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PubMed2006

Cost-effectiveness analysis based on the atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion Triage Study (ALTS).

BACKGROUND: The ALTS (atypical squamous cells of undetermined significance [ASCUS] and low-grade squamous intraepithelial lesion [LSIL] Triage Study) suggests that, for women diagnosed with ASCUS, human papillomavirus (HPV) DNA testing followed by referral to colposcopy of only those women with oncogenic HPV (i.e., HPV DNA testing) is as effective at detecting cervical intraepithelial neoplasia (CIN) 3 or cancer (CIN3+) as referring all women with ASCUS for immediate colposcopy. We conducted a cost-effectiveness analysis of the ALTS trial to determine whether HPV DNA testing is a cost-effective alternative to immediate colposcopy or conservative management with up to three cytology examinations. METHODS: Data from the ALTS trial were used in conjunction with medical care costs in a short-term decision model. The model compared the incremental costs per case of CIN3+ detected as measured by the incremental cost-effectiveness ratio (ICER) for the following management strategies for women with ASCUS: immediate colposcopy, HPV DNA testing, and conservative management with up to three cytology examinations. RESULTS: The least costly and least sensitive strategy was conservative management with one repeat cytology examination using a threshold of high-grade squamous intraepithelial lesion (HSIL) for referral to colposcopy. Compared with this strategy, triage to colposcopy based on a positive HPV DNA test result had an ICER of 3517 dollars per case of CIN3+ detected. Immediate colposcopy and conservative management with up to three repeat cytology visits detected fewer cases of CIN3+ and were more costly than HPV DNA testing. Immediate colposcopy became cost-effective at 20,370 dollars compared with HPV DNA testing only if colposcopy and biopsy were assumed to be 100% sensitive. CONCLUSIONS: HPV DNA testing is an economically viable strategy for triage of ASCUS cytology. The less than perfect sensitivity of colposcopy and biopsy needs to be accounted for in future clinical guidelines and policy analyses.

Adult↗
PubMed2004

The inadequate smear: does it matter?

The objective of this study was to quantify the incidence of underlying cervical intraepithelial neoplasia (CIN) among women referred for colposcopy with three consecutive inadequate smears. The design was a retrospective cohort study analysing data from a regional colposcopy database at Cervical Screening Wales. Women who were referred to all the colposcopy clinics in Wales with three consecutive inadequate smears, the third inadequate smear being taken between 1 April 2001 and 31 March 2002 constituted the study population. The results of the fourth smear taken at the colposcopy clinic after three consecutive inadequate smears, the worst biopsy results from any of the subsequent colposcopies and the relationship between the result of the fourth smear taken at colposcopy clinic and any histology result were the main outcome measures. The accuracy of the colposcopic opinion was also examined. Of the 433 women identified as having been referred because of three consecutive inadequate smears, 302 were linked to either a subsequent smear and/or a biopsy result. An adequate smear result was available for 85% of these women when the smear was taken in the colposcopy clinic; 77% were reported as negative and 8% were abnormal. Of the 347 women seen in the colposcopy clinic, high-grade CIN was seen in 3% and low-grade lesion in 8%. The sensitivity and specificity of the fourth inadequate smear test in predicting underlying CIN were 15% and 84% respectively, with a positive predictive value of 8%. The sensitivity and specificity of colposcopy in predicting histological CIN among patients with three inadequate smears was 70% and 49%, respectively, and the positive predictive value was 44%. This study raises the question as to whether three consecutive inadequate smears should be considered as an indication for colposcopy, or merely for a further smear to be taken in circumstances where there is a greater likelihood getting an adequate result.

Adult↗
PubMed2006

Colposcopic management of high-grade referral smears: a retrospective audit supporting 'see and treat'?

