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PubMed2002

Management of premalignant lesions of the cervix.

The screening, detection and treatment of precancer lesions of the cervix have resulted in a dramatic decline in the incidence of cervical cancer in many parts of the world. The effect is most pronounced in countries with organised screening. The proper management of premalignant lesions of the cervix is an important and integral part of any screening programme. The importance of proper colposcopic technique and the adherence to well-established colposcopic guidelines cannot be overemphasized to ensure appropriate treatment. The colposcope is indispensable in treatment planning as it guides the optimal amount of cervical tissue to be ablated or excised and the type of cone biopsy to be taken. Various methods of treatment involving ablative procedures and excisional procedures have been found to be highly efficacious and safe. The choice of treatment modality is very much dependent on individual preferences. However, in those with extensive high-grade lesions, an excisional method has the added advantage of detecting unsuspected microinvasive disease which can be missed if ablative methods are used. Although treatment for squamous intraepithelial neoplasia is well established, the treatment for adenocarcinoma-in-situ is more controversial. Newer methods of treatment are currently being developed to further improve on the good results achievable with present treatment modalities.

Catheter Ablation↗
PubMed2002

[The value of colposcopy and computerised colposcopy in diagnosis and therapeutic management of CIN and early invasive cervical cancer in pregnant women].

OBJECTIVES: The aim of the study was determining the value of colposcopy, especially with computerised documentation of serial colposcopic pictures in diagnosis and therapeutic management of CIN and early cervical cancer in pregnant women. MATERIAL AND METHODS: Material consisted of 96 pregnant women aged 26-45 with CIN and Ca IA. Patients were diagnosed and treated between 1990-1999. There were performed colposcopic examinations, cytology and histological evaluation of colposcopy directed specimen. Lately colposcopic pictures were stored as graphic files by camera connected to PC. RESULTS: The positive correlation between colposcopy and histology was established in 86 women (89.9%) and between cytology and histology in 76 women (79.2%). Progression of CIN and Ca IA was noted in 8 women (8.3%). CONCLUSIONS: Colposcopy, especially computerised colposcopy enables cervical lesion evaluation in pregnant women and thus enables proper therapeutic management.

Colposcopy↗
PubMed2002

"See-and-treat" loop electrosurgical excision. Has the time come for a reassessment?

OBJECTIVE: To review the results of a policy decision to offer selected women with cervical high grade squamous intraepithelial lesions (HSILs) loop electrosurgical excision (LEEP) at the time of their initial colposcopic evaluation. STUDY DESIGN: Sixty-one patients with newly diagnosed cytologic cervical HSIL were evaluated for inclusion in a "see-and-treat" protocol. Fifty of these patients met inclusion criteria and underwent immediate loop excision of the cervical transformation zone at their initial colposcopic visit. RESULTS: Forty-eight of 50 patients that underwent see-and-treat management at their initial colposcopic evaluation had histologic evidence of cervical dysplasia/neoplasia. The positive predictive value of diagnostic colposcopy in this setting was 96%, with a 95% confidence interval (88-99%). Two patients had no pathologic abnormality, for an overtreatment incidence of 4%. CONCLUSION: The selected use of see-and-treat management of cytologic cervical HSIL is feasible, highly predictive and associated with an extremely low incidence of overtreatment. Such management has the potential to increase patient satisfaction and compliance while drastically reducing health care dollars currently directed toward the management of HSIL. Strong consideration should be given to accepting see-and-treat management as a viable alternative in the care of patients with documented cervical cytologic HSIL.

Adolescent↗
PubMed2003

Using history and colposcopy to select women for endocervical curettage. Results from 2,287 cases.

OBJECTIVE: To enhance the yield of endocervical curettage (ECC) by defining risks for abnormality. STUDY DESIGN: Demographic and medical information collected at colposcopy and subsequent histology were reviewed retrospectively. Statistical analysis was by t and chi 2 tests. RESULTS: Among 2,287 women undergoing ECC at colposcopy, in only 105 (5%) did positive ECC require excisional therapy that would not otherwise have been recommended. Women with positive ECC were older (mean, 39.0 vs. 33.2 years; P < .001) and of higher parity (mean, 3.0 vs. 2.0 births; P < .001), with earlier first intercourse (at 16.6 vs. 17.2 years, P = .006), more unsatisfactory colposcopy (148 [27%] of 545 women with unsatisfactory colposcopy vs. 183 [12%] of 1,523 women with satisfactory colposcopy; P < .001) and more colposcopic impressions of cervical intraepithelial neoplasia (CIN) 2-3 (163 [51%] of 323 vs. 443 [25.6%] of 1,730 women with low grade or a negative impression; P < .001). The likelihood of missed CIN 2-3 was 0.4%, with no missed cancers among women with satisfactory colposcopy and either a normal colposcopic impression (1/254) or nulliparity (2/474). CONCLUSION: ECC identifies otherwise-undetected preinvasive and invasive lesions but may be avoided in women with satisfactory colposcopy who are nulliparous or have no colposcopic lesions.

