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 1,135 records · Page 63Linked to original sources
PubMed2003

Pigmented squamous cell carcinoma of the uterine cervix.

A 57-year-old female presented with an abnormal Pap smear. Colposcopic examination of the cervix revealed white mucosa with erosion and several areas of black pigmentation. After a colposcopically directed biopsy and loop conization, radical hysterectomy and bilateral salpingo-oophorectomy with pelvic and paraaortic lymphadenectomy were performed. Pathological examination disclosed an invasive squamous cell carcinoma admixed with many dendritic melanocytes. Melanin granules were present within the melanocytes and tumor cells. Although similar tumors have been reported in other sites, this is the first report to our knowledge of a pigmented squamous cell carcinoma of the uterine cervix.

Biopsy↗
PubMedDate not supplied

Diagnostic efficacy of optical coherence tomography in the management of preinvasive and invasive cancer of uterine cervix and vulva.

The purpose of this study was to understand the capabilities and utility of optical coherence tomography (OCT) in characterizing tissue in patients with precancer and cancer of the uterine cervix and vulva. OCT is an optical technique that uses low-coherence interferometer to develop a two-dimensional image of optical scattering from internal tissue microstructure. This study was designed to develop diagnostic criteria. Women undergoing colposcopic evaluation secondary to an abnormal Papanicolaou smear or visualized grossly abnormal vulvar lesion comprised the study population. Under colposcopic visualization, the OCT device was applied to normal regions in all patients and abnormal areas when present, and images were captured. Each subject then underwent multiple directed biopsies. Images were then reviewed and compared with matched histology. A total of 50 women were recruited for the study. Of the 50 patients evaluated, 18 had cervical intraepithelial neoplasia (CIN) II,III, 14 had CIN I, 13 had metaplasia/inflammation, two had invasive squamous cell carcinoma of the cervix, and three had a diagnosis of Paget's disease of the vulva. Analysis of the OCT images showed a repetitive pattern that represented normal squamous epithelium of the cervix in 100% of the normal biopsies. Images of the 18 patients with histologically proven CIN II,III showed an unstructured homogeneous highly backscattering region with fast attenuation of the signal in 16 (89%) of the patients. OCT is a new approach for the early identification of cervix and vulvar malignancies. Using information inherent to the returning photon signals from tissue, early morphological and light-scattering changes can be detected during tumorigenesis. It has the potential to be a true optical biopsy. If diagnostically comparable to a biopsy, then clearly the ability of OCT to provide a point of service diagnosis would serve a significant advantage.

Carcinoma, Squamous Cell↗
PubMed2006

Liquid-based cytology and conventional smears compared over two 12-month periods.

BACKGROUND AND OBJECTIVE: Liquid based cytology (LBC) was introduced across the Scottish Cervical Screening Programme in 2003-2004. The objective of this study was to compare in a large cytopathology laboratory the results of cervical samples over two twelve-month periods, 2001-2002, when the great majority of smears were conventional, with 2003-2004, when all were LBC. METHODS: The results of smears in both periods were analysed to give overall reporting profiles, and correlated with results of cervical biopsies. The numbers of patients referred for colposcopy were compared. RESULTS: The percentage of unsatisfactory smears fell from 13.6% to 1.9%. Colposcopic referrals for repeated unsatisfactory smears fell from almost 25% to 0.5%. There was a decrease in overall smear numbers, but despite this there was an increase in the number of smears reported as showing dyskaryosis of any grade. There was an increase in positive predictive value for moderate dyskaryosis and above, from 79.5% to 86.1%. The outcome of biopsies from patients referred with mild dyskaryosis showed no decrease in accuracy of predicting a low grade histological lesion. Workload in the laboratory decreased, due to fewer smears received overall, more rapid primary screening times and fewer multi-slide cases. Primary screening backlogs all but disappeared, and reporting times greatly improved. CONCLUSIONS: Introduction of liquid based cytology led to improvements in unsatisfactory smear rates, with significant benefits to colposcopic referrals and laboratory turnaround times. Pick-up rates of dyskaryosis were maintained, and the positive predictive value of a dyskaryotic smear report was improved.

