Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Colposcopes”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 865 records · Page 48Linked to original sources
PubMed1986

Management of 633 cervical intraepithelial neoplasias by CO2 laser: persistent diseases and recurrences.

During the past 6 years, we have managed 633 cervical intraepithelial neoplasias with the CO2 laser. If the lesion is located on the ectocervix, the CO2 laser is used to vaporize it under the microscope. If the lesion is located in the endocervical canal, the CO2 laser is used to excise a cylinder-shaped tissue with a handpiece. Colposcopic examination is performed 21 days after treatment. Persistent disease is recognized at this examination; healing is obtained spontaneously in 66% of those with persistent disease without second treatment. There were eight with recurrent disease with abnormal Pap tests and abnormal colposcopic findings, and 12 with recurrent disease with abnormal Pap tests and normal colposcopic findings (recurrent koilocytis cells). After laser treatment cervical function was good and pregnancies were normal.

Adolescent↗
PubMed1995

Independent clinical factors which correlate with failures in diagnosing early cervical cancer.

Our aim was to identify independent factors that correlated with colposcopically directed biopsy's reliability as a method for diagnosing early cervical cancer. One hundred ninety-one of a total of 2265 patients who had colposcopic examinations because of abnormal Papanicolaou smears were included in this study. These patients had all undergone a hysterectomy after being diagnosed as having cervical intraepithelial neoplasia grade III by colposcopically directed biopsy. By univariate analysis, old age (P = 0.0195), achievement of menopausal status (P = 0.0046), large lesion size (P = 0.0021), and unsatisfactory colposcopy (P = 0.0017) were found to be associated with the nondiagnosis of early cervical cancer. However, multivariate analysis using stepwise logistic regression revealed that large lesion size (P = 0.003) and unsatisfactory colposcopy (P = 0.0008) were the only independent factors that correlated with nondiagnosis. Our findings indicate that in order to reach a clear-cut diagnosis, cases with either unsatisfactory colposcopy or satisfactory colposcopy with large lesions (despite a lack of histologic evidence of invasions) should undergo a diagnostic conization.

Adult↗
PubMed1995

A decision analysis of practice patterns used in evaluating and treating abnormal Pap smears.

OBJECTIVE: The purpose of this study was to investigate contemporary methods of evaluating and treating abnormal Pap smears, in terms of their potential for excessive treatment and financial impact on health care delivery systems. METHODS: Clinical algorithms for the evaluation and treatment of abnormal Pap smears were constructed, taking into consideration different philosophies on the need for colposcopic biopsy, the role of cryotherapy, and LLETZ. The algorithms employed (1) colposcopy of all patients with cryotherapy of mild dysplasia and LLETZ of moderate to severe dysplasia; (2) colposcopy with observation of mild dysplasia, treatment of moderate dysplasia by cryotherapy, and severe dysplasia by LLETZ; (3) colposcopy of LGSIL Paps before treatment and immediate LLETZ of HGSIL; and (4) immediate LLETZ of LGSIL and HGSIL Paps. Each algorithm was theoretically applied to a cohort of colposcopy clinic patients based upon referral Pap smear, with excessive treatment and costs calculated. The cohort's repeat Pap smear, colposcopic biopsy, and candidacy for cryotherapy were included in the analysis. The decision to use repeat Pap smear in treatment planning, submit only diagnostic LLETZ pathology, and select immediate LLETZ candidates by HGSIL/severe dysplasia Pap smear was considered. Financial impact was calculated using nationwide fiftieth-percentile reimbursement costs for procedures and related pathology. RESULTS: Colposcopy provided little opportunity for excessive treatment. In contrast, 49.3% of cases subjected to immediate LLETZ would theoretically not have required treatment, if initially evaluated by colposcopy. The use of the subset of HGSIL cases encompassing severe dysplasia only identified patients suitable for immediate LLETZ, with an excessive treatment rate of only 2.8%. Traditional colposcopy (algorithm 2) would have been least expensive at $718 per patient. Algorithms 1 and 3 were intermediate at $785 and $754 per patient, respectively. Immediate LLETZ of all abnormal Paps (algorithm 4) would have been most costly at $838 per patient. CONCLUSIONS: The abandonment of colposcopy and reliance on immediate LLETZ for evaluation and treatment of cervical lesions would have been expensive and had significant potential for excessive treatment. Traditional colposcopic evaluation, coupled with observation of mild dysplasia, appeared to be the most cost-effective means of treating cervical dysplasia and had a low potential for excessive treatment.