Adult↗
PubMed2002

Validity of colposcopy in the diagnosis of early cervical neoplasia--a review.

This study was conducted to quantify by meta-analysis the validity of colposcopy in the diagnosis of early cervical neoplasia in order to assess the justification of its integral role in this regard. Eight longitudinal studies were selected, which compared correlation of colposcopic impression with colposcopically directed biopsy results. The prevalence of disease in the studies ranged from 40 to 89%. Colposcopic accuracy was 89%, which agreed exactly with histology in 61% of cases. The sensitivity and specificity of colposcopy for the threshold normal versus all cervical abnormalities were 87-99% and 26-87% respectively. For the threshold normal and low grade SIL versus high grade SIL, the values were 30-90% and 67-97%. Likelihood ratios increased with disease severity. Colposcopy performed better in differentiation of high grade from low grade disease than in differentiation of low grade disease from normal cervix. Colposcopy is a valid tool for the diagnosis of early cervical neoplasia. Its integral role in the management of early cervical disease is justified.

Biopsy↗
PubMedDate not supplied

Cold-knife conization versus photodynamic therapy with topical 5-aminolevulinic acid (5-ALA) in cervical intraepithelial neoplasia (CIN) II with associated human papillomavirus infection: a comparison of preliminary results.

BACKGROUND: The optimal treatment of preinvasive cervical lesions is still not clear as all surgical techniques cause substantial cervical stroma destruction with the risk of a possible incompetent cervix. Photodynamic therapy can preserve fertility due to selective tissue destruction. The aim of the present study was to compare the efficacy of cold-knife conization versus photodynamic therapy with topical 5-aminolevulinic acid in eradicating cervical intraepithelial neoplasia (CIN) II and associated HPV infection. PATIENTS AND METHODS: Eleven HPV-positive non-pregnant women were selected for photodynamic therapy (PDT). To be eligible for this procedure superficial cervical PAP smears as well as colposcopic biopsies performed before therapy had to show CIN II with the lesion involving at least 15% of the cervix and being colposcopically visible. The deep endocervical PAP smear had to show normal endocervical epithelium. The next (following each PDT) 11 HPV-positive women with CIN II treated with cold-knife conization were used as a control group. The cervical sampling for HPV DNA was performed 3 months after conization and PDT. Patients were followed-up for 1 year with cytological smears and colposcopy at the outpatient department of the hospital. RESULTS: Follow-up at three months revealed that HPV was eradicated by both techniques in 73%. After 12 months follow-up, 100 vs. 91% (conization vs. PDT) of the patients were disease-free. No systemic side-effects and no local necrosis, sloughing or scarring occurred due to PDT. One patient treated with PDT presented with a relapsing suspicious PAP smear and an abnormal white colposcopic lesion after application of acetic acid 6 months post-PDT. A subsequent conization was performed and revealed a CIN I lesion. No statistically significant differences concerning HPV eradication (p > 0.05) and recurrence (p > 0.05) could be observed between the two methods. CONCLUSION: The results presented in this study indicate that topical PDT with 5-ALA is in most cases a successful treatment of CIN II with comparable results to cold-knife conization. In contrast to cold-knife conization, PDT causes no substantial cervical stroma destruction with the risk of a possible subsequent incompetent cervix. Also the feasibility of topical PDT on an outpatient basis, the lack of significant post-treatment complications and the cost effectiveness make the topical approach with PDT preferable in selected circumstances. Due to the potential risk of invasive cancer with metastatic spread, patient's selection criteria must be strict and a pretreatment histological examination is obligatory.

Adult↗
PubMed1992

Colposcopy in family practice: pilot studies of pain prophylaxis and patient volume.

