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At least 109 records · Page 6Linked to original sources
PubMed1997

Routine colposcopic evaluation of patients with persistent inflammatory cellular changes on Pap smear.

OBJECTIVE: To assess the rate of undetected dysplasia in patients with two consecutive reports of inflammatory cellular changes without atypia on Pap smears despite anti-inflammatory therapy. METHOD: A prospective randomized study. RESULT: 2798 premenopausal non-pregnant patients were evaluated by Pap smears of the cervix. Of these, 397 (14.2%) were reported as 'inflammatory cellular changes'. A total of 238 (8.5%) had persistent inflammatory changes without atypia despite the anti-inflammatory therapy. Fourteen patients refused colposcope. The mean age and parity of the remaining 224 patients were 30.2 +/- 6.3 (18-46) and 1.7 +/- 2.3 (0-6), respectively. When these patients underwent colposcopically-directed biopsies of the cervix, in 51 (22.7%) patients human papillomavirus lesions, dysplasia and in situ cancer were noted. Mean age, parity, age of marriage, prevalence of smoking and contraceptive methods of the two groups of patients (173 vs. 51) did not show statistically significant differences. CONCLUSION: Colposcopically-directed biopsies of the cervix are indicated even when inflammatory cellular changes without atypia persist despite therapy.

Adolescent↗
PubMed2006

Controversy in colposcopic management: a Canadian survey.

OBJECTIVE: The substantial reduction in cervical cancer mortality over the last 40 years is attributed to the use of Papanicolaou cervical smear screening with subsequent colposcopic assessment and treatment. Although there is consensus regarding colposcopic management of high-grade intraepithelial cervical lesions, optimal management of patients with low-grade (LG) lesions is less clear. Our goal was to document the colposcopic management of the latter group in Canada. METHODS: A survey was mailed to 252 colposcopists in seven Canadian provinces who recommended management for colposcopy scenarios. Responses were reported in aggregate form. RESULTS: A total of 120/252 (48%) completed questionnaires. Most respondents were 41 to 50 years old, and 68% were male. For women found on colposcopy to have no evidence of a low-grade cervical LG lesion, 43% recommended discharge from colposcopy, and 53% recommended repeat colposcopy. For referrals with a biopsy-confirmed LG lesion, 13% recommended discharge to cytological follow-up, 65% recommended repeat colposcopy, and 16% recommended treatment. Following excisional treatment of LG lesions with negative margins, 13% recommended discharge to cytological follow-up, and 69% recommended further colposcopy. CONCLUSION: These results demonstrate wide variation in management of low-grade cervical lesions among Canadian colposcopists and highlight the need to establish evidence-based management protocols.

Canada↗
PubMed2002

Histologic findings after a colposcopic biopsy showing CIN2.

OBJECTIVE: To determine the risk of CIN3 and cancer in subsequent specimens among women with colposcopic biopsy showing CIN2. METHODS: A retrospective review of demographic and medical information collected at colposcopy. Patient records were again reviewed 8 to 26 months later for information on procedures and histology results. RESULTS: Histologic evaluation of specimens showed no lesions in 14, atypia or koilocytosis in 21, CIN1 in 25, CIN2 in 26, CIN 3 in 27, ungraded CIN in 3, and cancer in 3. No cancers were found in women at or below the median age of 33 years or those with satisfactory colposcopy. However, cancers were found in women with negative repeat cytology and negative colposcopic impression. CONCLUSION: Observation may be an option for young women with CIN2 on colposcopic biopsy if they are reliable for follow up and the entire squamocolumnar junction is seen.

Journal Article↗
PubMed2003

Local anesthetic reduces the pain of colposcopic biopsies: a randomized trial.

