findings was evaluated in 104 women treated in the Gynecology Ward of the District Hospital in Kielce in the years 1996-2000. Women with cytological diagnosis of LGSIL and HGSIL were included to the study. Histopathological findings of colposcopically directed punch biopsies and endocervical curettage were compared to definitive diagnoses of postoperative material obtained by conization or hysterectomy. RESULTS: Discrepancies between the diagnosis of CIN grade, evaluated by colposcopically directed punch biopsies, and postoperative findings were detected in 37 cases (35.5%). Lower grade of CIN evaluated in biopsy was found in 23 cases (22.1%). Discrepancies in this group were found most often when colposcopy was unable to examine the entire lesion and positive endocervical specimen was obtained by curettage. In 12 (11.5%) cases when preoperative diagnosis showed CIN an early invasion was detected in postoperative material. CONCLUSIONS: Significant discrepancies were found between pre- and post-operative evaluation of CIN grade. Therefore in each case of LGSIL diagnosed in punch biopsy HGSIL should be ruled out. Expectant management of LGSIL lesions and ablative treatment of CIN should be performed only in centers with highly qualified medical staff experienced in colposcopy and cytology. It seems to be advisable to discriminate a group threatened with fast progression into CIN III or cancer among women with LGSIL (e.g. typing of high risk HPV, aneuploidy).

Biopsy, Needle↗
PubMed2004

Is direct large loop electric excision for the transformation zone reasonable in the investigation of high-grade squamous intraepithelial lesions in cervical smears?

PURPOSE OF INVESTIGATION: To evaluate women with cytological high-grade squamous intraepithelial lesions (HGSIL) who received standard colposcopic evaluation and direct diagnostic large loop electric excision for the transformation zone (LLETZ) to determine the feasibility of using LLETZ alone (ie, skipping the colposcopic examination). METHODS: From May 1999 to May 2001, 70 women, with the mean age of 49.58 years (range, 20-82 years) and with cervical HGSIL categorized by the Bethesda system were all evaluated by colposcopic evaluation and LLETZ. Cases with a satisfactory colposcopy examination were classified as group A and those with an unsatisfactory colposcopy examination were classified as group B. "Over-treatment" was determined if the women did not need further LLETZ for evaluation or management. "Under-treatment" was determined if treatment might be potentially inadequate or invasive cancer could be ruled out during a satisfactory colposcopic evaluation. RESULTS: Group A consisted of ten women who were evaluated satisfactorily by colposcopy and group B consisted of 30 women who were not evaluated satisfactorily by colposcopy. Overall 8.6% of the patients (6/70) were considered "over-treated". The rate of over-treatment was 10.0% (4/40) in group A compared with 6.7% (2/30) in group B. In contrast, overall 10% of the patients (7/70) were considered "under-treated". The rate of under-treatment was 10% (1/40) in group A compared with 10% (3/30), in group B. The positive predictive values of group A and B were 90.6% and 88.0%, respectively. The negative predictive values were 33.2% and 40%, respectively. CONCLUSION: Direct diagnostic and therapeutic LLETZ for the management of cervical HGSIL may be a better alternative to colposcopy. This method of treatment avoids the possibility of under-treatment and is associated with an acceptable over-treatment rate, especially for postmenopausal women with cytological HGSIL. LLETZ has a good diagnostic accuracy with minimal morbidity and, most importantly, may help reduce patient anxicty, although further studies are needed to directly examine this effect.

Adult↗
PubMedDate not supplied

[Atypical cervical cytology during pregnancy in the region of Baranja].

In the period from 1985 to 1989, 2521 pregnant women, making up 18.7% of women in fertile age, were controlled in antenatal surgeries in the area of Baranja. In 73 (2.9%) women a cytologic picture of cervical atypia was found: in 2.1% of them there was a cytologic picture of light and moderate dysplasia (group IIIA), in 0.6% a picture of severe dysplasia (group IIIB), and in 0.2% pregnant women there was a picture of carcinoma in situ (group IV). Progression of cytologic findings into a higher stage was noted in 23.3% women, persistence was recorded in 21.9% and regression in 54.8% women. A total of 71.2% pregnant women with the cytologic atypia of the cervix were colposcopically examined. An abnormal colposcopic picture was found in 65.4% of them. By the end of the puerperium histologic verification was made in 38.4% cases and 61.6% were controlled only cytologically and colposcopically. By means of histologic examination of the tissue specimen, progression of an intraepithelial lesion into an invasive carcinoma was not found in any of the women. These results corroborate the point of view that in pregnant women with the cytologic atypia of the uterine cervix the histologic verification can be postponed until after the delivery without any considerable risk. Only in the case of a cytologic or colposcopic suspicion of invasion it is necessary to verify the finding histologically.

