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PubMed2002

Cost-effectiveness of alternative triage strategies for atypical squamous cells of undetermined significance.

CONTEXT: Every year approximately 2 million US women are diagnosed as having a cervical cytological result of atypical squamous cells of undetermined significance (ASC-US). OBJECTIVE: To determine the most efficient and cost-effective management strategy for women in the United States diagnosed as having ASC-US. DESIGN AND SETTING: Cost-effectiveness analysis of data from clinical trials, prospective studies, and other published literature. A computer-based model was used to compare 4 management strategies for a cytological result of ASC-US: immediate colposcopy; human papillomavirus (HPV) triage, which includes colposcopy if high-risk HPV types are detected; repeat cytology, which includes follow-up cytology at 6 and 12 months and referral for colposcopy if a repeat abnormal result occurs; and reclassifying ASC-US as normal in which a cytological result of ASC-US is ignored. Reflex HPV DNA testing uses either residual liquid-based cytological specimens or samples co-collected at the time of the initial screening for conventional cytology. Another method, referred to as the 2-visit HPV DNA triage, requires a woman with an ASC-US result to return within 1 month to provide another speciman sample. MAIN OUTCOME MEASURES: Years of life saved (YLS), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. RESULTS: The least costly strategy for biennial screening was to reclassify ASC-US as normal, resulting in a reduction in total cancer incidence of 75% for conventional cytology and 84% for liquid-based cytology compared with no screening. The next least costly strategy was HPV DNA testing resulting in a reduction in total cancer incidence of 86% for conventional cytology and 90% for liquid-based cytology, followed by immediate colposcopy with a reduction of 87% and 91%, respectively. Compared with reflex HPV DNA testing, a strategy of repeat cervical cytology or delayed HPV testing costs more but is less effective. When all strategies were compared simultaneously, varying frequency and type of cytological test, biennial (vs every 3 years) liquid-based cytology with reflex HPV testing had a cost of $174 200 per YLS. In a similar comparison, liquid-based cytology with reflex HPV testing conducted every 3 years (vs every 5 years) had a cost of $59 600 per YLS and was more effective and less costly than a strategy of conventional cytology incorporating repeat cytology or immediate colposcopy conducted biennially. CONCLUSION: Reflex HPV DNA testing provides the same or greater life expectancy benefits and is more cost-effective than other management strategies for women diagnosed as having ASC-US.

Colposcopy↗
PubMed2002

Evaluation of human papillomavirus testing in primary screening for cervical abnormalities: comparison of sensitivity, specificity, and frequency of referral.

CONTEXT: Human papillomavirus (HPV) DNA testing of women having Papanicolaou (Pap) smears showing atypical squamous cells of undetermined significance (ASCUS) has clinical usefulness. Whether HPV DNA testing alone is useful in primary screening remains to be determined. OBJECTIVE: To determine the accuracy of HPV DNA testing for detecting cervical intraepithelial neoplasia (CIN) grade 3 or cancer (the criterion standard). DESIGN, SETTING, AND PARTICIPANTS: Between December 1997 and October 2000, 4075 women who attended Planned Parenthood clinics in Washington State were screened simultaneously using thin-layer Pap and HPV DNA testing by a polymerase chain reaction (PCR)-based method and by a liquid-based RNA-DNA hybridization capture with signal amplification assay (signal amplification). Women who were positive for high-risk HPV types, or had Pap results of ASCUS or higher, were considered to have positive screening test results and were referred for colposcopy and biopsy. Additionally, a random sample of women with negative screening test results was referred for colposcopy. Based on individual and combined thin-layer Pap, HPV PCR, and HPV signal amplification test results from the screening and the colposcopy visits, 7 colposcopy triage strategies were defined and evaluated. MAIN OUTCOME MEASURE: Sensitivity and specificity for detecting cervical lesions graded CIN 3 or higher for each of the 7 triage strategies. RESULTS: The estimated prevalence of CIN 3 or higher was 3.2%. The sensitivity (95% confidence interval) of thin-layer Pap (with a result of > or = ASCUS) for identifying women with CIN 3 or higher was only 61.3% (48.5%-70.9%) compared with 88.2% (78.9%-93.8%) for HPV testing by PCR and 90.8% (83.1%-95.8%) by signal amplification. Differences in specificities were also observed: 82.4% (81.8%-83.1%) for thin-layer Pap (with a result of > or = ASCUS), 78.8% (77.9%-79.7%) for PCR, and 72.6% (69.4%-75.0%) for signal amplification. Compared with referral for colposcopy of all women with ASCUS or higher, signal amplification testing of women with ASCUS and referral of those with a positive result was about as sensitive (61.3% vs 60.3%, respectively) and significantly more specific (82.4% vs 88.9%, respectively). The strategy requiring repeat positive PCR tests on 2 visits had a sensitivity of 84.2% (75.3%-91.0%) and a specificity of 86.2% (85.1%-87.3%). All tests were more specific and less sensitive in older (> or = 30 years) vs younger women. CONCLUSIONS: Testing for HPV has higher sensitivity but lower specificity than thin-layer Pap screening. In some settings, particularly where screening intervals are long or haphazard, screening for HPV DNA may be a reasonable alternative to cytology-based screening of reproductive-age women.