In a family practice office with volume representative of an average one-person practice, the implementation of colposcopy services was studied. During six months, 257 patients received Papanicolaou (PAP) smears. These patients represented 16.2% of the total 1,585 female patient visits for ages greater than 16. Of the 257 cytology specimens, 10.1% (26) revealed dysplasia or evidence of Human Papilloma Virus (HPV), indicating the need for colposcopic examination. Pathology reports of all biopsied cases confirmed the presence of dysplasia or HPV. These results suggest that the average family physician might reasonably anticipate about 100 colposcopy sessions per year, assuming each patient receives a diagnostic and a therapeutic colposcopic evaluation. In the course of colposcopy services in a family practice, 46 patients underwent 67 colposcopic examinations with cervical biopsy and/or cryotherapy in the office. Some patients received nonsteroidal anti-inflammatory medication 30-60 minutes before the procedure, with selection according to physician preference. All patients rated the pain experienced during the procedure on a 10-point visual-analog scale. Pain scores were significantly lower in those who received medication. Overall, patients tolerated the procedure well and there were no reported complications. Because of the possibility of such factors as the placebo effect influencing these results, a randomized, placebo-controlled, double-blind study will be needed to verify the findings.

Adolescent↗
PubMed1992

Correlation of colposcopy and histology in cervical biopsies positive for CIN and/or HPV infection.

The purpose of our study was the investigation of colposcopic findings in 108 patients with histologically proved CIN and/or HPV infection in colposcopically directed cervical punch biopsies. The chi square test with Yates' correction was used for the statistical analysis. In 82 cases there were histological changes suggestive of HPV infection, 91 cases showed CIN while in 65 cases CIN was superimposed on HPV infection. The sensitivity of colposcopy was 89% for the detection of CIN and 61% for HPV. In 45% of CIN cases colposcopy underdiagnosed the CIN level, especially in more severe lesions (level II or higher, P < 0.001). We have also observed that the HPV-related colposcopic findings significantly increased the probability of underdiagnosing CIN (P < 0.05). Our results suggest that biopsy is always necessary in order to establish the diagnosis and determine the severity of CIN, especially if the colposcopist suspects HPV infection. We have also shown that many cases of HPV infection are not detected by colposcopy, because they are masked by the coexisting CIN.

Colposcopy↗
PubMed2003

[Is the directed biopsy accurate?].

The aim of the present study was to evaluate the diagnostic accuracy of the colposcopically directed biopsy of cytologically signalized women. Retrospectively were analyzed sixty women aged between 20 and 69 (mean 37.4), to whom was performed colposcopically directed biopsy and consequent in the interval of no more than 3 months extended excision (to 30 of them--surgical conisation and to another 30--LLETZ/LEEP). Summarized data shows, that in 47 (78.3%) of them there are coincidence to one degree difference in the histological findings, and of the remain 13 cases--in 4 (6.7%) there are false positive results, and in 9 (15.0%)--false negative. The value of the sensitivity is 83% and of the predictive value of the positive results is 91.7%, which put them in the borders of the good performance of the diagnostic test. The conclusion is that the accuracy of the directed biopsy is determined by the presence or absence of the good correlation between cytological, colposcopical and histological investigation, as the implementation of the excisional biopsies enlarged the possibilities of the diagnostic protocol for the following adequate therapeutic action.

Adult↗
PubMed2004

[Reliability of screening methods in the diagnosis of dysplasia and cervical carcinoma in asymptomatic women].

UNLABELLED: The aim of this study was to estimate the reliability and accuracy of the chosen methods: cytological results (PAP smear) and colposcopic findings in the detection of cervical dysplasia and cervical cancer. MATERIAL AND METHODS: We have analyzed post conization pathohistological results and compared them with cytology results and colposcopic findings in 51 patients. Surgical procedure (conization) was performed for diagnostic and therapeutic reasons. RESULTS: Results have shown that there is a positive correlation between cytological and colposcopic results on one side and post conization pathohistological results, on the other side (p < 0.02). CONCLUSION: According to our experience, both screening methods (cytology and colposcopy) are reliable methods if performed by properly educated staff, and they both influence (reduce) morbidity and mortality among women.

Adult↗
PubMed2004

Management of patients with two consecutive ASC-US smears.

INTRODUCTION: To determine whether aggressive or expectative management of patients after two consecutive smears with atypical squamous cells of undetermined significance is preferable. To determine whether triage with high-risk human papillomavirus will identify all patients with cervical intraepithelial neoplasia grade 2 and 3. METHODS: 140 of 282 patients referred for colposcopy with two consecutive smears with atypical squamous cells of undetermined significance were only treated when abnormalities suggestive of high-grade cervical intraepithelial neoplasia were present at colposcopy. The other 142 patients underwent excision of all detected colposcopic abnormalities. Both groups were compared regarding the final cytological follow-up, the number of diathermy loop excisions, and the detection of cervical intraepithelial neoplasia. Retrospectively, the outcome of triage with high-risk human papillomavirus in the first group was investigated. RESULTS: There was no significant difference in final cytological follow-up between patients managed by expectative or by aggressive colposcopic management. Significantly less diathermy loop excisions (p < 0.001) are performed in case of expectative management. The sensitivity, specificity, negative- and positive predictive values of triage with high-risk human papillomavirus detection were comparable with those of colposcopy alone. CONCLUSIONS: Patients referred with two consecutive ASC-US smears may be followed with an expectative colposcopic management and cytological follow-up. Triage with high-risk human papillomavirus will reduce the number of referrals and colposcopies, but (cytological) follow-up remains necessary in all high-risk human papillomavirus negative patients as well.