OBJECTIVE: This study was undertaken to determine whether administration of local anesthetic reduces pain associated with colposcopically directed cervical biopsies. STUDY DESIGN: Fifty-six patients undergoing colposcopically directed cervical biopsies were randomly selected prospectively to receive a 1% lidocaine injection or no injection before the biopsy procedure. Pain was assessed by using a 10-cm visual analog scale at various points during the procedure. Data were analyzed with the Student t test. RESULTS: Injection of lidocaine resulted in a reduction in pain scores for cervical biopsies (4.004 to 1.166, P: <.001), endocervical curettage (5.757 to 3.900, P =.0018), and overall procedure scores (4.911 to 3.145, P =.0013). CONCLUSION: This pilot study demonstrates that injection of local anesthetic at the site of colposcopically direct cervical biopsies decreases the pain perceived by patients.

Adult↗
PubMed1978

Colposcopically directed cone biopsies in the management of cervical intraepithelial neoplasia.

Thirty-three patients with severe dysplasia and carcinoma in situ had a colposcopically directed cone biopsy in the operating room immediately prior to vaginal hysterectomy. In 3 cases (9%), the hysterectomy specimen showed the same type of residual disease as in the cone biopsy; in the remainder no residual disease was evident in the hysterectomy specimen. If colposcopically directed biopsies were performed, the long-term debate over the use of cone biopsy or hysterectomy for intraepithelial neoplasms would be resolved. Selected patients could be treated adequately by cone biopsy with a small number of patients requiring hysterectomy as indicated by direct examination with the colposcope.

Biopsy↗
PubMed1976

Colposcopic management of abnormal cervical cytology during pregnancy.

A total of 104 pregnant patients with abnormal cervical cells were referred to the Dysplasia Clinic for evaluation and management by colposcopy. Seventy-one pregnant patients presenting with basal cell atypia on cytologic examination had colposcopically directed biopsy revealing 8.45% severe dysplasia and 1.41% carcinoma in situ. Cytologic study in 31 pregnant patients with basal cell dysplasia revealed severe dysplasia in 29% and carcinoma in situ in 12.9% of the colposcopic biopsies. Cervical cytology revealed carcinoma in situ in two patients. Directed biopsy in both cases revealed carcinoma in situ with one case of questionable microinvasion. Colposcopically observed normal and abnormal physiologic findings and the pregnant cervix, complications after conization during pregnancy, and the impact of colposcopy in the management of the cytologically abnormal cervix during pregnancy are discussed.

Adult↗
PubMed2002

Histologic and colposcopic correlates of ASCUS pap smears in pregnancy.

OBJECTIVE: A historic cohort analysis was performed to assess the colposcopic and histologic correlates of atypical squamous cells of undetermined significance (ASCUS) Pap smears in pregnant and nonpregnant women. MATERIALS AND METHODS: A chart review of all gynecologic and obstetric patients seen in the outpatient clinic at the Maimonides Medical Center between January 1996 and December 1999 was undertaken. All of the charts of patients with ASCUS Pap smears were reviewed to confirm the diagnosis and to obtain medical and demographic information. To be eligible for inclusion, patients needed to have a documented colposcopic exam within 6 months of the ASCUS Pap smear and be between the ages of 14 and 45 years old. The records from the colposcopic examination including histologic data were subsequently reviewed. The generalized Fisher exact test was utilized to determine the exact probability. RESULTS: Over a 4-year period from January of 1996 to December of 1999, 198 women were diagnosed with ASCUS on their Pap smears. A total of 122 patients met the inclusion criteria. Of those included in the study, 58 were pregnant at the time of diagnosis and 64 were nonpregnant. The mean age of the obstetric and gynecologic patients was 26.9 (range = 18-37) and 31.0 (range = 18-44) years, respectively (p = NS). Thirty-two (50%) nonpregnant patients had histologic findings of cervical intraepithelial neoplasia (CIN) compared with 15 of the 45 (33.3%) (p = .019) obstetric patients who had biopsies within the first 6 months postpartum. CIN 1 was detected in 12 of the 45 (26.7%) biopsies of the postpartum patients and 26 of the 64 (40.6%) (p = .16) gynecologic patients. CIN 2,3 was found in 2 of the 45 (4.4%) postpartum patients versus 6 of the 64 (9.4%) (p = .12) gynecologic patients. One pregnant woman with ASCUS was found to have cervical cancer (2.2%). Overall, a biopsy proven neoplastic lesion was found in 15 of 45 (33.3%) postpartum women compared with 32 of the 64 (50%) (p = .019) nonpregnant women. CONCLUSION: A cytologic diagnosis of ASCUS in pregnancy is associated with a significantly lower rate of neoplasia than the rate of neoplasia found among nonpregnant women with an ASCUS smear. A risk of cervical cancer following an ASCUS Pap smear was 2.2% in our pregnant population. Therefore, ASCUS diagnosed on the Pap smear in both pregnant and nonpregnant women warrants colposcopy and close follow-up.