OBJECTIVE: The National Health Service Cervical Screening Programme monitors the quality of colposcopy services through the annual KC65 returns. The 2002 returns demonstrated that Standard 7c, which specifies a biopsy rate > or = 90% at first colposcopy visit for high-grade referrals, was not met in the assessed 3-month period. This was investigated along with the other standards. METHODS: Retrospective colposcopy records were accessed for the 597 new referrals, excluding 10 pregnant patients, seen at the colposcopy clinic at the Royal Victoria Infirmary between 1 July 2001 and 31 December 2002, following an abnormal high-grade smear. Cytology and histopathology computer records were checked for confirmation. The results were assessed against the colposcopy standards applicable at that time and the revised standards (2004). RESULTS: Biopsies were taken from 94.47% (Standard > or = 90%) of women at index colposcopy visit including wire loop excision biopsies from 66.16% (87.97% of high-grade colposcopic appearances). Cervical intraepithelial neoplasia (CIN) on histology was found in 91.79% in the study group (Standard > or = 85%) and in 96.71% of index visit biopsies (Standard > or = 90%), meeting the applicable colposcopy standards. The revised 2004 standards specify a biopsy in > or = 95% of high-grade referrals and excision biopsies in 95% if colposcopic appearances are also high-grade, if colposcopy is low grade but the smear is severely dyskaryotic, or when the lesion extends into the canal. The positive predictive value of high-grade cytology for this entire group was 75.54% with CIN present in 90.95%. CONCLUSION: From this study it appears that high-grade cytology in this centre reliably indicates high-grade CIN. Therefore, in women referred for colposcopy following a high-grade smear, excision biopsies should be performed in a higher proportion at the first visit to comply with the revised standards.

Biopsy↗
PubMed1987

A critical evaluation of the endocervical curettage.

A prospective study was undertaken to critically evaluate the endocervical curettage. The study group consisted of 261 patients with colposcopically identifiable cervical lesions that had not been previously biopsied and were not macroscopically suspicious for invasive cancer. In 210 patients, the entire lesion, transformation zone, and squamocolumnar junction were visible (satisfactory colposcopy), and in 51 patients, the full extent of the lesion was not visualized colposcopically (unsatisfactory colposcopy). We used a method of examination not previously described. Colposcopy was performed before and after the endocervical curettage, but before the ectocervical biopsy. This method of examination allowed us to identify potentially contaminated endocervical curettages and to test the null hypothesis that a positive endocervical curettage in patients with satisfactory colposcopy is not the result of contamination. Twenty of 210 endocervical curettages in patients with satisfactory colposcopy were potentially contaminated, as suggested by an ectocervical lesion disrupted by the endocervical curettage. No patient with a positive endocervical curettage had an intact ectocervical lesion. Therefore, the null hypothesis was rejected (P less than .005). Of the 51 patients with unsatisfactory colposcopy, 39 (76%) underwent cone biopsy. Invasive cancer was diagnosed by cone biopsy in two patients when both ectocervical biopsy and endocervical curettage demonstrated only dysplasia. We also confirmed that patients with unsatisfactory colposcopy occasionally benefit from having an endocervical curettage. However, basing the treatment plan for any lesion short of invasive cancer solely on the results of colposcopy, ectocervical biopsy, and/or endocervical curettage could lead to significant undertreatment of some patients.

Biopsy↗
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↗
PubMed1998

Women's experiences of having a colposcopic examination: self-reported satisfaction with care, perceived needs and consequences.

This study was conducted in seven gynaecological clinics in New South Wales (NSW), Australia. The study aimed to assess the level of satisfaction with care, unmet needs and consequences following the procedure reported by women having a colposcopic examination. Of the 161 eligible women attending colposcopy clinics who were approached to take part, 156 (97%) gave written consent to participate and 138 (86%) completed interviews. Consenting women were telephoned within 1 week of their clinic visit to complete a computer-assisted telephone interview (CATI). The survey addressed a number of issues relating to the care they received during their colposcopic examination: satisfaction with care, satisfaction with the waiting time to have a colposcopy, preferences for provider gender, information and health care needs while waiting for the colposcopy, information and health care needs during the colposcopy, short-term physical consequences and shortterm psychosocial consequences of the procedure. Results indicate that satisfaction with care among women ranged from 69% to 96%. The highest expressed needs while waiting for the colposcopy were for information about risks of cancer (91%), reasons for needing a colposcopy (86%), and the colposcopy procedure (86%). Women reported that outcomes such as anxiety and disinterest in sex had further worsened or not been improved following the colposcopy. The results indicate that interventions to address specific concerns would need to be designed, implemented and evaluated.