Adult↗
PubMed2005

HPV DNA testing in the triage of atypical squamous cells of undetermined significance (ASCUS): cost comparison of two methods.

Human papillomavirus (HPV) DNA testing for triage of cervical cytologies showing atypical squamous cells of undetermined significance (ASCUS) has become the standard of practice. Currently, Hybrid Capture II (HCII) is the preferred method for ASCUS triage. In situ hybridization for HPV represents an alternative to HCII and appears to have a superior specificity but is more expensive. We compare the reimbursement rates of ASCUS triage (HPV high risk) using the methods of HCII and INFORM (in situ hybridization for HPV) in a series of 431 ASCUS patients. The patients were followed for 1 yr, during which each patient had either colposcopic biopsy or follow-up cervical cytology after ASCUS HPV DNA triage. Eighty-nine patients were excluded from the analysis because of incomplete follow-up. The HPV triage percentages, colposcopic biopsy positivity rates and cervical cytology positivity percentages were calculated for each method. The reimbursement rates of the tests/procedures used in the analysis were those in effect at the University of Utah in 2003. The total triage and follow-up reimbursement costs were calculated for HCII and INFORM and compared.HCII referred 19.9% of patients to colposcopy, with a biopsy positivity rate of 25.6% for dysplasia. INFORM referred 11.8% of patients to colposcopy, of whom 34% had a biopsy diagnosis of dysplasia. HCII negative cases revealed 19% to have ASCUS or higher on the follow-up cervical cytology, while 19.9% of INFORM negative cases had a reading of ASCUS or higher at follow-up cytologic examination. The 1-yr HPV DNA triage and follow-up reimbursements for HCII were 316,942.00 US dollars per 1,000 women, and for the INFORM methodology, the reimbursements were 369,484.00 US dollars per 1,000 women. The INFORM method was associated with higher specificity and sent fewer (41%) patients to colposcopy than did HCII. Although this smaller referral rate reduced reimbursement costs associated with colposcopy, the increased reimbursement paid for follow-up cytologies and office visits of HPV DNA negative patient and the greater cost of the INFORM test results in higher overall reimbursement for INFORM. Based on these costs and diagnostic accuracies, it appears that the INFORM HPV technology represents a viable option to HCII ASCUS triage. INFORM HPV appears to be 16% more expensive than HCII but has the advantage of sending 41% fewer women to colposcopy.

Adolescent↗
PubMed2006

HPV DNA patterns and disease implications in the follow-up of patients treated for HPV16 high-grade carcinoma in situ.

