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PubMed1991

Human papillomavirus screening for women with atypical Papanicolaou smears.

A study was undertaken to evaluate the utility of human papillomavirus (HPV) DNA screening and colposcopy in the management of women whose Papanicolaou smears demonstrated atypia less than dysplasia. Fifty patients whose initial Papanicolaou smears were interpreted as showing atypia less than dysplasia were evaluated for the presence of HPV 16 DNA in exfoliated cervicovaginal cells and for histologic findings on biopsy. Those 50 patients were compared to two groups of patients: one consisting of 124 patients with biopsy-documented cervical intraepithelial neoplasia (CIN) and another of 112 patients with normal Papanicolaou smears. The presence of HPV 16 DNA was confirmed with Southern analysis in 46% of patients with atypical Papanicolaou smears, 46% with confirmed CIN and 11.6% with normal Papanicolaou smears. The 50 patients with atypical smears underwent colposcopically directed cervical biopsies, revealing the following results: 14 (28%) had normal histology, 29 (58%) had koilocytosis without dysplasia, and 7 (14%) had CIN. HPV 16 DNA was present in exfoliated cervicovaginal cells from a large percentage of patients from each category (50% of patients with normal histology, 41.2% with koilocytosis and 57% with CIN). HPV 16 DNA screening did not predict which patients with atypical smears had underlying CIN. Colposcopically directed biopsy remains the evaluation method of choice.

Adolescent↗
PubMed1991

Koilocytotic atypia and underlying dysplasia.

BACKGROUND: Several studies have examined the agreement between Papanicolaou smear cytology and subsequent biopsy results in the diagnosis of cervical dysplasia. However, few studies have focused specifically on koilocytotic (KC) atypia. Given the increasing frequency of reporting KC atypia on Papanicolaou smears, we sought to obtain more information on the relationship between Papanicolaou smears and subsequent colposcopically directed cervical biopsies. METHODS: Retrospectively, we compared the Papanicolaou smears and colposcopically guided biopsy results for 132 college women who had abnormal Papanicolaou smears (KC, cervical intraepithelial neoplasia [CIN], or reactive atypia [RA]). Data were compiled through systematic review of the charts of these women. The cervical biopsies were taken 6 months or less after the Papanicolaou smears. RESULTS: Of 99 women having only KC atypia on cytology, histology revealed concordance in 51 cases and underlying dysplasia in 16 cases. Only one biopsy revealed CIN III, and no biopsies showed invasive carcinoma. We also noted variation in the histologic results between the laboratories that analyzed the biopsy specimens. In comparing the biopsy results after one or two KC atypic Papanicolaou smears 6 months or less apart, we found no statistically significant difference. CONCLUSIONS: These findings suggest that physicians who obtain an initial Papanicolaou smear read as KC atypia could obtain a second smear 3 months later to determine if there is persistent KC atypia before advising a patient to have cervical biopsy. In addition, physicians also should know the limitations of the laboratories providing them with information.

Adolescent↗
PubMed1991

Pattern of treatment failure following laser for cervical intraepithelial neoplasia: implications for follow-up protocol.

In an effort to devise a rational protocol for the follow-up of patients who have had destructive treatment for cervical intraepithelial neoplasia (CIN), an analysis has been performed of treatment failures following laser therapy in 2130 women treated between 1980-1989. Of this group, 1253 women have been followed up for 3 years or more and 380 for 6 years or more. There have been 119 treatment failures (5.6%), of which 71% of the women had the second lesion detected during the first year of follow-up, 24% during the second year, 3.3% during the third year, and 1.7% during the sixth year. In 18% of these 119, the second lesion was detected colposcopically in the presence of negative cytology. There were two cases of microinvasion and one frankly invasive lesion following laser, all diagnosed during the second year of follow-up. Our data suggest that if the first year of follow-up includes at least one colposcopic examination, some second lesions will be diagnosed in the presence of negative cytology.

Adult↗
PubMed1991

Management of cervical intraepithelial neoplasia where colposcopy is not available.

