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PubMed2004

Low-grade cervical squamous intraepithelial lesion during pregnancy: conservative antepartum management.

The purpose of this retrospective study was to determine the regression rate and management of low-grade squamous intraepithelial lesions (LSIL) in pregnancy. Seventy-four women with cytological findings of LSIL were analysed during the pregnant-puerperal period (until 12 months postpartum). Age, parity, cytological and colposcopic findings, route of delivery, and postpartum follow-up were studied. The age and parity of patients ranged (average) from 12 to 32 years (21.2 +/- 4.9), 0-5 (0.89 +/- 1.14), and 9-32 years (16.1 +/- 3.5), respectively. Thirty-nine of 55 (70.9%) and 12 of 19 (63.1%) pregnant women had normal cytology after vaginal delivery and caesarean section, respectively (p > 0.05). In postpartum, eight patients (10.8%) persisted with LSIL and ten (13.5%) presented high-grade squamous intraepithelial lesions. No case of unsatisfactory colposcopy and invasive carcinoma were found. LSIL during pregnancy has a high rate of regression, regardless of the route of delivery. Conservative management with colposcopic evaluation is proposed during gestation.

Adolescent↗
PubMed1992

Cytomorphologic, cytometric and histomorphologic observations after laser therapy for cervical lesions.

To analyze the healing process after laser therapy for cervical lesions, the clinical, cytologic, histologic and colposcopic features in 109 cases were studied chronologically. The healing process of the cervical epithelium usually began from both the squamous and columnar epithelial borders, starting around the 10th day after laser therapy; the process covered the whole tissue defect with multilayered epithelium within seven weeks. Inflammatory changes also usually abated within that time. Cytomorphologically, laser therapy resulted in the occurrence of (mostly degenerated) "fiber-type" and orangeophilic cells in smears taken during the first two weeks after treatment. Tissue repair cells were seen in smears collected from the first posttherapy day through the fourth week after laser therapy. Using computer-assisted image cytometry, the reparative cells in samples taken shortly after treatment (roughly, the first to fifth days) exhibited more hyperchromatic (3-4N) nuclei than did those in later samples; however, the mean DNA content of the early reparative cells was generally concentrated around that of the 2N reference cells. These findings suggest that follow-up, including cytologic and colposcopic examination, for the early detection of residual or recurrent lesions should start in the eighth week and continue periodically for at least one year.

Biopsy↗
PubMedDate not supplied

Accuracy of visual inspection with acetic acid (VIA) for early detection of cervical dysplasia in Tehran, Iran.

OBJECTIVE: To evaluate the accuracy of visual inspection with 5% acetic acid (VIA) when used to detect cervical cancer and its precursors. METHODS: The study population included women attended Family Planning and Gynecological Clinic in Bagher Abad Health Center and Mirza Koochak Khan Hospital for regular cervical screening tests. After obtaining informed consent from each woman, VIA was performed. One hundred with a positive VIA test and 100 women with a negative VIA test were randomly selected for this study. Cytology and colposcopy examination were performed for all 200 cases and cervical biopsies were conducted for those individuals showing abnormal colposcopic findings. RESULTS: Nine cases in VIA-positive group and two cases in VIA-negative group had an abnormal cytology. Ninety five women in the VIA-positive group and 25 in the VIA-negative group had abnormal colposcopic findings. From biopsy examination, 67 (71%) of cases in the VIA-positive group and 3 (12%) cases in the VIA-negative group had a final diagnosis of dysplasia. Among biopsied samples, only 7 cases of VIA-positive group showed abnormal result and the remaining were normal. Based on these results, VIA test sensitivity and specificity were 95.7% and 44.0% respectively, while they were 10% and 92% for cytology tests. CONCLUSIONS: The results of this study indicate that although VIA is a sensitive screening test for detection of cervical dysplasia, it can not be used by itself. Applying VIA along with Pap smears helps to detect a higher number of cases with cancer precursor lesions.

Acetic Acid↗
PubMed2005

Colposcopy vs Hybrid Capture II assay in detection of cervical human papilloma virus infection.