Twenty-five patients with high-grade cervical lesions associated with HPV16 infection were studied at the time of surgical treatment and followed up after conization. Before surgical treatment, the following parameters were analyzed: (1) physical status of HPV16 DNA, (2) viral load, (3) cytological presentation confirmed by histological diagnosis, and (4) colposcopy. At the time of conization, (5) margin presentation, and (6) cone biopsy were evaluated. At each stage of the follow-up (7) physical status of HPV16 DNA, (8) viral load, (9) cytological test, and (10) colposcopy were repeated. The correlation between the different parameters was examined. Significant differences in the viral loads were observed between integrated and episomal forms and between the coexisting integrated/episomal forms and the only episomal form, while no statistically significant differences were observed between integrated and coexisting forms. At the first stage of follow-up, 11 of 25 patients analyzed (44%) were negative to HPV DNA cytology and colposcopy tests, 13 of the 25 (52%) were HPV16 DNA negative, 17 (68%) cytology negative, and 20 (80%) colposcopy negative. At the closing stage, 15 of 25 subjects (60%) were negative to all three tests, 16 of the 25 (64%) were HPV16 DNA negative, 19 (76%) cytology negative, and 20 colposcopy negative (80%). These observations suggest that in surgery treated patients the viral clearance at the closing stage of follow-up was unrelated to the HPV DNA physical status and to the viral load before treatment, but was associated significantly with the effectiveness of surgery treatment, in particular with margin cone presentation.

Adult↗
PubMed1995

Comparison of the effects of different menstrual tampons on the vaginal epithelium: a randomised clinical trial.

The effects on the vaginal epithelium of three different menstrual tampons in normal conditions of use were studied in 41 women during the menstrual period. The vaginal epithelium was studied in a total of 123 cycles at a structural and ultra-structural level with colposcopy, vaginal smear and biopsy on TEM and SEM. One of the three tampons studied showed a lower level of abnormalities on colposcopy (36.6% vs. 56.1% vs. 68.3%), with an inverse correlation between the severity of the dryness and the quantity of blood absorbed by the tampon (4.2 g when the colposcopy was normal vs. 1.8 g in case of severe dryness). Cytology is not a good test for assessing the effects of tampons because of the high rate of acellular and uninterpretable samplings. The biopsy effects were defined according to their depth in the epithelium. The same tampon showed the lowest level in biopsy abnormalities. No correlation was found between severity of the colposcopy and biopsy results. Colposcopy can demonstrate the degree of severity of dryness or any other effect, but biopsy only confirms the effect and does not correlate the degree of severity. Materials and designs of tampons can play a role in reducing the drying effects to the vaginal epithelium.

Adolescent↗
PubMed1986

Predictive value of a positive endocervical curettage in diagnosis and treatment of CIN.

Predictive values of endocervical curettage (ECC) in the investigation of patients with abnormal Pap-smears were calculated with regard to a second histological diagnosis and with regard to results of conservative treatment of CIN. By using the combined follow up data of all 290 patients with colposcopically directed biopsies and ECC, the predictive value of a positive ECC for invasive cancer in patients with satisfactory colposcopy was 2%, and for unsatisfactory colposcopy 15%. Predictive value of a negative ECC was 100% in patients with satisfactory colposcopy, and 98% for unsatisfactory colposcopy. It is concluded that ECC should be used routinely in the investigation of patients with abnormal Pap smears. However, a positive ECC is not considered an absolute contraindication to conservative treatment, provided that colposcopy is satisfactory, that there is no suspicion of invasive cancer, and that a strict follow-up scheme can be maintained during the first year.

Biopsy↗
PubMed1993

Decision analysis for best management of mildly dyskaryotic smear.

Should a woman with a mildly dyskaryotic cervical smear be referred for colposcopy or should the smear be repeated? One way to answer this question is to use decision analysis and compare the expected mortality and cost of each policy. Data for each component of the question were obtained from published work worldwide and were supplemented with an audit of mildly dyskaryotic smears in West Yorkshire, UK. 2 out of 1000 women with an initial mildly dyskaryotic smear will develop cancer if a conservative repeat smear policy is adopted in association with five-yearly cervical screening. This number can be reduced to 1.6 per 1000 if cervical screening is offered every three years. A policy of immediate referral for colposcopy is also associated with a subsequent cancer rate of 1.6 per 1000. Therefore, repeating the smear is almost as effective as an immediate referral to a colposcopy unit. Even if a five-yearly cervical screening programme is adopted, 2500 women with a mildly dyskaryotic smear will need to be referred for immediate colposcopy to save 1 additional cancer. A conservative policy is not financially cheaper: an average of six additional smears is required to save each colposcopy referral. Sensitivity analysis shows that the excess cost of the conservative policy increases exponentially as the risk of a subsequent cytological abnormality exceeds 60%. Local cytopathology laboratories should audit their recurrent dyskaryosis rate associated with borderline, mild, and moderate dyskaryosis before accepting the U-turn in the national recommendations.