Algorithms↗
PubMed1997

The value of repeat Pap smear at the time of initial colposcopy.

OBJECTIVE: The objective was to determine if repeating a Pap smear at the time of an initial colposcopy has sufficient clinical benefit to justify its clinical and financial costs. METHODS: The records were reviewed of all patients who had an initial colposcopy at Queens Hospital Center between 1984 and 1995. Data were gathered regarding the referral cytology, the cytology done at the time of colposcopy, and the results of any biopsies which were taken. The terminology for cytology and histology done prior to 1989 was adjusted to the Bethesda classification system. A repeat Pap smear was defined as clinically valuable if it would have changed the patient's management, i.e., if it suggested more advanced disease than the referral Pap and that the disease was not identified on the colposcopically directed biopsy. RESULTS: Two thousand nine hundred sixty-nine records were reviewed. In 139 cases, no Pap smear was repeated at the time of colposcopy. Of the remaining 2830 women, only 1347 (47.6%) showed exact correlation between their referral Pap smear and the Pap done at the time of colposcopy. In another 1016 (35.9%), the Pap at colposcopy was within one grade of the referral Pap. In 312 women, the Pap at the time of colposcopy was a higher grade than the referral Pap. However, in 236, the higher grade of disease was detected by the colposcopically directed biopsy. Of the remaining 76 women, 58 had a normal biopsy, but their Pap at the time of colposcopy showed low-grade squamous intraepithelial lesions (44) or high-grade squamous intraepithelial lesions (HGSIL) (14). Seventeen others had a biopsy showing low-grade dysplasia while the Pap at the time of colposcopy showed HGSIL. In 1 patient, the repeat Pap showed malignant cells while the biopsy showed a high-grade lesion. Based on the triage protocols at our institution, this means that a repeat Pap at the time of colposcopy would have indicated a cone biopsy in 31 patients (1.1%) and more careful follow-up of another 44 patients (1.6%). Skipping the repeat Pap smear would not have resulted in any missed cancers. In our series of 2830 patients, the cost savings of skipping the repeat smear would have been $68,580 or $24.23 per patient. On a national level, skipping the repeat smear would save more than $24,000,000 annually. CONCLUSION: Using current triage protocols at our institution, repeating the Pap smear at the time of an initial colposcopy would have changed the management in 2.7% of patients and indicated a conization in only 1.1% of patients. It is doubtful that this justifies its cost and the potential detrimental effects on the colposcopic examination.

Adolescent↗
PubMed1997

The clinical course of cervical carcinoma in situ diagnosed during pregnancy.

OBJECTIVE: The objective was to determine the frequency with which regression or progression of disease without treatment occurred in women diagnosed with squamous cell cervical carcinoma in situ (CIS) during pregnancy. METHODS: . A retrospective chart review of all women evaluated at the University of Iowa Colposcopy Clinic diagnosed with CIS during pregnancy from 1987 through 1992 was used. Thirty-four women were evaluated during pregnancy, of which 26 also had postpartum evaluation. All pathology reports of initial cytology and biopsies, as well as colposcopic impressions, were reviewed and compared to the same evaluations postpartum. RESULTS: Of the 26 women evaluated both antepartum and postpartum, only 1 was treated (cone biopsy) during pregnancy. She had disease suspicious for microinvasion. She was disease free postpartum. Of the remaining 25, 20 (80%) had persistent disease, 2 (8%) had either missed disease or progressive disease postpartum, and 3 (12%) resolved without treatment at postpartum evaluation. No statistical significance was found between route of delivery and persistence (P = 0.34). No statistical significance was found between smoking and persistence of disease (P = 1.0). In 46% of women the initial cytology was CIN I or II, and the initial colposcopic impression was found to underestimate the severity of the disease in 35% of cases. Two women were found to have invasive disease postpartum. CONCLUSIONS: There is a high persistence rate of CIS complicating pregnancy. Given the relatively high rate of underestimation of disease severity by both cytology and colposcopic impression, the use of routine biopsy at the time of colposcopy is recommended. Invasive disease may be encountered on postpartum evaluation.