PURPOSE OF INVESTIGATION: Considering the relationship between high-risk human papillomavirus types and the presence or subsequent development of cervical high-grade preinvasive lesions, the aim of the study was to determine if the Hybrid Capture II test can be used to triage women with atypical colposcopic findings. METHODS: The study was carried out on 100 patients with suspicious colposcopy findings (suggestive of human papillomavirus infection) who underwent a cervical smear for human papillomavirus testing DNA Hybrid Capture II and direct biopsies for histopathological analysis. RESULTS: Sixteen patients were negative for human papillomavirus. Of the eight patients positive for high-risk HPV type, seven presented an abnormal transformation zone grade 2 (high-grade squamous intraepithelial lesion of the cervix at histopathology). There was a significant positivity of medium-high risk virus types in the cases with more abnormal colposcopy (chi2 = 7.44; p < 0.005). Histopathological findings of high-grade squamous intraepithelial lesions were registered in the patients positive for medium-high risk human papillomavirus types (chi2 = 7.66; p < 0.025). CONCLUSIONS: Based on these results it can be concluded that if a diagnosis of a high-grade squamous intraepithelial lesion has been made on the basis of colposcopic and histopathological findings, there is a high probability that the infection was due to one or more types of human papillomavirus. There are necessary further studies to interpretate both the advantages and disadvantages of intermediate triage procedures, like Hybrid Capture II testing, compared with immediate colposcopy.

Adolescent↗
PubMed2005

Effectiveness and persistence of a topical treatment for cervical ectropion with deoxyribonucleic acid.

AIM: The aim of this study was to estimate short and long term effectiveness of a topical treatment for cervical ectropion with 5 mg of deoxyribonucleic acid (DRNA). METHODS: A randomized case-control study was carried out. Two-hundred and twenty patients, colposcopically diagnosed with cervical ectropion, were consecutively enrolled and randomly divided into 2 groups: treated (group 1) and controls (group 2). The therapeutic plan consisted of DRNA 5 mg vaginal suppositories, administered for 15 days monthly; subsequently posology was reduced gradually. Both groups underwent a clinical and colposcopical follow-up on the 1st, 4th, 10th and 22nd months after the first examination. At the end of the study, the size of ectropion was considered a parameter of re-epithelialization and provided a criterion of treatment effectiveness. According to this protocol, subjects were defined improved, stable or worsened. Statistical analysis including Pearson chi2 tests, Fisher's exact tests, Yate's corrected chi2 and relative-risk (95% CI) was performed. RESULTS: Of the 220 enrolled patients, 140 completed the study protocol: 76 treated and 64 controls. Outcomes after treatment and follow-up consisted of: 74 (97.4%) improved in group 1, against 2 cases (3.1%) in group 2. High statistical significance was reported comparing outcome frequencies in the 2 groups (P<0.0001). CONCLUSIONS: This study shows a significant reduction (P<0.0001) in cervical ectropion size between cases (topical treatment with DRNA 5 mg) and controls. A follow-up of 22 months confirmed the persistence and effectiveness of this medical approach.

Adult↗
PubMed1992

[Colpo-cyto-histological correlations in intraepithelial lesions of the uterine cervix].

The aim of this study was to assess the clinical efficiency of colposcopic findings as diagnostic tests for intraepithelial lesion using the analysis of colpo-cyto-histological correlations. The results of 3340 colposcopic tests performed in the Colposcopy Unit of the Second Clinic of Obstetrics and Gynecology between March 1990 and May 1991 were analysed, taking into account 326 (9.7%) cases of Abnormal Transformation Zone (ANTZ). The colpo-histological correlation in ANTZ 1 cases (52 cases of white epithelium, 92 standard mosaic, 42 standard dotted and 61 mixed cases) was 65.2% (52.3%) for HPV; 12.9% for CIN). The colpo-histological correlation in ANTZ 2 cases (30 cases of thickened white epithelium, 5 irregular mosaic, 4 irregular dotted, 2 atypical vessels, 4 thickened gland outlets and 6 mixed cases) was 70.5% (43.3% for HPV; 27.2% for CIN an and Ca). In this retrospective study colposcopy showed a diagnostic accuracy of 64.6% in the cases examined and played a decisive role in the diagnosis of intraepithelial lesions of the uterine cervix.

Colposcopy↗
PubMed1991

ViraPap: can it help to reduce the need for colposcopy?

Two new tests recently became available for identifying cervical human papillomavirus (HPV). This study investigated the usefulness of the ViraPap and ViraType in the clinical setting. Thirty-six subjects considered to be at risk for HPV infection were examined; had specimens obtained for Papanicolaou smear (Pap smear), ViraPap, and ViraType; and were then referred for colposcopy. Results of these examinations were then compared to the findings of colposcopy and/or colposcopic biopsy. The sensitivity and specificity of the ViraPap in predicting an abnormality being found on colposcopic examination were 61.5% and 70%, respectively. Identifying the specific viral type by use of the ViraType did not prove to be clinically helpful in this population.