Female↗
PubMed1985

Colposcopy in women with papillomavirus lesions of the uterine cervix.

Colposcopic examinations for human papillomavirus lesions were performed in 271 women, some of whom had developed concomitant cervical intraepithelial neoplasia since 1981. The colposcopic appearance was classified into one of the following categories: normal, punctate, mosaic, warty, leukoplakial, or combination, and was related to findings in Papanicolaou smears and punch biopsy specimens. There was a good correlation between the colposcopic appearance and the findings in the Papanicolaou smears and punch biopsy specimens, facilitating the diagnosis of the lesions. The accuracy of colposcopy in disclosing the atypias varied according to the growth pattern of the papillomavirus lesions, with the most accurate (100%) in cases of papillomatous condylomas, and the least accurate (50%) in the inverted lesions. White epithelium and combination patterns were most frequently associated with the papillomavirus lesions and cervical intraepithelial neoplasia, as evidenced by both cytology and biopsy. During the follow-up, normal colposcopic appearance increased from 32 to 50%, reflecting the established spontaneous regression of a certain percentage of the cervical lesions, or their regression as a result of biopsy. The results are discussed in terms of the mutually complementary roles of colposcopy, cytology, and biopsy, and in view of the clinical behavior of cervical papillomavirus lesions. Colposcopy is mandatory for adequate prospective follow-up of these patients but should not replace cytology and punch biopsy.

Adult↗
PubMed1986

[Cryosurgical treatment of cervical intraepithelial neoplasia following cervical smears and curettage].

65 patients exhibiting colposcopically and cytologically atypical epithelium in the cervix were treated by cryosurgery with liquid nitrogen. 63 of whom were confirmed histologically after surface scraping and curettage of the cervix. The patient then were followed cytologically and colposcopically 8 and 12 weeks after cryosurgery. According to that the definitive histological diagnosis was performed after conization (48 patients) hysterectomy (12 patients) and surface scraping and curettage of the cervix (8 patients). Colposcopical, cytological and histological findings after surface scraping of the cervix showed a correlation rate in the 95% range. Treatment failure rate following cryosurgery showed an increased percentage with increased grade of CIN. A complete destruction of ectocervical pathologic tissue in CIN 1 and 2 is opposed to a persistent disease rate of 20 percent in patients with CIN 3. The failure rate was significantly higher in cases without fully visualization of squamocolumnar junction. Cytological follow-up predicted all cases with histologic diagnosis of persistent disease. Colposcopical evaluation was frequently unsatisfactory after cryosurgery. Cryosurgery of CIN should be reserved for the treatment of those patients in whom the criteria for patient selection are performed and the benefits of this method outweigh the possible drawbacks.

Carcinoma in Situ↗
PubMed1979

[Preoperative evaluation by colposcopy and cytology in cervical intraepithelial neoplasia (cin) (author's transl)].

Before conization in 108 patients with cervical intraepithelial neoplasia (CIN) colposcopic findings and the results of triple cervical smears (anterior and posterior cervical lip and endocervical canal) have been evaluated and compared with the microscopic findings, limiting the comparison to the separately investigated anterior and posterior cervical lips. Colposcopically and cytologically suspicious findings agreed with the microscopic findings of CIN in 48.3% (anterior lip) resp. 41.7% (posterior lip). Cytologically suspicious findings alone have been determined in 80.5% resp. 84.8%; colposcopically suspicious findings were found in 55.2% resp. 48.1%. The main causes of false negative smears may have been failures of sampling, of false negative colposcopical findings a wrong estimation of an atypical transformation zone. A combined application of colposcopy and triple cervical smear technique in patients with abnormal smears is strongly recommended. This may improve the results of localizing a lesion of CIN.

Adult↗
PubMed1982

[Clinical diagnosis of well differentiated cervical adenocarcinoma with plentiful mucous secretion].