Adult↗
PubMed1999

The significance of ASCUS cytology in HIV-positive women.

OBJECTIVE: The aim of this study was to determine the incidence and severity of dysplasia associated with a cytologic diagnosis of atypical cells of undetermined significance (ASCUS) in women infected with the human immunodeficiency virus (HIV). METHODS: A cross-sectional analysis of cervical cytology, colposcopic impression, and cervical biopsy results was performed on 261 HIV-positive women diagnosed with ASCUS. The prevalence and grade of histologically documented cervical intraepithelial neoplasia (CIN) was determined. Patients with CD4 counts above and below 200 cells/mm(3) were compared using chi(2) analysis to determine any effect of worsening immunosuppression on the rates of associated dysplasia. RESULTS: Seven hundred sixty-one Pap smears were performed during the study period. Two hundred nine (27%) were diagnosed as ASCUS. All patients (pts) received colposcopic evaluation. The incidence of human papilloma virus (HPV) effect, low-grade CIN (I), and high-grade CIN (II, III, and carcinoma in situ) documented by cervical biopsy, cervical conization or endocervical curettings was 40, 17, and 15%, respectively. No cases of invasive cancer were found. These results are similar to those of previous cytohistologic studies of ASCUS in HIV-untested populations. There was no significant difference in frequency or severity of CIN in pts with severe immunosuppression (P = 0.4). CONCLUSION: A cytologic diagnosis of ASCUS in HIV-positive women identifies a group at significant risk for histologic abnormalities. The majority of pts will be diagnosed with HPV or low-grade CIN. HIV infection and severe immunosuppression do not appear to increase the frequency or severity of CIN associated with ASCUS. Given the 32% risk of associated CIN, all HIV-positive women with ASCUS cytology should undergo colposcopic evaluation.

Adult↗
PubMed1987

Detection of DNA of human papillomavirus types 6/11 and 16/18 in cell scrapings of the uterine cervix by filter in situ hybridisation. Correlation with cytology, colposcopy and histology.

The application of filter in situ hybridisation (FISH) to detect the presence of the DNA of human papillomavirus genotypes 6/11 and/or 16/18 in cell scrapings of the uterine cervix of 248 women in Western Australia is described. The results obtained by FISH are related to cervical dysplasia as assessed by cytology, colposcopy and histology. The detection of HPV infection was more sensitive and specific by FISH than by either histological/cytological evidence of an HPV cytopathic effect (koilocytosis) or immunohistochemical staining for HPV capsid antigen using antiserum against genus specific antigen of the bovine papillomavirus. Viral DNA was detected by FISH in 65% of women with atypical cytology and of the HPV positive cases, 68% were HPV 16/18, 22% HPV 6/11 and 10% of mixed types. HPV-DNA was detected in the cervical smears of 16 women who also had HPV capsid antigen (HPV-Ag) in their cervical biopsies; HPV 6/11 was found in 4 cases and HPV 16/18 in 12 cases. The relative frequency of the HPV-Ag positive cases decreased markedly from 44% to 4% with an increase in the severity of cervical dysplasia. By comparison, the percentage of HPV-DNA positive cases remained relatively constant between 70% and 80% for all 3 categories of dysplasia. Of these, the percentage of HPV 6/11 positives decreased slightly with an increase in the severity of dysplasia as assessed by either cytology or histology, whereas the percentage of HPV 16/18 positive cases was relatively constant. HPV-DNA was found in cervical smears of 11 of 48 (23%) women who were diagnosed colposcopically to have atypical transformation zone of the cervix. In 138 women with an atypical transformation zone, 96 (70%) were found to have HPV-DNA with HPV 16/18 contributing to 83% of the HPV positive cases. All four genotypes of HPV were found to be associated with the colposcopic morphology of mosaicism (26 cases) but only HPV 16/18 was found in 12 HPV-DNA positive cases associated colposcopically with punctation and an atypical transformation zone. The detection and typing of HPV-DNA in cell scrapings by FISH is a relatively fast and non-invasive procedure which complements cytology, colposcopy and histology and should be useful in further studies of the natural history of different HPV infections and their role in cervical cancer.