Adolescent↗
PubMed1991

Cervical intraepithelial neoplasia and human papilloma virus infection.

Evidence of human papilloma virus (HPV) infection was sought in 50 patients with cervical intraepithelial neoplasia (CIN) and 50 controls. Cytologic, colposcopic and histopathological examinations were carried out in each one of them. Cytological evidence of HPV infection was found in 13 cases and two controls. Colposcopic evidence was found in 33 (66%) cases and 17 (34%) controls and histopathological evidence in 35 (70%) patients and 14 (28%) controls. These differences were statistically significant. Colposcopy proved to be a good method of diagnosing HPV infection with a sensitivity of 86% and specificity of 80% compared to histopathologic diagnosis.

Colposcopy↗
PubMed2006

[Combining high-risk human papillomavirus DNA test and cytological test to detect early cervical dysplasia].

OBJECTIVE: To assess the value of combining high-risk human papillomavirus (HPV) DNA test and cytological test in detection of early cervical dysplasia. METHODS: During January 2003 to June 2004, a total of 5210 women were screened by combining high-risk HPV DNA test (hybrid capture II, HC-II) and cytological test (liquid-based ThinPrep cytology test), and the abnormal cytological or HPV DNA findings were further biopsied under the colposcope. RESULTS: The age of the patients was between 17 to 80, the average was 34 +/- 9. Final pathological diagnosis was HPV infection in 890 cases, cervical intraepithelial neoplasia (CIN) I in 83 cases, CIN II in 73 cases, CIN III in 80 cases, invasive cervical cancer in 54 cases, endometrial cancer in 5 cases, vaginal intraepithelial neoplasia in 1 case and cervical tuberculosis in 1 case. Based on the criteria of histology and pathology, the sensitivity, specificity, positive-predictive value and negative-predictive value of high-risk HPV DNA test for detecting all cases of CIN II, III were 92.22%, 74.71%, 5.19% and 99.84% respectively. In detecting all cases of CIN II, III by cytological test, for atypical squamous cell of undetermined signification (ASCUS), the sensitivity, specificity, positive-predictive value and negative-predictive value were 90.00%, 80.34%, 11.94% and 99.63% respectively; for low-grade squamous intraepithelial lesion (LSIL), the sensitivity, specificity, positive-predictive value and negative-predictive value were 70.13%, 91.58%, 11.11% and 99.51% respectively; for high-grade squamous intraepithelial lesion (HSIL), the sensitivity, specificity, positive-predictive value and negative-predictive value were 48.05%, 98.46%, 31.90% and 99.21% respectively. By the combination of high-risk HPV DNA test and cytological test, the sensitivity, specificity, positive-predictive value and negative-predictive value for detecting all cases of CIN II, III were 98.70%, 73.08%, 5.21% and 100.00% respectively. The infection rate of HPV in cervical cancer was 85.2% (46/54), in CIN III 92.5% (74/80), in CIN II 86.3% (63/73) and in CIN I 45.8% (38/83). CONCLUSIONS: High-risk HPV DNA test has high sensitivity and negative-predictive value. The combination of high-risk HPV DNA test and cytological test increases the sensitivity and negative-predictive value, but it does not increase the specificity. The performance of biopsy under the colposcope can help the diagnosis of cervical dysplasia.

Adolescent↗
PubMed2006

[Cervical carcinoma in situ: a clinical and pathological analysis of 118 cases].

OBJECTIVE: To analyze the clinical characteristics and treatment of cervical carcinoma in situ. METHODS: The clinical data of 118 patients with cervical carcinoma in situ (CIS), aged 38.8 (24-77), were retrospectively analyzed. RESULTS: Cervical cytology showed that most of the lesions were cervical intraepithelial neoplasm (CINIII), high-grade squamous intraepithelial lesion (HSIL), or CIS. Most of the patients underwent colposcopic examination. All the patients underwent conization. 54% of the patients were given cold knife conization, and 46% of the patients received electric knife conization. 71 of the patients undergoing conization (60%) were followed-up. Another 40% received total hysterectomy and/or bilateral salpingo-oophorectomy. 17 cases were found pregnant after the conization. There were no differences in pathologically thorough resection and operational complication between the two surgery methods: cold knife conization and electric knife conization. Follow up study showed that conization had no effect on the subsequent pregnancy. CONCLUSION: Conization is necessary for the final diagnosis of cervical carcinoma in situ. Both cervical cytology and colposcopic examination are very important for screening of CINIII or CIS. For the young patients conization suffices, however, for the postmenopausal women or those unable to receive follow-up examination total hysterectomy and bilateral salpingo-oophorectomy should be considered.