A study was carried out to determine the effectiveness of the various methods used for treating patients with cervical intraepithelial neoplasia (CIN) detected by the cervicovaginal smear screening programme at the University College Hospital, Ibadan, Nigeria, over a period of five years. During the period, 3 004 patients were screened, of whom 292 (9.7 pc) had smears suggestive of CIN. There were no facilities for colposcopic evaluation of the patients. The patients were treated by cryotherapy, electrocautery, conization of the cervix and hysterectomy. Persistence rates of CIN after cryotherapy and electrocautery were 30.3pc and 31.2pc respectively. There was no evidence of persistent CIN in patients treated with conization or hysterectomy. It is suggested that in the absence of colposcopic guidance, conization or hysterectomy should be used to treat CIN rather than blind application of locally destructive methods like cryotherapy and electrocautery, particularly the higher grades of CIN.

Adult↗
PubMed1990

[Value of colposcopy in diagnosing recurrent gynecologic malignancies].

From 1983 to 1988, colposcopic follow-up examination was done in 82 treated gynecologic tumor patients (68 cervical cancer, 7 vulval cancer and 7 other cancers) comprising 10% of all examined by colposcopy during the same period. Twenty-one cases were found to have recurrence or metastasis in the cervix, vagina or vulva proven by pathology. Ten of these 21 cases were initially diagnosed by colposcopy. The conformation rate between colposcopic examination and pathology was 85.7%. An accuracy of 86.7% was achieved by combination of cytology and colposcopy for recurrent tumors. The results suggest that tumor recurrence can be detected earlier by colposcopy than by clinical examination. Colposcopy combined with cytology as follow-up examination can improve the clinical diagnosis and treatment of treated patients.

Colposcopy↗
PubMedDate not supplied

[Computerized evaluation of reparative processes of the cervix uteri].

This study was aimed to evaluate the effect of polydeoxyribonucleotide (PDRN), as reported in relevant literature, on cervical epithelia dynamics. Particularly, the interactions taking place between columnar epithelium and the squamous one have been examined. For the purposes of the study, the following computerized techniques, already widely known, have been used: The colposcope is joined to a videocamera connected with a computer (AT compatible). The computer is equipped with a graphic card capable to record and to digit the image, i.e. to make it recognizable by the computer itself. Thereafter, many operations can be performed on the colposcopic images: reductions, enlargements, retouches, record, recall, analysis, etc. Moreover, irregular epithelial areas can be easily determined to a good approximation and, using pre-established enlargement ratios, their evolution can be evaluated. By means of this technique 12 out-patients with uterine cervix ectopias, with or without normal transformation zone (NTZ), have been examined. The monthly therapy was 12 pessaries, each containing 5 mg polydeoxyribonucleotide (POLIDES 5--Farmigea), from the 7th to the 18th day of the cycle, repeated for 3 months. Since the first month of treatment a reduction of the ectopic columnar epithelium has been noted in most patients (9 on 12), with a squamous epithelium increase (peripheral reparative process). This process has kept on increasing during the following months in the 9 patients responding to the treatment, whose ectopic areas were covered by squamous epithelium (average 55% of the area; range 33%-78%). No response to the treatment has been shown in 3 cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

The pharmacologic therapy of post-cauterization and post-laser vaporization with polydeoxyribonucleotide.

The most widely used ablative techniques in the therapy of benign cervical lesions are physical treatments with cauterization or laser vaporization; these are, however, usually used for the largest or symptomatic lesions. Many Authors suggest, after physical treatment, the use of topical chemotherapy in order to abolish any possible inflammatory reaction. The use of drugs such as polydeoxyribonucleotide (PDRN) 5 mg (POLIDES 5--Farmigea), provided with reepithelialization and anticomplement action, seems to promote a quicker recovery of the cauterized or vaporized zone, avoiding, at the same time, the secondary inflammatory reaction. The Authors have assessed the quality of reepithelialization by means of PDRN 5 mg ovules of the cervical zone which has been previously subjected to laser vaporization or cauterization for benign cervical lesions or CIN I. The trial was performed with two groups of patients: Group A: laser vaporization, 45 patients, 23 of whom treated with PDRN and 22 with placebo. Group B: cauterization, 46 patients, 24 treated with PDRN and 22 with placebo. The treatment with PDRN 5 mg ovules started on the day of physical treatment and continued for twelve days. The examination of the patients, performed before the treatment (TO) included the following tests: bacteriological test; PAP-smear, colposcopic examination with eventual direct biopsy. The first follow-up (T 1) was performed after 14 days and included a Pap-smear, colposcopic examination and microcolpohysteroscopy (MC) carried out in the zone where physical treatment had been performed, in order to obtain a map of the reepithelialization process process.(ABSTRACT TRUNCATED AT 250 WORDS)