Six cases of cervical adenocarcinoma with plentiful mucous secretion were recently experienced. They were clearly distinguishable from the majority of adenocarcinoma without plentiful mucous secretion from the standpoint of clinical and colposcopic findings. As common features deduced from clinical and colposcopic findings, it could be pointed out that portio vaginalis become swollen as a whole showed resiliency as of a rubber ball, and that erosion widespread over nearly entire surface of portio vaginalis is accompanied with a plentiful mucus. On the surface of erosion was found neither localization of ulcer, nor necrosis and nor bleeding trend even in cases under progressing. Colposcopic findings were distinguished with features of papillea-, net-and transformation zone-like, and mixed type. On the other hand, all the cases were evaluated cytologically to be positive with difficulty. And they were histologically well differentiated adenocarcinoma with plentiful mucus. The distinctive feature in the clinical and colposcopic findings identified for the cases of well differentiated adenocarcinoma with a plentiful mucus was evaluated to be useful means to assist the diagnosis of cervical adenocarcinoma.

Adenocarcinoma, Mucinous↗
PubMed1994

Significance of a first-time atypical Papanicolaou smear in a young, high-risk African-American and Latino-American population.

The first atypical Papanicolaou smear in young, sexually active Latino and African-American women of low socioeconomic status may be predictive of underlying cervical neoplasia and human papillomavirus infection of significant quantity. The optimal management of first-time atypia on routine Pap smear has not been established. In many clinics, colposcopically directed sampling of the cervix is recommended only if atypia persists following specific or nonspecific treatment of cervicitis or after an arbitrarily determined time interval. Others recommend immediate colposcopic evaluation. To determine the best approach to the first-time atypical Pap smear in young minority women at high risk for the development of cervical cancer, 250 such patients were evaluated with colposcopically directed biopsy of the cervix prior to any form of therapy. Pap smears were repeated at the time of colposcopy. Histologically, there was evidence of cervical intraepithelial neoplasia in 41% of patients and human papillomavirus infection in 86%. Repeat Pap smears predicted the presence of cervical intraepithelial neoplasia in only 24% of patients. Immediate colposcopic evaluation represents the most prudent approach to the first-time atypical Pap smear in young, high-risk minority women.

Adolescent↗
PubMed1993

Women with human immunodeficiency virus infection and abnormal Papanicolaou smears: a prospective study of colposcopy and clinical outcome.

OBJECTIVE: To determine the effect of human immunodeficiency virus (HIV) infection on colposcopic and histologic findings and clinical outcome in women who have abnormal Papanicolaou smears. METHODS: We conducted a prospective study of women with abnormal Papanicolaou smears from among those participating in a longitudinal study of HIV infection, human papillomavirus infection, and genital neoplasia. Women with squamous intraepithelial lesions (SIL) on blindly interpreted Papanicolaou smears were referred for colposcopy and standard gynecologic care. Colposcopic and histologic findings were correlated with cytology, and differences between HIV seropositives and seronegatives were analyzed. RESULTS: Thirty-eight of 48 women referred underwent colposcopy, of whom 36 (94.7%) had colposcopic or histologic findings no more severe than those suggested by Papanicolaou smear. Seventeen of 25 HIV seropositives (68%) had cervical or vaginal condyloma or neoplasia, compared with three of 13 seronegatives (23%) (odds ratio [OR] 7.1, 95% confidence interval [CI] 1.5-33.0). Among seropositives, seven (28%) had cervical intraepithelial neoplasia (CIN) grade II or III; ten (40%) had cervical or vaginal condyloma, CIN I, or both; and eight (32%) had no vaginal or cervical SIL. There was no case of invasive carcinoma. Seven seropositives (28%) had or developed multicentric disease, compared with no seronegatives (P = .07). Follow-up ranged at 3-37 months and showed that all three treated seronegative women and five of ten treated seropositive women had normal examinations. Three seropositive patients had persistent disease without progression, and two had progression of condyloma. No CIN II, CIN III, or invasive carcinoma was seen during follow-up. CONCLUSIONS: Among women seropositive for HIV who had SIL on a Papanicolaou smear, colposcopic and histologic findings were predicted reliably by the cytologic smear. Rapid progression of CIN after standard gynecologic care for early genital lesions was not seen.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Ineffectiveness of topical benzocaine spray during colposcopy.