Colposcopy↗
PubMed2004

Optical detection of high-grade cervical intraepithelial neoplasia in vivo: results of a 604-patient study.

OBJECTIVE: The purpose of this study was to assess the in vivo optical detection of high-grade cervical intraepithelial neoplasia (2/3+) on the whole cervix with a noncontact, spectroscopic device. STUDY DESIGN: Cervical scanning devices collected intrinsic fluorescence and broadband white light spectra and video images from 604 women during routine colposcopy examinations at 6 clinical centers. A statistically significant dataset was developed of intrinsic fluorescence and white light-induced cervical tissue spectra that was correlated to expert histopathologic determination. On the basis of a retrospective analysis of the acquired data, a classification algorithm was developed, validated, and optimized. RESULTS: Intrinsic fluorescence, backscattered white light, and video imaging each contribute complementary information to diagnostic algorithms for high-grade cervical neoplasia. More than 10000 measurements that were made on colposcopically identified tissue from >500 subjects were the basis for algorithm training and testing. Algorithm performance demonstrated a sensitivity of approximately 90%. This performance was confirmed by various training methods. With the use of a multivariate classification algorithm, optical detection is predicted to detect 33% more high-grade cervical intraepithelial neoplasia (2/3+) than colposcopy alone. CONCLUSION: Full cervix optical interrogation for the detection of high-grade cervical intraepithelial neoplasia is feasible and appears capable of detecting more high-grade cervical intraepithelial neoplasia than colposcopy alone. With the use of this classification algorithm, a multisite, randomized controlled trial is underway that compares the combination of optical detection and colposcopy versus colposcopy alone.

Adolescent↗
PubMed2004

A comparison of techniques to assess cervicovaginal irritation and evaluation of the variability between two observers.

BACKGROUND: Colposcopy is used to evaluate effects of new vaginal products on cervicovaginal epithelium as part of the US Food and Drug Administration-mandated product approval process, yet few aspects of its use have been investigated. OBJECTIVES: To determine the effect of the colposcopic examination itself on the number and type of findings seen, to compare colposcopy with the AviScope hand-held device and the naked eye and to compare the findings reported by two examiners during a single visit. STUDY DESIGN: Fourteen healthy women volunteered for five paired examinations in random order: (1) naked eye inspection plus colposcopy done twice by a single examiner; (2) naked eye inspection plus AviScope examination, then naked eye inspection plus colposcopy by a single examiner; (3) Examination 2 repeated with the order of device reversed; (4) naked eye inspection plus colposcopy done by two examiners; (5) Examination 4 repeated with the order of examiner reversed. The colposcopic examinations were done per published standards but were limited to the areas visible without manipulation of the speculum. RESULTS: Length of colposcopic examination averaged 7 min. The number of colposcopic findings found when the examination was done twice by the same clinician was not statistically different (p = 0.12), suggesting that the examination itself did not induce findings. More findings were seen using magnification than naked eye. A similar number of findings were seen by AviScope compared to the colposcope (p = 0.99), but clinically significant findings were "undercalled" or "overcalled" by the AviScope. A weighted kappa score of the "worst" colposcopic finding was 0.32 (SE 0.10, p = 0.00), indicating moderate agreement between examiners. CONCLUSIONS: The colposcopic examination is not burdensome nor does it induce findings. If naked eye observation were used alone in practice, these data suggest that half the colposcopically detected findings would be missed. Using the naked eye observation for screening would minimally reduce the number of magnified observations carried out. For detecting epithelial changes, the colposcope seems to be the most sensitive technique, followed by the AviScope.