Journal Article↗
PubMed2004

Management of cervical cytologic abnormalities.

The American Society for Colposcopy and Cervical Pathology developed guidelines in 2001 for the management of cervical cytologic abnormalities. The guidelines incorporate the Bethesda System 2001 terminology and data from randomized studies of atypical squamous cells, low-grade intraepithelial lesions, human papillomavirus testing, and liquid-based cytology to formulate evidence-based recommendations. Each recommendation is graded according to the strength of the recommendation and the quality of the evidence, and specific terminology is added to highlight management options. The effectiveness of each triage recommendation is determined by the percentage of grade 2 and 3 cervical intraepithelial neoplasia it detects. Colposcopy, repeat cytology, and human papillomavirus DNA testing are acceptable options in women with atypical squamous cells of undetermined significance, but human papillomavirus DNA testing is preferred if liquid-based cytology is used. Colposcopy is recommended for women with a diagnosis of "atypical squamous cells-cannot rule out high-grade intraepithelial lesion." Women with low-grade squamous intraepithelial lesions should be referred for colposcopy, and women with high-grade lesions should undergo colposcopy and endocervical assessment. Colposcopy and endocervical sampling are recommended in women with all subcategories of atypical glandular cells. Endometrial sampling and colposcopy are recommended in women older than 35 years with atypical glandular cells and in younger women with unexplained vaginal bleeding. Women with a diagnosis of "atypical glandular cells-favor neoplasia" or adenocarcinoma-in-situ who are not found to have invasive disease on colposcopy should undergo a diagnostic excisional procedure, preferably a cold-knife conization.

Biopsy↗
PubMed1996

The colposcopic screening.

The objective of this paper is a valuation of colposcopy as a screening tool. As database, 392 patients with histologically confirmed intraepithelial neoplasia were used. Colposcopic and cytologic findings were compared with the final histologic diagnosis. The following results were obtained: (1)The colposcopic findings correlated with the histologic diagnosis to a significantly higher degree than the cytologic findings. Depending upon the rate of dysplasia, the colposcopic findings predicted the diagnosis in 84-97%. (2) The false-negative rate of cytology in condylomatous lesions and mild dysplasia was high (39 and 26%, respectively), in particular in comparison with the false-negative rate of colposcopy of 5% for both lesions. Thus, a negative smear does not exclude consistently a dysplasia of the cervix. (3) The false-negative rate of cytology for the high grade lesions (CIN II and CIN III) was 13 and 1% respectively and, thus, lower than in the low grade lesions. There were, however, considerable discrepancies in comparison with the histologic rating of the lesion. In CIN III cytology correlated with histology in only 61%, colposcopy, however, 85% (P < 0.001). Our results demonstrate that colposcopy is an excellent tool for detecting HPV caused lesions especially subclinical lesions and CIN I. Colposcopy is also a corrective for the false-negative cyto-smear rate (about 20-40%). Thus, colposcopy may be used as an effective quality assurance method and an excellent screening method in that colposcopy is superior in grading dysplastic lesions of the cervix. The application of the European terminology was advantageous.

Colposcopy↗
PubMed2004

Could precolposcopy information and counseling reduce women's anxiety and improve knowledge and compliance to follow-up?