Cautery↗
PubMed1990

Vaginal and vulvar adenosis. An unsuspected side effect of CO2 laser vaporization.

During a 15-month period, September 1984 through January 1986, 10 women who were treated in the Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, Pennsylvania Hospital, Philadelphia, Pennsylvania, developed vaginal or vulvar adenosis after CO2 laser vaporization. The indications for therapy were condylomata of the cervix, vagina and vulva refractory to conservative management in 3 patients, vulvar intraepithelial neoplasia in 3, lichen sclerosus in 1 and cervical intraepithelial neoplasia with condylomata on the cervix and vagina in 3. All the patients underwent treatment of the vagina. Most underwent treatment of the cervix, and some underwent treatment of the vulva at various degrees of intensity and depth. During the posttreatment colposcopic follow-up examination, all the patients demonstrated lesions colposcopically consistent with adenosis of the vagina or vulva within the area treated with the CO2 laser. Biopsies of the lesions were performed, adenosis was confirmed histologically, and endometriosis was ruled out histologically. This entity has not been previously associated with CO2 laser vaporization, and its clinical significance is undetermined. Further follow-up is indicated.

Adult↗
PubMed1990

Human papillomavirus detection in cervical lesions nondiagnostic for cervical intraepithelial neoplasia: correlation with Papanicolaou smear, colposcopy, and occurrence of cervical intraepithelial neoplasia.

Human papillomavirus (HPV) is associated with cervical intraepithelial neoplasia (CIN) and carcinomas. The present study involved women who had an abnormal Papanicolaou smear and whose cervix contained acetowhite area(s) that lacked the histologic features of CIN. Sequences homologous to HPV DNA, determined by Southern blot hybridization analysis, were detected in 20 of 59 cervical biopsy specimens (34%) that lacked the histologic features of CIN. When compared with the group in which HPV DNA was not detected, the HPV DNA-positive group had a lower chance of having a normal Papanicolaou smear (30 versus 61%) at the time of the biopsy. There was no difference in the colposcopic findings between the HPV DNA-positive and -negative cases for the biopsy specimens that lacked the features of CIN. However, there was a difference in the rate of histologically proved CIN in the two groups. Twelve of 17 women (71%) in the HPV DNA-positive group for whom there was follow-up information had a biopsy-proved CIN lesion noted at another location in the cervix at the time of biopsy (six) or 3-12 months after the biopsy (six). This rate was significantly higher (P less than .05) than the rate (five of 25, 20%) in the HPV DNA-negative cases, most of whom had no colposcopic abnormalities and a normal Papanicolaou smear at the follow-up examination. These findings indicate that HPV DNA detection in women with cervical lesions that lack the histologic features of CIN predicts current or future CIN in such patients.

Biopsy↗
PubMedDate not supplied

"Nonclassic" cytologic signs of cervical condyloma. A case-control study.

The association between "nonclassic" cytologic signs of condyloma and human papillomavirus (HPV) infection in women with negative Papanicolaou smears was analyzed via a case-control study. The cytologic signs considered were mild koilocytosis, mild dyskeratosis, binucleation or multinucleation, cleared cytoplasm and nuclear hyperchromatism. The Papanicolaou smears of 166 cases that showed colposcopic and histologic evidence of HPV infection (but whose smears lacked the classic cytologic signs of condyloma) and 166 controls that were negative colposcopically were randomly admixed and blindly reviewed by a panel of cytologists. A significant association to HPV infection was observed for all of the nonclassic signs studied, but multivariate analysis showed a weakly independent association only for mild koilocytosis. The sensitivity (0.46) and the specificity (0.87) of these nonclassic signs were not satisfactory. The utility of selecting women with negative Papanicolaou smears for colposcopy on the basis of these signs is discussed.