Adult↗
PubMed1988

Colposcopic evaluation of men with genital warts.

Colposcopy, which is the examination of the female genital tract that generally is performed after the application of acetic acid, has been an effective tool in the diagnosis of genital warts (condyloma acuminatum) in women for years. With the help of colposcopy, both microscopic and flat warts that cannot be visualized with traditional, noncolposcopic methods can be seen and, hence, treated. Recently, studies reported in the gynecologic and urologic literature have evaluated the usefulness of colposcopy in male patients. We present a patient whose genital warts were recalcitrant to treatment. When examined with colposcopy he was noted to have multiple additional areas of involvement. In view of the neoplastic potential of the human papillomavirus, the ease with which it is transmitted sexually, and the difficulty in discerning certain kinds of warts without colposcopy, we believe colposcopic examination should be routine in all men with genital warts and in those whose sexual partners have tested positive for human papillomavirus.

Adult↗
PubMed1998

Comparison of the risks of cytologic surveillance of women with atypical cells or low-grade abnormalities on cervical smear: review of the literature.

Minor cytological abnormalities--low-grade squamous intraepithelial lesions (LGSIL) and atypical squamous cells of undetermined significance (ASCUS)--are the most frequent abnormalities observed in smears performed in screening for cervical cancer. Surveillance through repeated smears has been proposed as an alternative to immediate colposcopy to reduce cost and avoid overloading colposcopy clinics. The aim of this review is to discuss the advantages and inconveniences of cytological surveillance of women with ASCUS or LGSIL, as reported in the literature. Cervical smears are not sufficient to establish the precise diagnosis of a lesion. In fact, the mean prevalence of normal cervices, high-grade CINs and cancers is estimated to be 58%, 7% and 0.5% for ASCUS and 34%, 27% and 0.2% for LGSIL. Cytological surveillance shows that minor cytological abnormalities regress in 28-69% of cases. In 6-9%, cytological regression masks a high-grade CIN, and a cancer may develop sooner or later in 0.30-1.12% of cases. Cancers often occur in patients temporarily lost to surveillance or in those with normal smears alternating with smears showing minor abnormalities. Strict modalities of surveillance are therefore required. The surveillance has to be carried out with smears repeated every 4-6 months for 2 years. If all smears are normal the regular screening at 3-year intervals may be resumed. On the other hand, an immediate colposcopy is recommended if a new abnormality is observed in these consecutive smears, regardless of its severity and of the time elapsed since the initial abnormality was discovered. With these recommendations in mind, cytological surveillance may slightly reduce the number of colposcopies but without reducing significantly the cost. At present, no arguments based on cost or efficacy clearly favour cytological surveillance over immediate colposcopy.

Cervix Uteri↗
PubMed1998

Cervical dysplasia and human immunodeficiency virus infection in women: prevalence and associated factors. Groupe d'Epidémiologie Clinique du SIDA en Aquitaine (GESCA).