OBJECTIVE: To investigate the effects of precolposcopy counseling on women's anxiety, knowledge about colposcopy and compliance to follow-up. METHODS: Two hundred and twenty women referred for colposcopy for the first time were recruited. They attended precolposcopy sessions in which written and video information were given and subsequently were randomized to have either further explanation and discussion with an experienced colposcopic nurse (study group) or no further discussion (control group). Each subject completed a Chinese version of the state-anxiety questionnaire (STAI) and a knowledge questionnaire before and immediately after the precolposcopy sessions and also before the colposcopy examination. Women's concern and opinion on the programme were also assessed. Follow-up data was compared with those who did not attend the precolposcopy sessions. RESULTS: Women's knowledge about colposcopy significantly improved after the precolposcopy sessions. The improvement was more significant in the study group than in the control group immediately after the sessions (P = 0.003). The difference between the groups in knowledge scores remained statistically significant before colposcopic examination (P = 0.015) but the difference diminished between these two assessment points. There was no statistically significant difference between the two groups in the anxiety scores at all assessment points. Women who attended the precolposcopy sessions had a significantly higher attendance rates and better compliance to follow-up than those who did not attend the sessions. CONCLUSION: Precolposcopy session with explanation and discussion improves women's knowledge about colposcopy, but has negligible effects on women's anxiety before colposcopy. Provision of written and video information at the precolposcopy sessions can improve compliance to follow-up after colposcopy.

Adult↗
PubMed2005

A clinical study of optical biopsy of the uterine cervix using a multispectral imaging system.

OBJECTIVE: To present the clinical application of the multispectral imaging colposcopic system (MIS colposcopy). METHODS: MIS colposcopy was performed on 123 enrolled women. After a 3% acetic acid application, sequential images were captured, analyzed, and stored automatically. Directed biopsies were taken from distinct marked acetic acid-responsive tissue areas indicated on the monitor, while a real-time assessment of the curves of intensity of the backscattered light (IBSL) vs. time was performed. Blind biopsies were taken from non-acetowhitening areas. Histological findings were correlated with MIS colposcopy results and compared with conventional colposcopy and Pap test results. RESULTS: Acetic acid-tissue interaction resulted in temporal and spatial alterations to the light scattering properties of the abnormal tissue that was analyzed. The shape of IBSL curve and the "relaxation time" (the time it takes for IBSL to decay to 1/e of its peak value) changed in accordance with the underlying lesion. More severe CIN lesions lead to higher maximum IBSL; longer durations of acetowhitening lead to increasingly delayed exponential decay of IBSL curve. To compare with histological examination, MIS colposcopy had a 1.7% false-diagnostic rate, while PAP test and conventional colposcopy had 24.4% and 22% false-diagnostic rates, respectively. A triple exponential function created a "pseudocolor" image that comprised the grade map of the lesion, and this is frequently representative of the duration/degree of the induced alterations. CONCLUSION: Improved diagnostic information can be gained by recording the optical information in a narrow spectral range with high spatial resolution. MIS colposcopy can be used in the diagnosis of uterine cervix pathological conditions and in the differentiation between CIN lesions.

Acetic Acid↗
PubMed2003

Results of a randomized trial on the management of cytology interpretations of atypical squamous cells of undetermined significance.

OBJECTIVE: This study was undertaken to compare alternative strategies for the initial management of a cytologic diagnosis of atypical squamous cells of undetermined significance (ASCUS). STUDY DESIGN: A total of 3488 women with a community-based ASCUS interpretation were randomly assigned to immediate colposcopy, triage that was based on enrollment HPV DNA testing and liquid-based cytology at a colposcopy referral threshold of high-grade squamous intraepithelial lesion (HSIL), or conservative management based on repeat cytology at a referral threshold of HSIL. All arms included 2 years of semiannual follow-up and colposcopy at exit. Loop electrosurgical excision procedure was offered to women with histologic diagnoses of cervical intraepithelial neoplasia (CIN) grade 2 or 3 at any visit or persistent CIN grade 1 at exit. The study end point was 2-year cumulative diagnosis of CIN grade 3. RESULTS: The 2-year cumulative diagnosis of CIN grade 3 was 8% to 9% in all study arms. The immediate colposcopy strategy yielded 53.6% sensitivity for cumulative cases of CIN grade 3 diagnosed over 2 years. The human papillomavirus (HPV) triage strategy referred 55.6% of women and detected 72.3% of cumulative cases of CIN grade 3. A conservative management strategy of repeat cytology at the HSIL threshold referred 12.3% of women while detecting 54.6% of cumulative CIN grade 3. To compare triage tests, we re-estimated the performance of HPV and cytology in successfully referring women with underlying CIN grade 3 (ie, ignoring the insensitivity we discovered in colposcopically directed biopsies). A single enrollment HPV test identified 92.4% of the women diagnosed with CIN grade 3. Serial cytology, even at an ASCUS threshold, would have required two visits to achieve similar sensitivity (95.4%) and would have referred 67.1% to colposcopy. CONCLUSION: HPV triage is at least as sensitive as immediate colposcopy for detecting CIN grade 3 and refers about half as many women to colposcopy. Follow-up that used repeat cytology is sensitive at an ASCUS referral threshold but requires two follow-up visits and ultimately more colposcopic examinations than HPV triage.