BACKGROUND: Colposcopic evaluation can cause patients to experience pain and anxiety. This study investigated the use of benzocaine spray, a topical anesthetic, and its effects on pain and anxiety associated with colposcopy and colposcopic biopsy. METHODS: The study was a double-blind, placebo-controlled trial of the effectiveness of benzocaine spray applied to the cervix immediately before colposcopic examination, cervical biopsy, or endocervical curettage in patients of a family practice center. Prior to the gynecologic procedure the patient's cervix was sprayed with either benzocaine spray or matching placebo spray. After waiting at least 30 seconds the clinician started the procedure. Pain and anxiety, measured on 10-cm visual analog scales, were determined at the following times: (1) before the start of the gynecologic examination; (2) immediately before using the spray; (3) immediately after using the spray; and, (4) after the procedure was completed. RESULTS: Of 58 consecutive patients who underwent colposcopy, 36 patients were eligible for the trial and were evaluated. Participants were similar to patients not participating with regard to race, gravidity, and parity. Statistical analysis found significant differences in both pain and anxiety scores over time (repeated measures multivariate ANOVA, P < .0001), but no difference between the use of active drug and placebo. Pain scores increased significantly after application of either benzocaine or placebo spray before the start of the procedure (average increase 1.3 cm, P < .0001). CONCLUSIONS: Benzocaine, in a spray vehicle, confers no benefit when used to decrease pain and anxiety in women undergoing colposcopic procedures.

Administration, Topical↗
PubMed1976

Management of cervical neoplasia with colposcopy.

During a 44-month period the introduction of colposcopy to a metropolitan dysplasia clinic resulted in 1, 144 colposcopic examinations on 442 patients. Agreement between colposcopically directed biopsy and final diagnosis was found in 84%, and directed biopsy revealed the most advanced lesion in 42.5%. Satisfactory colposcopy was performed on 93% of patients, and some degree of histologic abnormality was obtained in 86% of patients with colposcopic abnormalities. Undetected invasive cervical cancer occurred in both cervical conization and colposcopic examinations with equal frequency. Endocervical curettage detected two cases of occult invasive cancer, and increased use of this procedure is recommended. Guidelines for management of cervical neoplasia are suggested.

Biopsy↗
PubMed1998

The clinical value of digene hybrid capture HPV DNA testing in a referral-based population with abnormal pap smears.

PURPOSE OF INVESTIGATION: The hybrid capture human papillomavirus (HPV) DNA assay is offered by the manufacturer to assist clinicians with patients with ASCUS pap smear results to assess the risk factor and to potentially direct follow-up of these patients. In our practice, a gynecologic oncology practice that has a referral based population with abnormal pap smears, our purpose was to evaluate the patients referred with all grades of abnormal cervical cytology. METHODS: One hundred consecutive patients who were referred for evaluation of abnormal cervical cytology: atypical squamous cells of undetermined significance (ASCUS); low-grade squamous intraepithelial lesion (LGSIL); high-grade squamous intraepithelial lesion (HGSIL); or squamous cell carcinoma (SCC) were evaluated by repeat pap smear, hybrid capture HPV DNA analysis and colposcopy. Colposcopic findings were recorded, and if appropriate, cervical biopsies were performed. Hybrid capture results were correlated with histologic and cytologic findings. Using histopathologic diagnosis as the reference standard, the sensitivity and positive predictive value of pap smear and high risk HPV were calculated. The Kappa test was used to correlate colposcopic and histopathologic findings. RESULTS: Repeat pap smears at the time of initial consultation demonstrated 25 patients with normal results, 39 with LGSIL, 30 with HGSIL, 1 SCC and 5 ASCUS. Seventy-eight patients underwent cervical biopsy. Colposcopic findings correlated significantly with histopathologic findings (p<0.0001). Forty-four percent of patients tested positive for HPV DNA: 40 patients with high risk HPV, three patients with low risk HPV, and one patient with both high risk and low risk HPV. Sixteen of 39 patients (41%) with LGSIL on pap smear tested positive for high risk HPV; 37% of patients in this group required cervical conization because cervical biopsies demonstrated moderate/severe dysplasia. The diagnosis of moderate/severe dysplasia significantly correlated with the presence of high risk HPV [OR 78.9 (8.31-389.30)]. There was no significant correlation between the HPV DNA signal strengths and the histologic grade of dysplasia. The sensitivity and the positive predictive value of pap smear alone in identifying moderate/severe dysplasia was 62% and 96%, respectively. The combination of HGSIL pap smears and high risk HPV increased the sensitivity but not the positive predictive value for the detection of moderate/severe dysplasia to 77.7% and 95%, respectively (P=NS). CONCLUSIONS: Although in this setting, the use of hybrid capture DNA testing did not significantly improve the sensitivity or positive predictive value of the diagnosis of HGSIL cytology when compared to cytologically indicated plus colposcopically directed cervical biopsies in this population of women at high risk for the presence of disease, the combination of HGSIL pap smears and high-risk HPV did result in a clinically important increase in the diagnosis of moderate/severe dysplasia.