Colposcopy↗
PubMed1993

Diagnostic problems relating to uterine cervical polyps with malignancy.

In order to clarify the diagnostic problems relating to, and the proper treatment of, uterine cervical polyps, 951 polyps were analyzed clinicopathologically. All polyps were examined histopathologically and divided into 2 groups: benign polyps (Group-1), and polyps with neoplastic or malignant lesions (Group-2). Polyp size and cervical cytology are not always reliable for predicting the correct diagnosis of neoplastic or malignant lesions. Colposcopic diagnostic accuracy was 56.3%, but increased to 75.0% when combined with cytology. Neoplastic or malignant lesions were found at both the cervical polyp and the cervix in 21 out of 24 Group-2 patients (87.5%). These results suggest that in order not to miss rare neoplastic or malignant lesions in polyps and/or cervices, histopathological examinations of all polyps, aided by cervical cytology and colposcopic observation, are necessary.

Cell Transformation, Neoplastic↗
PubMed2000

A clinicopathological study of postoperatively upgraded early squamous-cell carcinoma of the uterine cervix.

OBJECTIVE: To investigate the clinicopathological backgrounds and diagnostic problems of postoperatively upgraded early squamous-cell carcinomas of the uterine cervix. PATIENTS AND METHODS: A total of 23 patients with postoperatively upgraded early squamous-cell carcinomas who were treated at the Saitama Cancer Center during the period of January 1, 1976, through December 31, 1991, were analyzed clinicopathologically. We reexamined the Pap smears (ectocervix, endocervix), colposcopic findings, punch biopsies, and histological findings of the operative specimens. All patients were divided into one of 3 groups based on each patient's main location of the carcinoma of the cervix: Type A: ectocervical type; Type B: endocervical type; or Type C: combined (ectocervical and endocervical) type. Clinical staging of the uterine cervical carcinomas was done in accordance with the 1994 FIGO rules. RESULTS: The numbers of patients were: Type A, 2; Type B, 10; Type C, 11. Of the 23 patients, 21 (91.3%) had lesions in the endocervical portion at least. Fifteen patients (65.2%) complained of atypical vaginal bleeding. Colposcopic findings suggesting an invasive carcinoma appeared for only 6 patients (26.1%). A cytological reevaluation revealed that the endocervical findings were much stronger than the ectocervical ones in 10 (66.7%) of 15 patients whose smears of both sites could be rechecked. CONCLUSIONS: Even if the preoperative diagnosis was early cervical carcinoma, CIS or Stage Ia1, the signs of atypical vaginal bleeding suggested that the final clinical stage would be upgraded after an operation. Furthermore, when the endocervical cytological findings were much more exaggerated than the ectocervical ones, the possibility of deeply invaded endocervical lesions should be considered.

Adult↗
PubMed1998

Impact in general practice of the policies of the organised approach to preventing cancer of the cervix.

This cross-sectional survey of cancer screening in May 1996 used a national random sample of a specified group of general practitioners (GPs). The survey included items to assess the impact of the Organised Approach to the Prevention of Cervical Cancer (OAPCC). Of the 1,271 GPs who satisfied the eligibility criteria, 855 (67%) returned a completed questionnaire. Fifty-two per cent indicated they would be 'highly' likely to introduce a discussion about cervical smears to a 58-year-old woman who was in good health and had come for a non-gynaecological consultation. Female sex, RACGP affiliation, practising in a metropolitan area and awareness of the OAPCC booklet were independent predictors of an opportunistic orientation. By contrast, 91% indicated that they would be 'highly' likely to include a Pap smear in a general health checkup. Thirty-eight per cent reported that they had found the booklet about the 1991 screening policy 'very' useful, while 38% found the NHMRC guidelines for the management of women with screen detected abnormalities 'very' useful. Around one-fifth of the GPs were not aware of these documents. Overall, 19% still recommended annual or more frequent screening. GPs from NSW and Queensland were less likely to support biennial screening than GPs from other states. Overall, 26% of GPs did not indicate that they would refer a woman who had tested positive for any grade of CIN for colposcopic assessment. Female GPs were more likely to refer women with CIN for colposcopic assessment while older doctors were less likely to do so.