Colposcopy↗
PubMed1992

Clinical usefulness of computerized colposcopy: image analysis and conservative management of mild dysplasia.

OBJECTIVES: The purposes of this study were to evaluate the clinical usefulness of computerized colposcopy and image analysis, to investigate the correlation between lesion size and grade of dysplasia, and to examine and record the colposcopic changes associated with progression or regression of cervical dysplasia. METHODS: Sixty-eight patients with a fully visualized squamocolumnar junction and a histopathologic diagnosis of mild dysplasia were serially monitored for a period of 1 year using computerized colposcopy and image analysis. All patients had baseline computer-assisted measurements of their cervical lesions and repeat measurements at 3-month intervals. RESULTS: The mean age of the patients was 31 years, and the mean size of the colposcopically visualized lesions was 58 mm2. During the 12-month observation, 5.9% of the lesions increased in size, 32.4% decreased in size, 13.2% remained unchanged, 20.6% disappeared, and 27.9% completely changed location. In patients with an increase in lesion size (N = 4), a repeat biopsy was performed, revealing a progression to moderate dysplasia. Treatment was withheld from patients whose lesions disappeared (N = 14), decreased in size (N = 22), or remained unchanged (N = 9). Active therapy was unnecessary in 66% of cases and repeat biopsy was avoided in 94.1%. CONCLUSIONS: Computerized colposcopy provides objective information and may be an adjunct to cytology and histopathology in some cases. Computerized colposcopy replaces subjective colposcopic evaluation with objective computer assessment and may hold promise for conservative management of cervical dysplasia.

Adult↗
PubMed2006

[Three cases of vaginal adenosis after topical 5-fluorouracil therapy for vaginal HPV-associated lesions].

Three cases of vaginal adenosis after topical 5-fluorouracil therapy for vaginal HPV-associated lesions are reported. Three patients with colposcopic, histologic and viral evidences for subclinical papillomavirus infection (in combination with low-grade vaginal intraepithelial neoplasia in of them) are treated with 5-FU. In follow-up control examinations persistent ulcerations were found without regression after applied therapy. By colposcopic and histologic examinations vaginal adenosis was proved without histories of intrautering DES exposure. After the destructive therapy the reported lesions were regressed without appearance of new lesions in follow-up control examinations. The application of 5-fluorouracil has to be used only in cases of recurrent vaginal warts and in cases of high-grade vaginal intraepithelial neoplasia with strict folow-up cytological and colposcopic control examinations.

Administration, Intravaginal↗
PubMed2001

Cyto-colpo-histological Study in Sexual Workers.

OBJECTIVE: To determine the false-negative, false-positive, sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) rates of Pap smears and colposcopy in sexual workers. MATERIALS AND METHODS: Four hundred thirty-eight prostitutes were given a gynecological examination, Pap smear, and colposcopic examination of the cervix. A cervical biopsy was taken under colposcopic guidance when there was abnormal epithelium. RESULTS: There were 81 premalignant and malignant lesions. Twenty-two Pap smear reports were abnormal: 17 CIN1, four CIN2, and one CIN3. Pap smears had a 14.4% false-negative rate, 0.9% false-positive rate, sensitivity 22.2%, specificity 98.8%, NPV 84.4%, and PPV 81.8%. Eighty-four biopsies were taken from abnormal colposcopic findings, and 96.4% were reported as premalignant and malignant lesions. Colposcopy had a 0.8% false-positive rate, sensitivity 100%, specificity 99.2%, NPV 100%, and PPV 96.4%. CONCLUSIONS: Pap smear had a low-sensitivity and colposcopy had a high sensitivity and specificity.

Journal Article↗
PubMed1991

Genital human papillomavirus infection in men. Diagnosis and treatment with a laser and 5-fluorouracil.