Adolescent↗
PubMedDate not supplied

Can precolposcopy education increase knowledge and decrease anxiety?

OBJECTIVE: To investigate the impact of an educational intervention on knowledge and anxiety level of women scheduled for colposcopy after an abnormal Papanicolaou (Pap) test. DESIGN: Experimental, randomized controlled study. SETTING: An inner-city medical school. PARTICIPANTS: The final sample consisted of 58 women in the intervention group and 55 women in the control group. Exclusion criteria included any previous colposcopy. INTERVENTIONS: The women in the intervention group received in the mail, approximately 1 week before their appointment, a one-page handout about colposcopy. The control group received no mailed handout. After arriving for the visit, women were asked to participate in the study and then were interviewed. MAIN OUTCOME MEASURES: Knowledge of reason for visit and knowledge of colposcopy as measured by content analysis of interview; and anxiety as measured by the Spielberger State/Trait Anxiety Inventory. RESULTS: Women in the intervention group demonstrated significantly more knowledge about the reason for their visit and about colposcopy than did the other women. No significant difference in mean anxiety score was found between the groups. CONCLUSIONS: The intervention increased knowledge about colposcopy for this population. Because patient education is an essential nursing function, these results are encouraging. This intervention can be replicated by nurses in other settings. Further research is necessary to understand how nurses can best help women alleviate anxiety before colposcopy.

Adaptation, Psychological↗
PubMed2004

[Endocervical curretage: an analysis of results in 1997 women].

OBJECTIVE: To study the value of endocervical curettage (ECC) in the detection of cervical intraepithelial neoplasia (CIN) and cervical cancer, and the necessity of ECC during colposcopic examination. METHODS: In the high prevalent area of cervical cancer in Shanxi Province, China, a total of 1997 women aged 35 approximately 45 years old were enrolled. Cervical cytology, colposcopy and targeted multiple biopsies, as well as ECC were performed for all women. RESULTS: Among the 1997 women received ECC, 31 was positive for abnormal histologic changes with a frequency of 1.6%. Of the 31 cases, 9 had low grade squamous intraepithelial lesions (LSIL, 0.5%), 20 had high grade squamous intraepithelial lesions (HSIL, 1.0%), and 2 had squamous-cell carcinoma. No pathologic diagnosis could be made in 131 women because the tissue curretaged was insufficient. The women with positive cytologic findings had higher frequency (5.3%) of abnormal ECC than those with negative cytologic findings (0.3%). There was positive correlation between the frequency of abnormal ECC and the grade of cytolologic findings. Abnormal ECC was present in 9.1% of those with unsatisfactory colposcopy while 1.3% of those with satisfactory colposcopy (P < 0.01). The frequency of abnormal ECC was 0.6% in patients with negative colpocopy, 0.9% in LSIL and 24.1% in HSIL. Frequency of abnormal ECC in women with a negative colposcopy or LSIL was significantly lower than that with HSIL. The positive rate of ECC pathologically verified was 3.3% in LSIL, 22.2% in HSIL and 50.0% in squamous carcinoma, respectively (P < 0.01). Of the 316 patients with positive cytology but negative colposcopy, ECC was abnormal in 8 (2.5%), of which HSIL cytologically verified was in 3. CONCLUSION: If cytology or colposcopy shows HSIL or more severe changes, and cytology is positive while colposcopy is unsatisfactory, ECC should be done routinely.