Journal Article↗
PubMed1977

Colposcopic evaluation of pregnant patients with abnormal cervical smears.

Colposcopic examination and biopsy were used to assess 123 pregnant patients presenting with abnormal cervical smears. Eighty-seven per cent were 30 years of age or less and 95 (77 per cent) had had one or no previous children. Two patients were found to have microinvasive carcinoma and, in an additional 95 patients, either severe dysplasia or carcinoma in situ was present. Fifty-five patients (45 per cent) had subsequent conization or hysterectomy and in no instance was the histological diagnosis more serious than that anticipated from the colposcopic evaluation. Only three patients (1-6 per cent) had a cone biopsy during pregnancy; only one minor complication occurred. Colposcopic examination is the choice method of evaluating patients with abnormal cervical smears in pregnancy.

Adolescent↗
PubMedDate not supplied

Should punch biopsies be used when high-grade disease is suspected at initial colposcopic assessment? A prospective study.

The reliability and applicability of colposcopically directed cervical punch biopsy was assessed in a sample of 170 paired punch and large loop excision of cervical transformation zone (LLETZ) specimens obtained from previously untreated women who had been selected for treatment on the basis of cytology and/or colposcopic findings and in whom the entire cervical transformation zone was visible. A single punch biopsy was taken immediately before the LLETZ, and all the specimens were reviewed by a single pathologist. Nine (5.3%) punch biopsies were inadequate. In terms of whether or not there was cervical intraepithelial neoplasia (CIN), the chance-corrected kappa analysis rated overall agreement as poor (kappa = 0.21, 95% confidence limits 0.02-0.39), whereas in terms of histologic grade, it was fair to moderate (kappa = 0.32, 95% confidence limits 0.23-0.42). Punch biopsy tended to underestimate the disease. The sensitivity and specificity of colposcopically directed punch biopsy for the detection of high-grade CIN was 74% and 91%, respectively, with positive- and negative predictive values of 97% and 48%, respectively. Two microinvasive and two intraepithelial glandular lesions were missed on punch biopsy. Punch biopsy should be avoided when high-grade disease is suspected.

Adult↗
PubMed1996

Interobserver variation in the reporting of cervical colposcopic biopsy specimens: comparison of grading systems.

AIMS: To assess interobserver variation in reporting cervical colposcopic biopsy specimens and to determine whether a modified Bethesda grading system results in better interobserver agreement than the traditional cervical intraepithelial neoplasia (CIN) grading system. METHODS: One hundred and twenty five consecutive cervical colposcopic biopsy specimens were assessed independently by six histopathologists. Specimens were classified using the traditional CIN grading system as normal, koilocytosis, CIN I, CIN II, or CIN III. The specimens were also classified using a modified Bethesda grading system as either normal, low grade squamous intraepithelial lesion (LSIL) or high grade squamous intraepithelial lesion (HSIL). Participants were also asked to categorise biopsy specimens by the CIN system with the addition of the recently proposed category "basal abnormalities of uncertain significance (BAUS)". The degree of agreement between participants was assessed by kappa statistics. RESULTS: Using the CIN system, interobserver agreement was generally poor: unweighted and weighted kappa values between individual pairs of observers ranging from 0.05 to 0.34 (average 0.20) and from 0.20 to 0.54 (average 0.36), respectively. With the modified Bethesda system, interobserver agreement was better but still poor: unweighted and weighted kappa values ranging from 0.15 to 0.58 (average 0.30) and from 0.21 to 0.61 (average 0.36), respectively. There was little or no agreement between observers in the diagnosis of BAUS. CONCLUSIONS: Interobserver agreement in the reporting of cervical colposcopic biopsy specimens using the CIN grading system is poor. Agreement, while still poor, is better when a modified Bethesda grading system is used. There is little or no consensus in the diagnosis of BAUS.