Adult↗
PubMed2006

[Possibilities of colposcopy in the diagnostics of cervical Chlamydia-mycoplasmatic infections (population prospective study)].

Possibilities of colposcopy in the diagnostics of cervical chlamydia-mycoplastic infections are less investigated. The aim of given work was the study of this problem. Colposcopic examination was performed in 952 women (age - from 16 to 67) asked to clinics for examination and more precise definition of diagnosis because of different complaints. It was revealed specific colposcopic features of chlamydia-mycoplastic genital infections, which were compared with the results obtained from "gold standard" methods - direct immunofluorescence method and bacteriological analysis of cervical smears. High sensitivity (Se) - 0,96, specificity (Sp) - 0,79 and diagnostic effectiveness (De) - 0,93 of colposcopy were established. Authors conclude that the application of colposcopy for diagnostics of chlamydia-mycoplastic genital infection is particularly important: during urgent cases; during the case, when it is impossible to carry out the deep diagnostics of the sexually transmitted infections; for optimization of the diagnostics of the sexually transmitted infections.

Adolescent↗
PubMed2006

Cervical-vaginal disease in HIV immunosuppressed patients: management and present screening programme.

The aim of this study was to evaluate the rate of the cervical intraepithelial neoplasia (L-SIL and H-SIL) in HIV-positive patients using cytological, colposcopic and histological examinations. The correlations between these cervical lesions, the role of HPV and the clinical and immunological aspects of HIV infection and inflammatory cervical-vaginal disease were studied. We believe that HPV infection and preneoplastic and/or neoplastic lesions occur more often in immunodepressed HIV-positive patients, and that on the grounds of the high risk of precancerous lesions in this population and the low sensibility of the Pap test, it is advisable to perform a colposcopic examination to discover early lesions that must undergo a specific biopsy.

Adult↗
PubMed2006

Regression rate of clinical HPV infection of the lower genital tract during pregnancy after laser CO2 surgery.

The objective of the study was to evaluate the effects of laser CO2 surgery during pregnancy to prevent clinical HPV infection recurrence after delivery and vertical infection. A case-control study was performed on 280 pregnant women affected by clinical HPV infection treated during pregnancy with 256 women treated three months after delivery. Follow-up was performed for a minimum of three colposcopic examinations for two years. Recurrence rates were calculated considering the number of positive findings for at least one colposcopic examination confirmed by biopsy after a negative control in a year. Statistical comparison of rates was performed by chi-squared and Fisher's exact test. Recurrence rates were higher in the women treated in postpartum (p < .01) than in the group treated during gestation (p < .005). Clinical HPV infections treated during the second trimester of pregnancy showed a sensitive decrease in recurrence-rate of infection. Rarity of respiratory papillomatosis makes conclusions inconsistent for the prevention of vertical infection.

Carbon Dioxide↗
PubMed2001

Home study course: spring 2001.

OBJECTIVE: The Home Study Course is intended for the practicing colposcopist or practitioner who is seeking to develop or enhance his or her colposcopic skills. The goal of the course is to present colposcopic cases that are unusual or instructive in terms of appearance, presentation, or management or that demonstrate new and important knowledge in the area of colposcopy or pathology. Participants may benefit from reading and studying the material or from testing their knowledge by answering the questions. ACCME ACCREDITATION: The American Society for Colposcopy and Cervical Pathology (ASCCP) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education for physicians. The ASCCP designates this continuing medical education activity for 1 credit hour in Category 1 of the Physician's Recognition Award of the American Medical Association. Credit is available for those who choose to apply. The Home Study Course is planned and produced in accordance with the ACCME's Essential Areas and Elements.

Journal Article↗
PubMed2001

Home study course: summer 2001.