Adult↗
PubMed2006

Management of histologic abnormalities of the cervix.

The American Society for Colposcopy and Cervical Pathology sponsored a consensus conference in 2001 to develop evidence-based guidelines for women with histologic abnormalities of the cervix. The options for management of cervical intraepithelial neoplasia 1, 2, and 3 are ranked according to the strength of the recommendation and the quality of the evidence. Follow-up with repeat cytology at six and 12 months or DNA testing for high-risk types of human papillomavirus at 12 months is the preferred management approach for women with cervical intraepithelial neoplasia 1 and satisfactory initial colposcopy. If results from repeat cytology are reported as atypical squamous cells of undetermined significance or greater, or if DNA human papillomavirus testing is positive for oncogenic types of the virus, repeat colposcopy is preferred. When the initial colposcopy is unsatisfactory, a diagnostic excisional procedure is preferred. Follow-up without treatment is acceptable only in women who are pregnant and adolescents with cervical intraepithelial neoplasia 1 who had unsatisfactory colposcopy. Biopsy-confirmed cervical intraepithelial neoplasia 2 and 3 requires treatment except during pregnancy and in compliant adolescents with cervical intraepithelial neoplasia 2 and negative endocervical curettage. When colposcopy is satisfactory, treatment includes ablative or excisional procedures. A diagnostic excisional procedure is recommended in women with biopsy-confirmed cervical intraepithelial neoplasia 2 or 3 and unsatisfactory colposcopy.

Algorithms↗
PubMed2003

Psychological effects women experience before and after a colposcopic examination and primary care appointment.

OBJECTIVE.: To estimate the psychological impact, health and behavior concerns, and coping styles of women awaiting colposcopic examination compared with women awaiting a scheduled primary care appointment. MATERIALS AND METHODS.: A convenience sample of 150 women presenting for a scheduled colposcopy examination and 201 women scheduled for a primary care appointment were assessed for demographic status, depression (Center for Epidemiologic Studies/Depressed Mood Scale), anxiety, health beliefs and concerns, and coping style (Miller Behavioral Style Score). Subjects also completed a postexamination questionnaire. Mean responses were compared using Wilcoxon rank sum test. RESULTS.: Mean anxiety scores were considered "mild" and equivalent for women in the two groups. Although the colposcopy group had a significantly greater mean depression score (36.3) compared with the noncolposcopy group (33.4, p = .03, Wilcoxon test), both mean scores indicated mild depression. Women undergoing colposcopy reported greater mean scores for concern about their disease, the procedure, and potential consequences (p < .01, Wilcoxon test). CONCLUSION.: Women scheduled for colposcopy have a similar level of mild anxiety and mild depression as women scheduled for a primary care appointment. Consequently, universal, instead of selective, use of anxiolytic agents before colposcopy appears unjustified. Avoidance of triage to colposcopy for atypical squamous cells of undetermined significance Pap smear results may be unwarranted based on concerns for causing excessive anxiety. In fact, colposcopy provides substantial reassurance.

Journal Article↗
PubMedDate not supplied

Women's triage and management preferences for cervical cytologic reports demonstrating atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesions.