Adolescent↗
PubMed2005

Contribution of combined colposcopy and cytology in cervical pathology.

AIM: The regular Papanicolaou (Pap) smear is the cornerstone of women's preventive healthcare. The introduction of the regular Pap smear as a screening tool for cervical cancer has markedly decreased the number of deaths from cervical cancer. During the past decade, however, the rate of death from cervical cancer has remained relatively static. This screening method is known to have a high percentage of false negative results. To improve the detection of cervical lesions using the Pap smear in screening, a number of adjunct procedures have been developed. The purpose of this study is to evaluate the utility of a magnified chemoluminescent screening examination (Colposcopy) combined with the Pap smear in detecting cervical abnormalities. METHODS: We investigated a cohort of 58 subjects who have been forwarded for colposcopic evaluation due to referral cytology suggestive of persistent inflammatory process not otherwise specified, and cervical intraepithelial or invasive neoplasia, in Chania Colposcopic clinic. RESULTS: The higher the lesion detected by cytology, the more severe the corresponding colposcopic impression viewed. CONCLUSION: The data presented here are in harmony with previous reports and share our experience in a Regional Community Hospital Colposcopy Clinic. An integrated cytology-colposcopy program facilitates the assessment and identification of women harboring cervical pathological conditions.

Adult↗
PubMed1978

Vaginal and cervical squamous cell dysplasia in women exposed to diethylstilbestrol in utero.

Two hundred and fifty patients were examined because of a history of in utero exposure to diethylstilbestrol (DES) or because of the presence of physical findings suggesting such exposure. One thousand biopsies were examined for the presence of neoplasia and then compared to the colposcopic findings. There were no cases of glandular or squamous cell carcinoma. Fifteen (6 per cent) of the patients had squamous cell dysplasia. The degree of dysplasia was mild in 11 and moderate in only 4 (1.6 per cent) of the women. The majority of the cases of dysplasia involved the cervix, whereas the vagina was involved in only four cases, with simultaneous cervical dysplasia in three of these. Patients with cervical mosaic and white epithelium had dysplasia on biopsy much more frequently as compared with patients with similar colposcopic appearances in the vagina. Our results suggest a low incidence of significant squamous precancerous change in the DES-exposed population and provide evidence that colposcopic data concerning dysplasia pertinent to the cervix cannot be applied without modification to the evaluation of dysplasia in vaginal adenosis.

Adolescent↗
PubMed1981

Cervicography: a new method for cervical cancer detection.

A new diagnostic method, cervicography, provides permanent, objective documentation of normal and abnormal cervical patterns. The projected cervicogram is comparable to direct visual colposcopic magnification and resolution. The cervicogram can be obtained by a technician and sent to an expert for evaluation. A study of 700 women was undertaken to compare the diagnostic accuracy of colposcopic, cytologic, and cervicographic findings. In 296 women with abnormal cytologic findings, 136 cases of dysplasia or carcinoma were diagnosed by directed biopsy. In 91.1%, both colposcopic and cervicographic findings were suspicious; 2.9% of the cases were detected solely by cervicography, and 5.9% were detected solely by colposcopy. In 404 routinely screened patients with no previous abnormal cytologic findings, nine cases (2.2%) of dysplasia were detected solely as a result of cervicographic screening.