Adult↗
PubMed1985

Topical 5-fluorouracil in the treatment of vaginal intraepithelial neoplasia.

The effectiveness of 5-fluorouracil (Efudix) in the treatment of vaginal intraepithelial neoplasia was assessed in 14 patients diagnosed with the condition between January 1980 and December 1982. All patients received a standard dose of 2.5 g 5-fluorouracil cream once weekly for at least 10 consecutive weeks; mean duration of treatment was 12 weeks (range 10-20 weeks). The vaginal lesion was associated with a major dysplastic lesion of the cervix in all patients. The duration of follow-up ranged from 4 to 42 months (mean 15 months). Thirteen patients had complete resolution both colposcopically and cytologically. One patient still had colposcopic evidence of intraepithelial neoplasia (aceto-white epithelium) but a vaginal smear has been negative. This patient has since been lost to follow-up. We conclude that in the regimen described 5-fluorouracil is an effective treatment for vaginal intraepithelial neoplasia.

Administration, Topical↗
PubMed1986

Evaluation of colposcopy in the postmenopausal woman.

Cytology, colposcopy and histology findings in 121 postmenopausal and 120 premenopausal women referred to the Oxford colposcopy clinic were compared; 88% of postmenopausal and 69% of premenopausal women were referred by their general practitioners. Cervical smear reports, within the preceding 5 years, were available for 21% of the postmenopausal and 54% of the premenopausal women. Colposcopic assessment was technically unsatisfactory in 53% of the postmenopausal women because the transformation zone was not completely visible, this contributed to a cone biopsy rate of 71% in this group. Only 17% of postmenopausal women with cervical intraepithelial neoplasia (CIN) were managed with local ablative techniques compared with their use in 61% premenopausal patients overall and in over 70% of the women under 35 years. Local ablation was used in 10 of 14 women using hormone replacement therapy. The cytological false negative rate for postmenopausal Papanicolaou class III, IV and V smears was 9% but for persistent class II inflammatory smears it was 43%. Nine of 23 postmenopausal women with persistent inflammatory dyskariosis despite antibiotic or antifungal treatment were found to have colposcopic appearances of CIN and four had microinvasion or invasion. Colposcopy revealed probable microinvasive or invasive disease in 17 postmenopausal women, seven of whom had class II or III cytology.

Aged↗
PubMed1987

Negative cone biopsies after colposcopy and their prediction.

A retrospective study of 899 cone biopsies revealed significantly more cones containing no dysplastic epithelium in patients who had a prior colposcopic assessment compared with those who had not been so assessed. A case-control study of 48 'negative' cones, 47 cones containing intraepithelial neoplasia (CIN), 44 microcarcinoma containing cones and 27 occult Ib containing cones has allowed five variables to be identified which can predict the presence of dysplastic or neoplastic tissue in the cone specimen. These variables include a colposcopic suspicion of invasion; a positive or worse pre-cone smear; two severely dyskaryotic smears within a 12-month observation period, previous abnormal histology and previous treatment for CIN. Using these criteria, 44% of 'negative' cones could be avoided without overlooking any cases of microcarcinoma or occult carcinoma.

Adult↗
PubMed1988

Radiotherapy in the management of vaginal intraepithelial neoplasia after hysterectomy.

Intravaginal radium was used to treat 11 patients who were found to have vaginal intraepithelial neoplasia (VAIN) following hysterectomy for cervical intraepithelial neoplasia. All were discovered by cytological follow-up, were colposcopically assessed and diagnosis was confirmed by histological examination before treatment. Nine of 10 patients questioned continue to enjoy satisfactory sexual intercourse after treatment but 6 of 8 premenopausal patients subsequently became oestrogen deficient and required hormone replacement therapy. No other significant morbidity has been observed. All remain cytologically and colposcopically free of disease after a median follow-up of 26 months. We conclude that radiotherapy is an effective treatment of VAIN following hysterectomy.