OBJECTIVE: To determine women's triage test preferences for the evaluation and management of atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesion (LSIL) Papanicolaou smear reports. DESIGN: A 35-item questionnaire. SETTINGS: Primary care clinic waiting rooms. PARTICIPANTS: A convenience sample of 968 women. INTERVENTION: Women received standardized descriptions of the meaning of ASCUS and LSIL Papanicolaou smear classifications and uniform descriptions of the 4 triage tests: Papanicolaou smear, human papillomavirus DNA test, cervicography, and colposcopy. MAIN OUTCOME MEASURES: Subjects' responses to questionnaire. RESULTS: More women (58.4%) preferred a repeat Papanicolaou smear for an ASCUS report than would choose human papillomavirus DNA testing (7.3%), cervicography (20.6%), or colposcopy (13.8%) (P < .001, chi 2). Alternatively, 51% of women wanted colposcopy to evaluate an LSIL report compared with the other 3 options (P < .001, chi 2). Test accuracy was the most important factor that influenced women's decisions for each test, compared with cost, discomfort, and other reasons (P < .001, chi 2). Positive predictors for women's selection of colposcopy to evaluate a Papanicolaou smear showing LSIL included older age (P < .01, logistic regression analysis), higher level of income (P < .001, chi 2), greater level of education (P < .001, logistic regression analysis), greater level of knowledge of colposcopy and Papanicolaou smears (P < .001, logistic regression analysis), family history of cervical cancer (P < .01, chi 2), and history of cervical dysplasia (P = .02, chi 2). CONCLUSIONS: Most women preferred a repeat Papanicolaou smear to further evaluate an initial Papanicolaou smear demonstrating ASCUS and colposcopy to evaluate a report of LSIL. Women identified test accuracy as the most important reason for triage test selection. Multiple factors, primarily involving patient and family history of cervical neoplasia, level of education, income, age, and knowledge of tests, influence women's desire for specific triage tests. Because no optimal management of women with ASCUS and LSIL Papanicolaou smear reports has been determined, consideration of women's triage test preferences should complement overall patient care.

Adult↗
PubMed2000

Self-reported desire to improve colposcopic impressions.

BACKGROUND: Women who participate in cervical cancer screening programs must have access to high quality colposcopy services when their cytology test are abnormal. The purpose of this project is to evaluate colposcopic services currently available in New Hampshire and whether colposcopy providers are willing to network to maintain and improve their colposcopic pattern recognition skills in order to improve their colposcopic correlations. METHODS: A survey was mailed to 1314 providers throughout New Hampshire. The survey ascertained the extent of current colposcopic services in New Hampshire through practitioner and practice demographics, the cervical procedures performed, the self-reported colposcopy skill level, and the self-reported quality of past colposcopic education. It also measured interest in networking with others to improve their colposcopic pattern recognition skills. RESULTS: The survey response rate was 62%. 145 of the 810 respondents (18%) are currently performing colposcopies, indicating a statewide potential colposcopy accommodation rate of 3.5 to 7 women per month per colposcopist. 57% of the physician assistants, 59% of the family physicians, 75% of the gynecologists and 100% of the nurse practitioners were interested in enhancing their colposcopic pattern recognition skills by networking through quarterly meetings. CONCLUSIONS: The crude accommodation rate for colposcopy appears sufficient for the women of New Hampshire although the geographic distribution of the colposcopists is unknown. A majority of the colposcopists were interested in networking to improve their colposcopic pattern recognition skills, which could improve patient care.

Clinical Competence↗
PubMed1986

Cervical intraepithelial neoplasia and condyloma: an analysis of diagnostic accuracy of posttreatment follow-up methods.

The appropriate follow-up method of patients treated for cervical intraepithelial neoplasia and condyloma is controversial. One school of thought favors cytologic testing alone, whereas the other favors cytologic testing combined with colposcopy. We have analyzed the records of 750 patients treated for cervical intraepithelial neoplasia or condyloma or both in our Colposcopy Clinic. Cytologic testing, colposcopy, and histologic examination were done routinely at 3 to 4, 6 to 8, and 12 to 15 months after treatment of the above conditions in 750 patients. Totals of 95% and 5% of all 128 persistent lesions were detected by histologic examination at the first (3 to 4 months) and second (6 to 8 months) posttreatment visits, respectively. The combined false negative rates for both visits were 23% for cytologic testing, 8% for colposcopy, and 5% for histologic examination. False negative rates at first visits were 1.5% for colposcopy combined with cytologic testing. These observations suggest that colposcopy and, if appropriate, histologic examination significantly contribute to cytologic testing for diagnosing the majority of persistent disease during the first posttreatment visit. Cytologic testing alone seems to be sufficient for the subsequent follow-up of patients treated for cervical intraepithelial neoplasia and/or condyloma.

Biopsy↗