Adult↗
PubMed1998

The natural history of CIN I lesions.

The published literature indicates 11% of CIN I lesions on average progress to a higher grade dysplasia and the remainder either regress or persist. Reliable markers of disease outcome are yet to be identified. A longitudinal study of 342 women referred for colposcopic examination of a CIN I detected by a screening Pap test, and classified by the colposcopic impression and Pap test at that exam as </= CIN 1 was designed to identify predictors of disease outcome. The cohort was comprised of 220 women who satisfactorily completed the study and whose disease was neither biopsied or treated at the initial examination. All had HPV DNA testing by PCR, and were followed with interval colposcopic examinations and repeat Pap tests for a limited time period. The initial HPV DNA status and a number of measured clinico-pathological and risk factor variables were analyzed to identify outcome predictors. All underwent a biopsy either at the conclusion of the study or because their disease was considered to have progressed during the follow up period. Biopsy confirmed progression to CIN II/III occurred in 41 (18.6%), persistence of CIN I/Condyloma in 41 (18.6%), and regression to <CIN I/Condyloma in 138 (62.7%). HPV DNA positivity and current, oral contraceptive use were the only independent predictors of progression when age at diagnosis, the number of follow up visits, and time to progression were controlled. Predictors of persistent and regressed disease were not identified. The study highlights a clinical role for HPV testing in the colposcopic management of CIN I lesions. Oral contraceptives may promote progression by regulating the oncogenic sequences of the HPV.

Adolescent↗
PubMed2005

Results of a pilot study of multispectral digital colposcopy for the in vivo detection of cervical intraepithelial neoplasia.

OBJECTIVE: Fluorescence spectroscopy is a promising technology for the detection of cervical squamous intraepithelial precancers and cancers. To date, many investigators have focused on point spectroscopy as an adjunct to diagnostic colposcopy. A device that visualizes the whole field of the cervix is needed for screening. To that end, we have developed a multispectral digital colposcope that works through the colposcope to image with white light, UV excitation at 345 nm, and blue light at 440 nm excitation. Here, we report the pilot study that precedes a Phase I trial. METHODS: The MDC system is composed of a light source, a colposcope, and a video rate color CCD camera with a frame grabber and takes approximately less than 1 min to make images of the cervix. Patients were measured at baseline and after acetic acid placement with white light, 345 nm excitation, and 440 nm excitation from the xenon arc lamp. The white light is in the visible spectrum, 345 nm excitation is in the UV spectrum and is not visible, and 440 nm excitation is blue light in the visible spectrum. White light generates a pink image of the cervix. 345 nm excitation, the UV light, excites fluorophores to emit a blue image. 440 nm excitation, the blue light, excites fluorophores to emit a green image. The patients underwent a loop excision procedure and the histopathology was inked and cut into 12 sections by the study pathologists. The histopathologic slides were scanned and the images were then reconstructed into maps. A diagnostic algorithm was calculated. The data were preprocessed, transformed, and analyzed by the K-means clustering method. Disease maps were generated using the algorithm and classifier and compared to white light colposcopy and the blue and green images obtained at 345 and 440 nm. RESULTS: Forty-six patients were measured at four clinical sites. Images were made of the cervix with white light, 345 nm excitation, and 440 nm excitation and are presented in the figures. As the study went on, images improved with improvements in the instrument. The white light and fluorescence images are presented with crudely constructed histopathologic maps and algorithmic maps. At 345 nm excitation, the UV light, histologically confirmed CIN appears darker blue; while at 440 nm excitation, the blue light, histologically confirmed CIN appears lighter green. CONCLUSIONS: This pilot study shows that MDC images can be matched to both histopathologic and algorithmic maps. The device and the algorithm are evolving but show promise. A Phase I trial is planned.