Adult↗
PubMed1990

Reliability of colposcopy and directed punch biopsy.

A group of 118 women underwent laser cone biopsy. Data were collected routinely on proforma case notes and entered into a computerized database. The histology of the cone biopsies was compared with that of previous, colposcopically directed punch biopsies, with the cytology of smears taken in the clinic and with the colposcopic diagnosis. The punch biopsy had a 54% false negative rate and neither of the two microinvasive carcinomas biopsied in this way were detected by the biopsy. Ten of 24 women with negative punch biopsies had CIN III in the cone. When the punch biopsy showed CIN II or worse, the cone biopsy confirmed the presence of CIN in 86%. There was some evidence of false negative cone biopsies. The data suggest that management should not be based solely upon the punch biopsy result but should include consideration of the cytology and colposcopy findings. Excisional methods of treatment are more likely to reveal early invasion and adenocarcinoma-in-situ.

Biopsy↗
PubMed1990

Unsatisfactory colposcopy and the response to orally administered oestrogen: a randomized double blind placebo controlled trial.

Thirty-six women with dyskaryotic cervical smears and unsatisfactory colposcopy were randomly allocated to receive either 30 micrograms ethinyl oestradiol or placebo daily by mouth for 10 days. Thirty-four women were available for review (17 women in each of the two groups), full colposcopic inspection of the transformation zone was possible in a significantly greater proportion of the oestrogen treated group (70% versus 23%, P less than 0.01). As most diagnostic conizations are currently performed on the basis of unsatisfactory colposcopy, the use of oestrogen medication followed by colposcopic reassessment should permit a reduction in the number of patients subject to operation.

Adult↗
PubMed1992

A prospective study of conization of the cervix in the management of cervical intraepithelial glandular neoplasia (CIGN)--a preliminary report.

OBJECTIVE: To assess the efficacy of cervical conization as primary management of cervical intraepithelial glandular neoplasia (CIGN). DESIGN: A multicentre prospective cohort study. SETTING: CRC Clinical Trials Unit, Birmingham. SUBJECTS: 84 women registered with the Unit between May 1986 and January 1989. After excluding 33 women, 51 who had been managed in accordance with the described protocol and had the presence of CIGN confirmed by central review of diagnostic histopathological material were included in the study. INTERVENTION/PROTOCOL: Women with CIGN diagnosed on a cervical cone specimen were managed in accordance with a specific protocol: (a) women with negative cone margins were managed conservatively and followed up with regular cervical cytological and colposcopic examinations; (b) women with involved cone margins were managed by hysterectomy. MAIN OUTCOME MEASURES: Presence or absence of CIGN at cone margins, results of cervical cytological examinations following conization, results of histopathological assessment of any surgical specimens taken after initial cone biopsy. RESULTS: Of the 51 women with confirmed CIGN, managed by conization, 14 (27%) were aged 30 or less and 15 (29%) were nulliparous. Thirty five women who had a cone biopsy showing margins free of CIGN have been managed by conization alone. After a median follow-up period of 12 months there is no apparent residual CIGN or invasive disease in this group. Thirteen women have had further surgical procedures (according to protocol) and two have had a hysterectomy for benign gynaecological disorders. Eight further procedures were carried out because the original cone biopsy had margins involved with CIGN, and only one of them was found to have residual CIGN. The other five procedures were carried out solely because of abnormal cytology, only one of them had a diagnosis of CIN 1. A total of 10 women had cytological abnormality following cone biopsy, one had CIGN, one had CIN 1 and a third had CIN 3. CONCLUSIONS: Our preliminary data suggests that when a diagnosis of CIGN is made upon a cone biopsy, further surgery is unnecessary in those women in whom the margins of the cone specimen are free of disease. Cytological and colposcopic follow up, including cytological sampling of the endocervical canal, is recommended for these women.

Adult↗
PubMed1993

What is vestibular papillomatosis? A study of its prevalence, aetiology and natural history.

