Management of cervical dyskaryosis. Colposcopy is not cost effective.
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In the Republic of Panama between the years 1982-1992 we carried out an investigation on 5,112 women with the aim of evaluating those with oncological risk (OR), and we found 3,003 of them (87.6% of cases) where HPV infection in its diverse forms (Pure, NIC, invasive cancer) was the most predominant characteristic.
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Both epithelial and structural abnormalities of the lower genital tract are known to occur in women exposed in utero to DES with greater frequency than in the general population. These changes are usually easily identified by pelvic and colposcopic examination. In general, no treatment is suggested for benign changes. DES-exposed women, however, must be carefully followed-up because of the potential, although rare, of the development of clear cell adenocarcinoma and the increased incidence of squamous intraepithelial neoplasia. With rare exception, screening at yearly intervals is sufficient.
The colposcopic appearances of VIN III differ on the vulva and adjacent sites according to the anatomic sites. Lesions on the hairy skin appear more well defined than lesions on nonhairy areas. VIN III histologically can extend into underlying adnexal structures. Most frequently, it is the hair follicles in which it may extend deeply. This involvement is not identified by colposcopic methods. A variety of colposcopic mimics or "look-alike" lesions occur on the vulvar skin. Therefore the performance of a biopsy is required to establish the diagnosis.
To recognize the typical transformation zone, the colposcopist must first be familiar with the normal appearance of other parts of the cervix. These can be summarized as follows: original squamous epithelium, original columnar epithelium, squamo-columnar junction, metaplasia, and the congenital transformation zone.
An awareness of the pitfalls associated with the various aspects of the colposcopic examination should minimize erroneous diagnosis and inappropriate treatment. The colposcopist, armed with current knowledge and guided by a diagnostic and therapeutic protocol, should be able to avoid them (summarized in Table 1).
Human papillomaviral infections can affect the entire lower female genital tract as multifocal or multicentric disease as well as the surrounding anatomic and adjacent sites. The traditional colposcopic methods are necessary to assist in the diagnosis and help differentiate these infections from other disease mimics.
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