Adult↗
PubMed1999

A matched prospective study of human immunodeficiency virus serostatus, human papillomavirus DNA, and cervical lesions detected by cytology and colposcopy.

OBJECTIVE: To compare the prevalence and type of human papillomavirus (HPV) infections in the genital tract of human-immunodeficiency-virus- (HIV) seropositive and -seronegative women matched for cytology and to examine prospectively the relationship of HPV DNA, colposcopic findings and cervical squamous intraepithelial lesions (SIL) in these matched seropositive and seronegative cohorts. METHODS: A matched prospective study of HIV-seropositive and -seronegative women undergoing cytologic screening, colposcopy, and testing for HPV DNA and other infections at each visit. RESULTS: Twenty-three HIV-seropositive women were matched with 23 seronegative women by cervical cytology reading, lifetime number of sexual partners, age, and follow-up length. Fourteen pairs of these women had follow-up visits every 4 months, for 56 and 53 total visits in seropositive and seronegative women, respectively. After matching, the groups had a similar overall prevalence of HPV DNA and of HPV oncogenic (high risk) types at baseline. On follow up, HIV-seropositive women were more likely than seronegative women to develop SIL (38% vs. 10%), less likely to have negative cytology (34% vs. 60%, overall P = 0.03), more visits with HPV DNA detected (68% vs. 40% P = 0.04), and more visits with multiple HPV DNA types detected (18% vs. 0%, P = 0.02). Colposcopic lesions in the seropositive women were more likely to have sharp borders or mosaicism or to be thick white (P = 0.009). CONCLUSIONS: After matching for baseline Papanicolaou smear readings, these data suggest that over time seropositive women have more visits that yield abnormal cytology, more persistent HPV DNA detection, and more colposcopic abnormalities than seronegative women.

Adult↗
PubMed2001

Usefulness of concurrent Papanicolaou smear at time of cervical biopsy.

The reliability and cost-effectiveness of a repeat Papanicolaou (Pap) smear performed at the time of colposcopic biopsy is uncertain. To evaluate the usefulness of this practice, Pap smear and biopsy results of 718 patients were reviewed and compared: 619 patients had Pap smears performed prior to colposcopy with a 1.1% false-negative rate, 97.5% sensitivity, and 83.6% positive predictive value. Ninety-nine patients had Pap smears performed at the time of colposcopy with a 19.1% false-negative rate, 56.8% sensitivity, and 92.6% positive predictive value. Repeat Pap smear at the time of colposcopy resulted in significant changes in the management of only 2 patients (2%) and more careful follow-up in one (1%). Pap smears performed at colposcopic biopsy are less sensitive than those done prior to biopsy (P < 0.001). The clinical benefit of this practice is marginal, considering the added costs and potential detrimental effects to the colposcopic examination, provided patients receive adequate follow-up.

Biopsy↗
PubMed1976

Carcinoma-in-situ of the cerivix treated with colposcopy guided epithelial conization. Report of a 4-7 year follow-up study.

Twenty-five patients with the diagnosis of carcinoma-in-situ (CIS) of the cervix were treated with colposcopy guided epithelial conization. During the follow-up study of 4-7 years' duration, there was no recurrence of CIS in 20 of the 25 patients. Between 6 and 12 months after conization, 3 patients showed recurrence of CIS. Two of these patients were treated with further epithelial conization with no evidence of further recurrence 4 years after the second treatment. The third patient refused to accept further epithelial conization and modified radical hysterectomy was done without any evidence of residual tumour in the hysterectomy specimen. One patient showed stromal invasion in both colposcopically guided biopsy and bone biopsy. Modified radical hysterectomy specimen showed remnants of stromal invasion. One patient with Class IV smear failed to show any atypical transformation zone and cervicitis was proven on colposcopy guided biopsy following treatment with Flagyl. For two of the 25 patients, cytology was Class II and therefore failed to diagnose the pre-malignant condition; but colposcopy showed a grade 3 atypical transformation zone and the presence of CIS was confirmed histologically. Simultaneous use of cytology, colposcopy and colposcopically guided biopsy confirmed the diagnosis of CIS in all cases. The authors recommend colposcopically guided epithelial conization in younger patients, provided the malignant lesion is strictly intra-epithelial, and limited to the ectocervix. Routine follow-up with the aid of cyto-colposcopy remains the key factor in this schedule of therapy.

Adult↗