OBJECTIVES: To clarify the prevalence, aetiology, symptoms and natural history of vestibular papillomatosis. DESIGN: Study in two parts: 1. prevalence assessed by colposcopic examination of the vulva of unselected patients by one doctor (J.M.W.); 2. patients selected by clinical appearance as having vestibular papillomatosis (by J.M.W. and other doctors) assessed in a research clinic. SETTING: Outpatient genitourinary medicine clinic in South London. SUBJECTS: Part 1 study: 295 female clinic attenders; part 2 study: 18 women with clinical vestibular papillomatosis. MAIN OUTCOME MEASURES: Part 1 study: number of unselected patients found to have vestibular papillomatosis. Part 2 study: associated symptoms, histology, DNA hybridisation and polymerase chain reaction on vulval biopsies. Clinical regression of lesions. Cervical cytology and colposcopy. RESULTS: Part 1 study: Vestibular papillomatosis was identified by colposcopic examination of the vulva in 3/295 (1%) of women. Part 2 study: 9/18 (50%) women with vestibular papillomatosis were asymptomatic; the other nine had intermittent mild symptoms. Thirteen (72%) had a history of genital warts. Vulval biopsies had features suggestive of wart virus infection on histology in 17/18 (94%) and HPV16 was found by DNA hybridisation studies or polymerase chain reaction in 7/18 (39%). On follow up (mean duration 9 months) the vulval lesions had regressed in 9/12 patients. Ten patients had cervical wart virus infection or intraepithelial neoplasia (CIN), or both, and five needed laser treatment for this. CONCLUSIONS: In this study vestibular papillomatosis was associated with human papillomavirus (HPV) infection. This study suggests that vestibular papillomatosis need not be treated, but patients with it may be at increased risk for CIN.

Adolescent↗
PubMed1993

Destruction of CIN 1 and 2 with the Semm cold coagulator: 13 years' experience with a see-and-treat policy.

OBJECTIVE: To assess the efficacy of the Semm Cold Coagulator (100 degrees C) for CIN 1 and 2 applying a 'see and treat' policy. DESIGN: Retrospective review of women with CIN 1 and 2 seen and treated at their first visit when specific criteria were satisfied. SETTING: Colposcopy Clinic, Ninewells Hospital, Dundee. SUBJECTS: 485 women with CIN 1 and 680 women with CIN 2 confirmed by colposcopically directed biopsy and treated between 1 January, 1978 and 31 December, 1990. RESULTS: Overall, a 96.7% primary success rate with a single treatment (97.1% for CIN 1, 96.5% for CIN 2) and 99% overall success rate after one or more treatments with the cold coagulator. None of the women developed micro-invasive or invasive cancer and only 1.1% developed CIN 3. In 98.3% treatment was undertaken at their first and only colposcopy clinic attendance. Heavy vaginal bleeding occurred in 1.5% after treatment and 0.6% complained of a heavy vaginal discharge. One woman developed cervical stenosis which required dilatation because of dysmenorrhoea. CONCLUSION: Cold coagulation at 100 degrees C of CIN 1 and 2 proven by colposcopically directed biopsy using a 'see and treat' policy subject to specific conditions is a safe, cost effective, practical approach. It is more likely to return the cervix to sustained normality than withholding treatment and simply maintaining cytological surveillance, and it should prevent some of the invasive cancers that have been described in reports of management by cytological surveillance.

Carcinoma in Situ↗
PubMed1997

The management of cervical carcinoma within the south west region of England. Expert Tumour Panel.