One hundred twenty-eight consecutive men, sexual partners (for more than six months) of women treated for genital condylomata acuminata, were evaluated with colposcopy to assess the percentage of infected men among the couples. Ninety-three (73%) of the men were found to have a genital human papillomavirus infection on colposcopically directed biopsies. All but one patient were treated with outpatient colposcopically guided laser vaporization under local anesthesia (one patient with extensive condylomata required general anesthesia). Two weeks after laser surgery, 5% 5-fluorouracil cream, used in the genital area, was initiated on a weekly basis for two months and every other week for two more months. Patients were followed in the clinic with colposcopy performed every eight weeks for six months to evaluate the regimen's results. Thirty-seven (40%) of the 93 men had "clinically" apparent genital HPV infection, and 56 (60%) of the 93 had "subclinical" disease (as determined with colposcopy). The majority of the patients (87 of 93, or 94%) responded to one laser treatment followed by 5-fluorouracil cream and had no visible lesions at six months. Colposcopic evaluation of the male partners of infected women and laser surgery followed by topical 5-fluorouracil therapy appear to be safe and effective in controlling genital HPV infection.

Acetates↗
PubMed1990

Cervical conization findings in women with dysplastic cervical cytology and normal colposcopy.

A review of 134 cervical conizations performed in a 36-month period showed that 18 were performed on patients with two or more cervical smears showing dysplasia but with essentially negative, satisfactory colposcopic evaluations, including normal colposcopically directed biopsies and endocervical curettings. A histologic diagnosis of cervical intraepithelial neoplasia (CIN) of various grades was established in 15 (83%) of the 18 conization specimens. Six (33%) of the 18 specimens harbored CIN 3. The histologic diagnosis of a more severe lesion than that indicated on cytology was rendered in five of the cases. Cervical conization should be performed when colposcopic evaluation of the cervix, vagina and vulva fails to identify the source of persistent CIN on Papanicolaou smears.

Adult↗
PubMed1990

Colposcopy as a method of management strategy in CIN and microinvasive cancer.

During nearly 40 years of using colposcopy, an original management strategy in CIN and early cervical cancer was developed and confirmed in 2 study groups of cervical lesions containing respectively 1228 and 6001 cases. This approach is based on colposcopy as the main method in early detection of CIN and cancer, with supplementary cytology in necessary cases, and on a coloposcopic-histological staging of these lesions for treatment qualification. Colposcopy alone is a fairly adequate method for diagnosis of 60% of examined cases, and coloscopy with directed biopsy in the next 20% of colposcopically highly suspect findings. Only in the remaining 20% of colposcopically less suspect findings and in the cases of "unsatisfactory colposcopy", supplementary was cytology required. In this study colposcopy findings connected with histological evaluation of the specimens provided a basic way for determining the advancement of processes and the selection method for the appropriate type and extent of treatment. CIN 1 and 2 and small focuses of CIN 3 including CIS entirely visible on the ectocervix, in childless young women were treated by cryosurgery. In all remaining cases of CIN 3, the basic therapeutic method was cold-knife conization. In exceptional cases simple hysterectomy can be a more adequate treatment. Depending on our colposcopic-histological staging, in Stage IA1--conization, whereas in Stage IA2--a moderately extended hysterectomy should be optionally performed. The management strategy introduced is an economical, fully effective and quick way of detection and selection of the method for the treatment of CIN and early cervical cancer.

Biopsy↗
PubMedDate not supplied

[Evaluation of severe dysplasia and carcinoma in situ detected by directed biopsy].

Eighty women with Papanicolaou smears groups IIIa and IIIb and an abnormal colposcopic picture, where colposcopic biopsy pathologic results showed severe dysplasia or carcinoma in situ, were analyzed. Severe dysplasia was found in 51 (63.7%) and carcinoma in situ in 29 (36.2%)cases. By using methods of a definitive diagnostic value, in cases of severe dysplasia, the early diagnosis was confirmed in 24 (47.1%) cases, in 14 (27.4%) cases carcinoma in situ was detected, in 3 (5.9%) moderate dysplasia, in 2 (3.9%) mild dysplasia, and in 8 (15.7%) cases benign histologic changes were found. Carcinoma in situ detected by colposcopy-directed biopsies was confirmed, after a definitive diagnostic procedure, in 24 (82.8%) cases, in 3 cases (10.3%) severe dysplasia was found and in 2 (6.9%) cases there were benign histologic changes. The results suggest that carcinoma in situ and severe dysplasia are vulnerable lesions which can be transformed into a lower grade or even completely disappear by directed biopsies. Such an evolution is significantly more to be expected within the population with an abnormal colposcopic picture if lesions cover not more than one fourth of the cervical circumference.

Adolescent↗