OBJECTIVE: The Home Study Course is intended for the practicing colposcopist who is seeking to develop or enhance his or her colposcopic skills. The goals of the course is to present colposcopic cases that are unusual or instructive in terms of appearance, presentation, or management, or that demonstrate new and important knowledge in the area of colposcopy or pathology. Participants may benefit from reading and studying the material or from testing their knowledge by answering the questions. ACCME ACCREDITATION: The American Society for Colposcopy and Cervical Pathology (ASCCP) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education for physicians. The ASCCP designates this continuing medical education activity for 1 credit hour in Category 1 of the Physicians' Recognition Award of the American Medical Association. Credit is available for those who choose to apply. The Home Study Course is planned and produced in accordance with the ACCME's Essential Areas and Elements.

Journal Article↗
PubMed2002

Home study course: winter 2002.

OBJECTIVE: The Home Study Course is intended for the practicing colposcopist who is seeking to develop or enhance his or her colposcopic skills. The goals of the course is to present colposcopic cases that are unusual or instructive in terms of appearance, presentation, or management, or that demonstrate new and important knowledge in the area of colposcopy or pathology. Participants may benefit from reading and studying the material or from testing their knowledge by answering the questions. ACCME ACCREDITATION: The American Society for Colposcopy and Cervical Pathology (ASCCP) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education for physicians. The ASCCP designates this continuing medical education activity for 1 credit hour in Category 1 of the Physician's Recognition Award of the American Medical Association. Credit is available for those who choose to apply. The Home Study Course is planned and produced in accordance with the ACCME's Essential Areas and Elements.

Journal Article↗
PubMedDate not supplied

Histopathological outcomes of women with squamous cell carcinoma on cervical cytology.

The aim of this study was to determine the final histopathological outcome for women with a squamous cell carcinoma (SCCA) diagnosed by cervical cytology. The medical records and computerized colposcopic database of patients with SCCA on cytology who underwent colposcopy at Chiang Mai University Hospital between February 2003 and December 2005 were reviewed and 48 women with SCCA cytology were identified (mean age 50 years, range 31-73). Nineteen (39.6%) women were postmenopausal. Unsatisfactory colposcopy was noted in 42 (87.5%). Thirty one (64.6%) of the patients had a final pathological diagnosis of high-grade squamous intraepithelial lesions (HGSIL), whereas only 16 (33.3%) had invasive cancer. The remaining one patient had a low-grade squamous intraepithelial lesion. Sensitivity and specificity of colposcopic examination for predicting invasive cancer was 50% and 78%, respectively. In conclusion, most women with a SCCA on cervical cytology have high-grade cervical lesions on final pathology, with only one third demonstrating invasive cancer. The loop electrosurgical excision procedure (LEEP) remains an important measure for combined treatment and diagnosis.

Adult↗
PubMed2006

[Colposcopy of abnormal transformation zone].

UNLABELLED: The aim of the study was the determination of colposcopic images of the atypical transformation zone and the estimation of their relationship with cervical intraepithelial neoplasia. MATERIAL AND METHODS: 8700 women hospitalized in the Department of Gynaecology and Gynaecologic Oncology of the Municipal Hospital in Kielce between October 1996 and March 2003 were included in this study. In every investigated women the gynaecological examination, PAP smear, vaginal biocenosis, image colposcopy and histological examination were performed. Colposcopic images underwent computer analysis. Patients were divided into two groups. Behind the criterion of the division one accepted the occurrence (group 1) or the lack (the group II) cervical intraepithelial neoplasia in the histological examination. RESULTS: Atypical transformation zone occurred in 3.8% of investigated women. The statistical analysis showed the lack of the correlation between occurrence of flat punctation pattern and negative iodine uptake in women with the atypical transformation zone. Acetowhite epithelium, very white or gray opaque epithelium, flat mosaic, coarse mosaic, flat and coarse leukoplakia, coarse punctation and atypical vessels correlated statistically (p < 0.05) with the atypical transformation zone. CONCLUSIONS: Acetowhite, very white or gray opaque epithelium, coarse punctation, flat mosaic, coarse mosaic, flat and coarse leukoplakia, coarse punctation, atypical vessels are the characteristic colposcopy images of the transformation zone. There is a correlation between acetowhite epithelium and flat leukoplakia and CIN 1. Coarse punctation, coarse mosaic and coarse leukoplakia correlate with the presence of CIN 3. Flat punctation and negative iodine uptake are not characteristic colposcopy images of the atypical transformation zone.

Adolescent↗