OBJECTIVE: 1. To audit the management of cervical carcinoma in the South West Region with the aim of identifying and addressing deficiencies. 2. To determine whether recent NHS restructuring has affected the provision of cancer care. DESIGN: Retrospective review of hospital case notes. SETTING: All hospitals in the South West Region of England. POPULATION: Three hundred and twenty-four women with a diagnosis of cervical carcinoma: 191 were diagnosed in 1989 and 133 in 1993. MAIN OUTCOME MEASURES: Documentation of patient assessment and management. RESULTS: There was a mean delay of 17 days (range 0-66) from cervical smear to cytology report and 34 days (range 1-380) from general practitioner referral to attendance at a hospital clinic. Overall, 175 women (54%) had evidence of cytological assessment prior to treatment and 137 (42%) had a colposcopic assessment; 49% had cytological assessment and 37% had colposcopy in 1989, compared with 60% and 50%, respectively, in 1993. Excluding 49 cases of micro-invasive carcinoma, 238 case notes (86%) contained evidence of clinical examination; 195 women (71%) had had an examination under anaesthesia, 115 (42%) a chest radiograph, 123 (45%) an intravenous urogram or renal ultrasound, and 92 (33%) cystoscopy. One hundred and forty-seven women (53%) had FIGO staging recorded in the notes. As first line treatment, 69 had conservative surgery (39 for Stage IA), 138 had radiotherapy, and 107 had radical surgery. Ten had radical surgery for Stage IA but eight had a > 3 mm invasion or lymphatic/vascular spread. Thirty-one had Stage IB treated with radiotherapy of whom 14 were younger than 50 years of age. Following radical surgery 30% had evidence of sampling > or = 10 nodes, and 9% had tumour extending to the resection margins. CONCLUSIONS: Record keeping was inadequate but appeared to indicate inconsistent cytological, clinical, colposcopic and radiological assessment, leading to inappropriate clinical delays and conservative surgery. Radical surgery often appeared inadequate, but poor node sampling rates may also reflect insufficient histopathological preparation or reporting. There was a reduction in the number of new cases of cervical carcinoma diagnosed in 1993, perhaps reflecting an observed increase in cytological surveillance. No other alterations in clinical practice were observed over the four-year period. We feel it is imperative to standardise assessment throughout the region with a minimum clinical and histopathological dataset.

Adult↗
PubMed2005

Detection of cervical intraepithelial neoplasia using impedance spectroscopy: a prospective study.

OBJECTIVE: To compare cervical impedance spectrometry in the cervical epithelium of women with cervical intraepithelial neoplasia (CIN) and normal epithelium. DESIGN: Prospective observational study. SETTING: Colposcopy clinic, Jessop Wing, Royal Hallamshire Hospital, Sheffield, UK. POPULATION: Eighty-seven women referred to colposcopy with a moderate or severely dyskaryotic smear. METHODS: A pencil probe incorporating four gold electrodes was used to measure an electrical impedance spectrum from cervical epithelium. Colposcopy examinations, including probe positioning, were recorded by video to allow for correlation between results obtained from colposcopic impression, histopathological examination of colposcopically directed punch biopsies and the impedance measurements. MAIN OUTCOME MEASURES: Cervical impedance derived parameters R, S and C were assessed to see if there was a significant difference in values obtained in CIN and normal squamous epithelium. Analysis was based upon matching the electrical components measured to those identified by cellular modelling as being most sensitive for premalignancy. RESULTS: From normal epithelium through CIN 1 to CIN 2/3, R decreased by a factor of 4.5, S increased by a factor of 2.5 but C remained unchanged. CONCLUSIONS: Cervical impedance spectrometry provides a potentially promising screening tool with similar sensitivity and specificity to currently used screening tests, but with the potential advantage of providing instant results. Further work is currently being undertaken to improve the probe in its clinical use.

Area Under Curve↗
PubMed1987

Management of squamous atypia (borderline nuclear abnormalities): repeat cytology or colposcopy?

A prospective cytological, colposcopic and histological study was conducted in 44 women with cervical cytology showing borderline nuclear abnormalities insufficient for the diagnosis of dyskaryosis. Atypical squamous epithelium was found on colposcopy in 41 patients and cervical intraepithelial neoplasia (CIN) was diagnosed on histology in 33 patients (75%) including 10 with CIN 3. Repeat cytology obtained under colposcopic vision was negative in 12 (33.4%) patients with CIN. The high prevalence of CIN in smears showing only borderline nuclear abnormalities and the high false negative rate of repeat cytology indicate that colposcopy should be the first line of management for these patients.

Adult↗