Biopsy↗
PubMed1976

[Comparative colposcopic, cytological and histological studies of the uterine cervix during pregnancy].

The suspected findings, of colposcopic and cytologic cervix uteri in the pregravidity, was reported. Among 5852 patients, who primarily were directed in the clinic for interruption, 63 of them were examined because of their suspected colposcopic results and 3 cases of them were examined because of their suspected cytologic results, at the same time a detailed histological clarifications of their portio during the interruption were made. About 30,8% of the cases were in preinvasive or invasive stages, which were histologically clarified and precarcinogenic treatment of the patients was carried out. On the evidence of the results, we recommend, that by all suspected colposcopic cases -- taken into consideration of the cytologic results -- an early histologic clarification be made.

Abortion, Induced↗
PubMed1999

Comparison of the grade of CIN in colposcopically directed biopsies with that in outpatient loop electrosurgical excision procedure (LEEP) specimens--a retrospective review.

BACKGROUND: It has been suggested that LEEP should be the standard for the diagnosis of cervical dysplasia, rather than colposcopically directed biopsy as traditionally so, since it is both diagnostic and therapeutic. PATIENTS: Seventy-eight patients who underwent LEEP at the Gynaecological Cancer Centre, KK Hospital from 1 January 1995 to 31 December 1997 for cervical dysplasia diagnosed by colposcopically directed biopsy were retrospectively reviewed. The mean age of the patients was 40.3 years (SD 8.4), with 78.2% of them with CIN I or CIN II. The mean operating time was 11.8 minutes (SD 4.9) and 53.8% (42/78) were given prophylactic antibiotics, with the only complication being moderate postoperative haemorrhage in 3.8% (3/78). The mean follow-up period was 19.1 months (SD 9.3) with the cure rate being 97.4% (76/78). RESULTS: Only half of the patients had corresponding histologies on biopsy and LEEP, with 28.2% (22/78) undergraded and 21.8% (17/78) overgraded. CONCLUSION: Significant discrepancies may be found between the results of colposcopically directed biopsy and loop excision, and LEEP, which is safe and effective may be the choice procedure for the diagnosis of cervical dysplasia.

Adult↗
PubMed2002

[Colposcopic findings in HPV lesions of the uterine cervix].

Colposcopics Finding in HPV Lessions of Uterine Cervix, Busalov S, Todorova M, Vasilev I, Galabova M. Medical Faculty, Thracian University Stara Zagora. For 10 years period 6690 colposcopics examinations were provided. In 247 patients (3.69%) is determined atypical colposcopics findings suspected for HPV infection and is done target biopsy of PVCU. According to hystological results the cases are divided in 2 groups: with CIN and without CIN. The most frequently observed lesions of the uterine cervix in HPV infection are: flat papilloma--65.9%, inverting papilloma--25%, exotic papilloma--4.25% and mixed papilloma--4.79%. In 188 (75.8%) patients HPV lesions are without association with CIN and in 59 (23.7%)--they are in association with various CIN diseases. The most common age is to 35 years old.

Adult↗
PubMed2003

[New revision of the international colposcopic terminology: Barcelona--2002].