Adult↗
PubMed1990

[Experience with 1000 cases of conization of the uterine cervix].

Authors made a follow-up study of 1000 portio conisations. They analysed the early and late postoperative complications with special regard to the further obstetrical outcome. They valued the previous cytologic and colposcopic examinations on the basis of histologic diagnosis. It has been found that complications were neither frequent nor serious and had no unfavourable influence on further pregnancies. They found a higher ratio both of false positive and negative cytologic and colposcopic results then it is given by the literature. Authors come to the conclusion, that even in cases of anatomical portio alterations it's necessary the detailed histologic examinations, that for the portio conisation is a preferable method.

Cervix Uteri↗
PubMed1990

[The diagnosis, management and treatment results in patients with carcinoma in situ of the cervix uteri].

The authors analysed the results of 225 women with carcinoma of the uterine cervix, treated at the gynecological clinic of the National Oncological Center for a 10-year period. The mean age was 36.7 years. No complaints were found in 206 patients. Cytological Pap 3-5 was established in 221 women. Conformity between histological examination after a colposcopic-directed biopsy, conization or total hysterectomy was found in 117 patients (53.18%). Carcinoma was discovered at 0 degree in 34 patients (11.44%) only just after conization, but in 69 women the tumour was removed during a colposcopic-directed biopsy and was not found in the operation material. Treatment of 217 women was conization, of 3 women--classical total hysterectomy and of 5 patients--intracavitary brachytherapy. In 7 patients the tumour was not removed till healthy tissue, which caused reconization in one woman and total hysterectomy in 6 patients. A relapse of the disease was found in 9 patients up to 2 years after conization (6 cases with carcinoma in situ, 3--with microinvasive carcinoma). Total hysterectomy was performed in all patients. Possibility for discovery of a relapse in the form of invasive carcinoma is ruled out during systemic and continuous observation. It is possible to perform reconization in women with persistent carcinoma in situ in view of preserving their generative function.

Adult↗
PubMed1990

[Follow-up in cervix intra-epithelial neoplasia and condylomatous lesions of the uterine cervix].

77 women with colposcopic and/or cytologic suspicious signs had been followed up 6 to 46 months. In 23 (44 per cent) out of 52 women with CIN we could observe progredience, in 19 (37 per cent) cases dysplasias and carcinoma in situ remained unchanged and in 10 (19 per cent) there was a regression. From 18 benign condylomatous lesions 8 were regredient and sones were progredient. Only in 1 out of 7 cases with benign lesions without papilloma virus infection a CIN II developed. Follow up of pregnant women demonstrated twofold more regredient findings compared with nonpregnant women. Follow up over a period of several years with colposcopic, cytologic and histologic examination in young women with CIn and childwish is possible without risk if definite management will be secured.

Biopsy↗
PubMed1989

The multicentric nature of disease related to human papillomavirus infection of the female lower genital tract.

Two hundred fifty-one consecutive patients from our colposcopy clinic were evaluated to establish the extent to which human papillomavirus (HPV) infection is a disease of the entire female lower genital tract. Colposcopic examinations and biopsies of the cervix and vulva were performed on all patients. Two hundred two women had cervical disease, of whom 164 (81%) also had vulvar disease. The percentage was the same regardless of the severity of the cervical disease. One hundred ninety-four of the patients had vulvar disease and of these, 164 (85%) also had cervical disease. Twenty-nine of 37 women (78%) with overt vulvar condylomata had cervical disease; 15 of these presented without a Papanicolaou smear, and 13 had cervical disease. We conclude that HPV infection of the female lower genital tract is a multicentric disease. All patients with evidence of HPV infection should undergo colposcopic evaluation of the entire lower genital tract. The significance that this will have on future attempts to cure this infection needs to be studied.

Condylomata Acuminata↗
PubMedDate not supplied

Significance of mild cervical cytologic atypia in a sexually transmitted disease clinic population.