Adolescent↗
PubMed1990

Cervical pathology with intrauterine contraceptive devices--a cyto-colpo-pathological study.

One-hundred Lippes loop and 100 Cu T-200 intrauterine contraceptive device (IUCD) users, for more than one year, and 200 control non-users were examined clinically, cytologically, colposcopically and histopathologically for associated cervical pathological lesions. Nonspecific infection increased significantly in both Lippes loop and Cu T-200 IUCD users, compared to non-users (P less than 0.05). On the other hand, there was no statistically significant difference in the incidence of total, or individual, specific infections, dyskaryosis or CIN between both groups (P greater than 0.05). Colposcopically, there was a significant increase in inflammatory changes with both Lippes loop and Cu T-200 IUCD, compared to controls (P less than 0.05), but there was no difference in other colposcopic findings (P greater than 0.05).

Cervix Uteri↗
PubMed1990

Role of endocervical curettage in the diagnostic workup of preinvasive cervical lesions.

The aim of the present study was to evaluate the clinical value of endocervical curettage in the diagnostic workup of patients with colposcopically suspect lesions, by correlating the findings of colposcopically directed biopsy with the results of endocervical curettage in patients with both satisfactory and unsatisfactory colposcopic examination. Our results (positive curettage findings in 55.6% of the patients with unsatisfactory colposcopy and in 16.7% of the patients with satisfactory colposcopy) indicate that endocervical curettage could be a useful guide to correct management.

Biopsy↗
PubMed1983

The value of colposcopy in follow-up care of the treated gynecologic oncology patient.

The diagnostic value of colposcopy for primary gynecologic malignancies is well accepted. This study was conducted to determine the value of colposcopy in follow-up examinations of treated gynecologic oncology patients. The original gynecologic malignancies included carcinomas of the cervix, endometrium, ovary, vulva, vagina, fallopian tubes, and uterine sarcomas. Distinct colposcopic changes could be identified secondary to radiation therapy, granulation tissue, surgery, and recurrent disease. One-hundred eight treated gynecologic oncology patients were colposcopically examined. Twenty-four of the one-hundred eight patients developed recurrent disease. Thirteen of twenty-four patients had recurrent disease in the vagina, on the cervix, or the vulva. The recurrent disease in these 13 patients was colposcopically diagnosed.

Colposcopy↗
PubMed1985

Preclinical cancer of the cervix: diagnostic pitfalls.

This paper outlines the pitfalls encountered in the diagnosis of 127 preclinical cancers of the cervix. Each patient had cervical cytology, colposcopy, and histology performed within the same institution. Early stromal invasion was diagnosed in 55 patients and occult invasion was diagnosed in 72 patients. For preclinical cancers as a group, the possibility of invasive carcinoma was predicted cytologically in 36% and suspected colposcopically in 41%. However, in over 85% of patients the abnormal transformation zone (TZ) extended into or was totally confined within the endocervical canal and could not be adequately evaluated with the colposcope. A feature of this study was the high incidence of incomplete excision of abnormal tissue by cone biopsy and a high incidence of residual disease at hysterectomy. Cone biopsy was necessary to accurately assess the maximum depth and extent of invasion prior to definitive therapy whenever invasion was suspected colposcopically or on target biopsy. In 10 of 16 such patients, the cone biopsy demonstrated occult invasion. Colposcopy and directed target biopsy alone was adequate for the diagnosis of frank invasive cancer in 22 of the 72 patients in the occult invasion group, enabling definitive therapy to be undertaken without further delay.

Adenocarcinoma↗
PubMed2006

Colposcopy at a crossroads.

New cervical cancer prevention strategies are arising from rapidly improving insight into human papillomavirus (HPV) natural history and cervical carcinogenesis, challenging the conventional roles of cytology and colposcopically directed biopsy as the reference standards of screening and diagnosis, respectively. HPV testing has high sensitivity but mediocre specificity and positive predictive value, making the role of colposcopy for the accurate identification of patients requiring treatment even more important. We believe that deficiencies of the colposcopically guided biopsy must be addressed, in particular, the inaccuracy of biopsy placement leading to low sensitivity for detection of CIN3. This opinion outlines our concerns and summarizes new data, suggesting possible steps that may lead to improvement in colposcopic accuracy.