The present review makes a brief survey of the development in the colposcopic terminology and the causes for its new revision, made by IFCPC Terminology Committee, accepted at its 11th World Congress of this organization in Barcelona, 9-13 june, 2002. In general, the changes are connected with the definition of all colposcopic findings as well as the determination of the colposcopic signs of metaplastic epithelium, low-grade and high grade lesions or findings, suspicious for invasive cancer. It is pointed out that changes are significant for the development of colposcopy from theoretic, practical and scientific point of view.

Colposcopy↗
PubMed2001

Correlating Papanicolaou Smear, Colposcopic Impression, and Biopsy: Results from the Women's Interagency HIV Study.

OBJECTIVE: To determine associations among cervical cytology, colposcopy, and biopsy in HIV-seropositive women. MATERIALS AND METHODS: HIV-seropositive women and uninfected comparison women in a multicenter prospective cohort study underwent colposcopy for protocol indications. Women were eligible if they had a cervix, satisfactory cytology, and colposcopy between October 1994 and September 1999. Cytology, colposcopic impression, and biopsy were compared using equivalent categorizations. Kappa statistics with bootstrap sampling assessed strength of associations. RESULTS: Colposcopy was performed in 978/1370 HIV-seropositive women and in 154/224 seronegative women. Biopsies were performed on 603 (44%) seropositive women at least once during 1015 colposcopy visits and on 82 (37%) seronegative women at 116 visits. The positive predictive value of cytology was 72% for seropositive women and 60% for seronegative women. The positive predictive value of colposcopy was 71% for seropositive women and 55% for seronegative women. CONCLUSION: The correlation between either cervical cytology or colposcopic impression and colposcopic biopsy was poor.

Journal Article↗
PubMed1991

Abnormal cervical cytologic, colposcopic and histologic findings in exposed DES young Israeli Jewish women.

A consistently higher rate of abnormal cervical cytology, colposcopic and histologic findings in 89 DES exposed Israeli Jewish women was found as compared to 318 women in a control group. This trend however reached statistical significance for abnormal colposcopic and histologic findings only in the 25-34 age group. The higher rate of abnormal findings can be attributed to DES exposure and not to an excess of other risk factors in the study group. Routine cytologic and colposcopic examination is recommended for DES exposed Israeli Jewish women who are otherwise at low risk for development of cervical neoplasia.

Adult↗
PubMed1990

The accuracy of colposcopically directed biopsy in the diagnosis of cervical intraepithelial neoplasia.

In order to evaluate the accuracy of colposcopically directed biopsy in the diagnosis of Cervical Intraepithelial Neoplasia (CIN), in a series of 164 patients we compared findings from histological serial section of colposcopically directed biopsy with those from histological serial section of the entire lesion after diathermic loop excision. Colposcopically directed biopsy allowed a correct diagnosis to be made in 73 to 76.3% of cases, depending on the importance of the cervical lesion.

Adolescent↗
PubMed1978

Colposcopic examination of the cervix of cebus monkeys.

A total of 410 colposcopic examinations were performed on 188 female cebus monkeys that were under study to determine the oncogenic potential of herpes simplex virus type 2 in this genus. A split-cone vaginal speculum was developed that permitted good observation of the vaginal cervix in the cebus monkey. The cervical anatomy of cebus monkeys was found to differ from that of humans in that the surface of the animal cervix was more papilliform, with thinner squamous epithelium, and the squamocolumnar junction lay within the endocervical canal. Therefore, the ability to detect abnormalities in the cervical epithelium by colposcopic examination in the cebus monkey was restricted to vascular changes in the squamous epithelium. After 100 examinations, several vascular patterns were distinguishable and interpretations of these patterns were compared with cytologic findings on the same animals. Findings by both cytology and colposcopy were mild in nature; no carcinoma was detected. Colposcopic and cytologic findings correlated at a level of 84%. More abnormalities were detected with colposcopy than with use of cytologic techniques.

Animals↗