OBJECTIVE: To study the prevalence of Cervical Intraepithelial Neoplasia (CIN) and its association with HIV-I infection, controlling for other risk factors of CIN. DESIGN: Cross-sectional survey. SUBJECTS AND METHODS: HIV-1 seropositive (HIV+) and seronegative (HIV-) women were enrolled at the Obstetrics-Gynecologic Departments of the Bordeaux University Hospital from April 1993 to June 1995. A gynecologic check-up was performed with a clinical examination, a colposcopy and a Papanicolaou smear. Sexually Transmitted Diseases (STDs) were screened. Colposcopy was interpreted as: normal, low-grade or high-grade lesions. Interpretation of Papanicolaou smears was based on the 1988 Bethesda system using three descriptive diagnoses: normal, low-grade and high-grade Squamous Intraepithelial lesions (SILs). If colposcopy showed a high grade lesion or Papanicolaou smear a high-grade SIL, a cervical biopsy was performed. Absence of CIN was defined by normal Papanicolaou smear and colposcopy. High grade CIN was defined by either identification of high grade SIL on Papanicolaou smear or high grade lesion on colposcopy confirmed by CIN2-3 lesion on biopsy. Other cases were classified as low-grade CIN. HPV infection was diagnosed on presence of koilocytosis on cytological or histological specimens. RESULTS: Prevalence of CIN was significantly higher in the 128 HIV+ women than in the 102 HIV- women: 34.4% vs. 13.7% (O.R.=3.30). Among HIV+ women, 25.8% had low-grade CIN and 8.6% high-grade CIN versus 10.8% and 2.9%, respectively among the HIV- women. Prevalence of HPV infection was 50.0% among women with CIN vs. 5.8% in women without CIN (P= 10(-6)). In the multivariate analysis of the determinants of CIN, smoking more than ten pack-years and HPV infection were the only two variables associated with CIN while association with HIV infection disappeared. Among HIV+ women, the variables associated with CIN were clinical AIDS and HPV infection.

Acquired Immunodeficiency Syndrome↗
PubMed2004

The relationship between atypical glandular cells of undetermined significance on Pap smear and a clinically significant histologic diagnosis.

OBJECTIVE: To determine whether the cytologic diagnosis of atypical glandular cells of undetermined significance (AGUS) on Pap smear was associated with a clinically significant histologic diagnosis. METHODS: A retrospective cohort study was performed on the charts of women diagnosed with AGUS on Pap smear in 2 referral colposcopy clinics, between January 1999 and July 2002. The factors considered included age, menstrual status, use of birth control pills or hormone replacement therapy, parity, referral Pap, type of evaluation at colposcopy, histologic diagnosis, and final diagnosis at pathology. RESULTS: Of the 124 women with a referral diagnosis of AGUS, 41 (33.1%) had significant histology at colposcopy. Premenopausal and nulliparous women were more likely to have a significant histologic diagnosis. The categories of "favour neoplastic" and "favour reactive" were not predictive of significant histology. Menopausal status was not predictive of either endometrial or endocervical disease among serious lesions. CONCLUSIONS: Because almost one-third of women with the finding of AGUS on Pap smear will have a diagnosis at the time of colposcopy that requires treatment, a colposcopy and endocervical curettage should be recommended to all women with AGUS. The new designation of "atypical glandular cells" (AGC) under the 2001 Bethesda classification system is appropriate, as "favour reactive" and "favour neoplastic" are not predictive of serious histologic findings.

Adenocarcinoma↗
PubMed2000

An alternative approach to the management dilemma of the mildly dyskaryotic smear based on audit of outcome.

We describe a study which takes an alternative approach to the management dilemma of the mildly dyskaryotic cervical smear. Two hundred and fifty women with a smear showing mild dyskaryosis were studied by auditing the clinical outcome as well as the cost. The cost of providing the colposcopy services during the index year was approximately pounds sterling 70000 for an average size district general Hospital. The proportion of women managed by the current guidelines and avoiding colposcopy after a first mildly dyskaryotic smear was only 30%. The majority of patients will eventually have colposcopy despite a policy of cytological surveillance. The alternative approach, to offer colposcopy immediately after the first mildly dyskaryotic smear, would result in a small increase in cost for our unit, equivalent to one extra colposcopy patient per week.

Colposcopy↗
PubMed1983

Contribution of endocervical curettage in evaluating abnormal cervical cytology.

A review of 540 patients evaluated by the Gynecologic Colposcopy Clinic for abnormal cervical cytology revealed that 372 (68.9%) had cervical intraepithelial neoplasia (CIN), microinvasive carcinoma, or frank invasive carcinoma. The repeat cytologic smear taken before biopsy was falsely negative in 26.4%. An endocervical curettage was obtained in 52.5% of patients with an adequate colposcopy who had a neo-plastic lesion and was positive in 17.9% of those sampled, including six patients with no lesion found on the ectocervix. An endocervical curettage was obtained in 88.5% of patients with an inadequate colposcopy who had a neoplastic lesion, and was positive in 48.7%. All patients with an inadequate colposcopy not having an endocervical curettage underwent conization of the cervix. Twelve patients (2.2%) were ultimately found to have invasive or microinvasive carcinoma. A positive endocervical curettage and an inadequate colposcopy were both correlated with a final diagnosis of invasion. The contribution of endocervical curettage to the outpatient work-up of abnormal cervical cytology is substantial and it should be performed in all patients in whom cone biopsy is not planned.