While the clinical management of patients with cytologic atypia consistent with cervical intraepithelial neoplasia (CIN) is well established, the management of so-called nondyskaryotic or benign atypias is controversial. The natural history of such atypias was prospectively studied in 124 patients attending a sexually transmitted disease clinic. The benign atypias were subdivided into different categories according to the cell type involved, and the patients were followed cytologically and colposcopically without cervical biopsy until they reached one of the study end points. Benign atypias often signified the presence of CIN: 17% of the patients had a smear consistent with CIN on the first study visit, and an additional 24% had such a smear by six months of follow-up. After 30 months of follow-up, the overall cumulative rate of biopsy-confirmed CIN 2 to CIN 3 was 13.5%; it was 12.5% among those with two consecutive smears showing benign atypias. Of the ten patients who reached biopsy-confirmed CIN 2 to CIN 3, a cytologic smear consistent with CIN was obtained in less than one year of follow-up in all but one case; however, colposcopic evidence of progression was seen in only half of the ten cases, suggesting a sampling error rather than true progression in many cases. Patients with metaplastic cell atypia had a higher progression rate to biopsy-confirmed CIN 2 to CIN 3 (21%) than did those with nonmetaplastic cell atypia (3%). This study provides direct evidence of the potential significance of metaplastic atypia as a marker of CIN. We conclude that patients with mild atypia are often found to have CIN and warrant further investigation by colposcopy and biopsy.

Adult↗
PubMed1989

[Genital human papillomavirus infections in certain groups of women in the Antwerp region].

Different groups of women, living in the Antwerp region, are examined for the occurrence of genital human papillomavirus (HPV)-infections. To detect these infections, physical examination and DNA-DNA-hybridisation technics (Southern Blotting with the probes of HPV 6, 11, 16 and 18) have been used. Part of these women are also examined colposcopically. The following groups of women have been included in the study: --women who present for cervical cancer screening with their general practitioner after a communal campaign. (HPV detection by physical examination, cytology and hybridisation); --women who present for cervical cancer screening with the mobile team after a communal campaign. (HPV detection by physical and colposcopical examination, by cytology and by hybridisation); --women who are routinely screened for cervical cancer in a gynecological private practice, situated in the same region. (HPV detection by physical examination and hybridisation). Prevalences of HPV infections in these groups will be presented and the detection methods used will be discussed.

Adult↗
PubMed1989

Paired Papanicolaou smears in the evaluation of atypical squamous cells.

Between February 1985 and April 1988, 360 women were seen at Tripler Army Medical Center's cervical clinic as part of a prospective study to assess the value of paired Papanicolaou smears in the follow-up of atypical squamous cells in a cervical cytologic smear. The evaluation consisted of paired repeat Papanicolaou smears and colposcopy. Colposcopically directed biopsies and/or endocervical curettage were performed in 86% of the subjects. The results of the paired Papanicolaou smears were negative/negative in 202 patients (56%). Cervical intraepithelial neoplasia was diagnosed histopathologically in 16% of all patients and in 10% of those with negative/negative repeat smears. We conclude that the presence of atypical squamous cells in a Papanicolaou smear should be considered abnormal and that colposcopy and colposcopically directed biopsies should be performed for these patients.

Adolescent↗
PubMed1989

Laser excision rather than vaporization: the treatment of choice for cervical intraepithelial neoplasia.

We are concerned that the use of ablative therapy in the treatment of cervical intraepithelial neoplasia may lead to a failure to diagnose early invasive carcinoma. In view of this, since June 1986, 196 patients considered suitable for laser vaporization were treated by a shallow laser excision cone biopsy instead. The mean age of the women treated was 31 years, and the mean length of the excised specimen, measured after fixation, was 14 mm. All procedures were completed in the colposcopy clinic and took no longer to perform than vaporization. The complication rate was low, and an excellent specimen was available for pathologic examination. In this series, histology on the excised cone revealed that two patients had microinvasive carcinoma and one had adenocarcinoma in situ. In addition, 16 patients had a lesion two or three grades worse on the laser excision biopsy than was predicted by the colposcopically directed biopsy. Because of the inaccuracy of colposcopic biopsy, we now recommend a small laser excision cone biopsy as the treatment of choice for all patients with cervical intraepithelial neoplasia.

Adolescent↗