Carcinoma in Situ↗
PubMed2005

Evaluating the clinical safety of three vaginal applicators: a pilot study conducted in the Dominican Republic.

BACKGROUND: Targeted research on applicator safety has not been conducted as part of microbicide clinical trials and was considered necessary for ensuring safe and effective product use. Colposcopy, regarded as a standard method for assessing the safety of vaginal products, including microbicides, was used in this study to assess the external genitalia, vaginal epithelium and cervical epithelium after a single applicator use. OBJECTIVES: The objectives of this study were to assess and compare the effects of three vaginal applicators on symptoms and signs of irritation of the external genitalia, vagina and cervix as seen by colposcopy after applicator use. METHODS: Twenty women used three different vaginal applicators over three separate clinic visits 7-14 days apart and underwent a colposcopic examination before and after each applicator use. In total, the safety of each applicator was assessed over 20 product uses. RESULTS: No severe colposcopic finding was reported. Four minor colposcopic findings (petechiae) were considered possibly related to product use. No difference was found between applicators. CONCLUSIONS: This study provides reassuring data on the safety of the three applicator products from the perspective of causing vaginal trauma or irritation. Epithelial changes that could be more important for risk of disease transmission were not observed.

Administration, Intravaginal↗
PubMed2006

Treatment of high-grade squamous intraepithelial lesions: a "see and treat" versus a three-step approach.

OBJECTIVE: The study's subject was to examine the correlation between histologic findings in patients with high-grade squamous intraepithelial lesion (HGSIL) who have undergone loop electrosurgical excisional procedure (LEEP) with and without prior colposcopically directed biopsy. STUDY DESIGN: This retrospective study included 144 patients with cytologic HGSIL, of which 62 were treated by a three-step protocol, in which LEEP was performed only if the colposcopically directed cervical biopsies were positive (CIN II-III), and 82 women who were treated by "see and treat" protocol, in which LEEP was immediately performed if colposcopy was suggestive of CIN II or III lesions. RESULTS: There were no differences in the final histological findings between the groups. CONCLUSIONS: The colposcopically directed LEEP after a HGSIL on PAP-smear may reduce the time interval between diagnosis and treatment with a similar accuracy of diagnosis compared to the standard three-step protocol.

Adult↗
PubMed2006

Intraoperative and postoperative lower genital tract changes after global endometrial ablation using the Hydro ThermAblator device.

OBJECTIVE: To identify any heat transfer areas in the lower genital tract during a Hydro ThermAblator (HTA) (BEI Medical Systems) procedure and to characterize the changes in the cervix that occur in the immediate weeks after an HTA treatment. DESIGN: A prospective cohort study (Canadian Task Force classification II-3). SETTING: A university hospital in the United Kingdom. PATIENT(S): Twenty-five patients with menorrhagia. INTERVENTION(S): All patients underwent global endometrial ablation using the HTA device. Infrared thermal camera imaging of the lower genital tract was performed per-operatively, and colposcopic examinations of the cervix were performed at 2 and 4 weeks after the operation. MAIN OUTCOME MEASURE(S): The surface temperature rise of the cervix and vagina during a procedure. RESULT(S): Thermal temperature measurements of the lower genital tract in five patients and colposcopic examination at 2 and 4 weeks after the procedure. The maximum temperatures recorded during a procedure were those of the cervix, reaching 36.5 degrees C. Colposcopic images at 2 weeks showed that 15% of patients had a whitish discoloration of the cervix. At 4 weeks, the appearance of the cervix was normal. CONCLUSION(S): This study shows that during an HTA treatment cycle using a bivalve speculum to visualize the cervix, no area of the lower genital tract reaches a temperature at which thermal damage may occur. A whitish change in the cervix at 2 weeks is normal, and the lower genital tract should appear normal 4 weeks after the procedure.

Adult↗