Adenocarcinoma↗
PubMed1997

Video colpography: a new technique for secondary cervical screening.

OBJECTIVE: To assess the diagnostic accuracy of a new technique of cervical imaging and to consider its potential as a secondary cervical screening method. DESIGN: A prospective cross-sectional study with each case acting as its own control, comparing video colpography with colposcopy. SETTING: University of Birmingham colposcopy clinics, City Hospital and Birmingham Women's Hospital. PARTICIPANTS: Fifty women referred for colposcopy. INTERVENTIONS: The women had a video colpogram recording made prior to colposcopy. MAIN OUTCOME MEASURES: The proportion of technically suitable colpograms obtained and the level of agreement between colposcopist and video screener. RESULTS: The images were satisfactory or good in 94% cases, and there was a very high level of agreement between colposcopist and video screener (kappa = 0.79). If the technique had been used in a primary health care setting as a secondary screening method for women with low grade cervical smear abnormalities, 61% would have avoided referral for colposcopy. CONCLUSIONS: Video colpography is an accurate, portable and quick method of cervical imaging. It combines the simplicity of a video camera with the versatility of computerised digital imaging and has great potential in the fields of teaching, audit and screening of low grade smear abnormalities.

Colposcopy↗
PubMed1997

A study of treatment failures following large loop excision of the transformation zone for the treatment of cervical intraepithelial neoplasia.

OBJECTIVE: To examine the long term efficacy of large loop excision of the transformation zone (LLETZ) in the treatment of cervical intraepithelial neoplasia (CIN) and to evaluate the relative diagnostic merits of colposcopy and cytology in the follow up of these women. DESIGN: A retrospective examination of cytology, colposcopy and histology records of the first 1000 women treated with LLETZ in Aberdeen from 1989 to 1991. SETTING: Colposcopy Clinic Aberdeen Royal Infirmary, Grampian Region, Scotland. RESULTS: Nine hundred and seventy-seven women (97.7%) were seen for follow up at least once and 317 were followed for as long as four years. This comprises 2812 woman years of follow up. The incidence of recurrent CIN was 27/1000 woman years and the cumulative rate of recurrence at four years was 10.1 per 100 women. Twenty-eight of the 59 women (47%) with abnormal colposcopy and proven CIN had a concurrent smear that did not show dyskaryosis. CONCLUSIONS: LLETZ is an effective from of treatment for CIN. Colposcopy was useful in the follow up of these women and expedited the treatment of persistent disease. We recommend that any follow up protocol should include a colposcopic assessment and cytological follow up for at least four years following treatment. Further data are required to determine the risk of recurrence beyond this time.

Adolescent↗
PubMed1995

The use of cervicography in the follow-up of cervical intraepithelial neoplasia treated by CO2 laser.

After treatment for cervical intraepithelial neoplasia (CIN) the follow-up of patients would be simplified if colposcopy could be safely omitted. A study of 50 patients was performed to determine the feasibility of such an approach. Cervical cytology, cervicography and colposcopy, with or without biopsy, was performed in each patient. From the results the following criteria for colposcopy were adopted: (a) patients thought to have CIN on cytology or cervicography, (b) inadequate cervicography picture (vagina covering cervix or poor quality photography), (c) high-risk factors present (immunosuppression, after cone biopsy, postmenopausal). In this study the number of colposcopies would have been reduced from 50 to 11 if these criteria were adopted. Cervical cytology combined with cervicography is a reasonable alternative to colposcopy and we feel this is a technique worth pursuing for the follow-up of patients treated for CIN.

Carbon Dioxide↗