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PubMed2003

Strength of correlations between colposcopic impression and biopsy histology.

OBJECTIVE: The aim of this study was to determine the strength of the correlation between colposcopic impression and biopsy histology. METHODS: In an urban referral clinic, colposcopy and directed biopsy were performed between July 1, 1996, and December 31, 1999, by residents supervised by board-certified attending obstetrician-gynecologists. Impression and biopsy were graded as benign, suggesting condyloma or koilocytosis, cervical intraepithelial neoplasia (CIN) grades 1-3, or cancer. The significance of association was assessed by chi(2) testing and the strength by kappa statistics. RESULTS: Colposcopies were performed on 2825 women, with colposcopic impression and biopsy grade known for 2112. Exact agreement was found in only 893 (37%) women, but results agreed within one grade in 1203 (75%). The association between impression and histology was significant (P < 0.001), but the strength of the correlation was poor (0.20). The positive predictive value of any colposcopic abnormality for any histologic abnormality was 80%. The negative predictive value of a benign colposcopic impression was 68%. The sensitivity of colposcopy with a threshold of any lesion detected was 89%, and the specificity was 52%. The sensitivity for CIN 2/3 was 56%. CONCLUSION: Colposcopy is imprecise, although useful in estimating lesion grade. Management decisions require biopsy.

Adolescent↗
PubMed2003

Management of women who test positive for high-risk types of human papillomavirus: the HART study.

BACKGROUND: Certain types of human papillomavirus (HPV) are the primary cause of almost all cervical cancers. HPV testing of cervical smears is more sensitive but less specific than cytology for detecting high-grade cervical intraepithelial neoplasia (CIN2+). HPV testing as a primary screening approach requires efficient management of HPV-positive women with negative or borderline cytology. We aimed to compare the detection rate and positive predictive values of HPV assay with cytology and to determine the best management strategy for HPV-positive women. METHODS: We did a multicentre screening study of 11085 women aged 30-60 years. Women with borderline cytology and women positive for high-risk HPV with negative cytology were randomised to immediate colposcopy or to surveillance by repeat HPV testing, cytology, and colposcopy at 12 months. FINDINGS: HPV testing was more sensitive than borderline or worse cytology (97.1% vs 76.6%, p=0.002) but less specific (93.3% vs 95.8%, p<0.0001) for detecting CIN2+. Of 825 randomised women, surveillance at 12 months was as effective as immediate colposcopy. In women positive for HPV at baseline, who had surveillance, 73 (45%) of 164 women with negative cytology and eight (35%) of 23 women with borderline cytology were HPV negative at 6-12 months. No CIN2+ was found in these women, nor in women with an initial negative HPV test with borderline (n=211) or mild (32) cytology. INTERPRETATION: HPV testing could be used for primary screening in women older than 30 years, with cytology used to triage HPV-positive women. HPV-positive women with normal or borderline cytology (about 6% of screened women) could be managed by repeat testing after 12 months. This approach could potentially improve detection rates of CIN2+ without increasing the colposcopy referral rate.

Adult↗
PubMed2003

How significant is a cervical smear showing glandular dyskaryosis?

OBJECTIVE: To evaluate the incidence, outcome and predictive value of cytology showing glandular dyskaryosis. PARTICIPANTS: Fifty-seven women with a smear diagnosis of glandular dyskaryosis registered between January 1997 and December 2001. SETTING: Colposcopy and cytopathology units in a large district general hospital. RESULTS: Sixty smears in 57 women showing glandular dyskaryosis were identified from a cohort of 135,120 smears, giving an incidence of 0.05%. Hospital records were available for 50 women. Final diagnosis included 13 cases of cervical glandular intraepithelial neoplasia (CGIN), 4 microinvasive cervical adenocarcinomas, 2 undifferentiated tumours, 1 microinvasive squamous carcinoma, 21 cases of CIN and 13 cases of endometrial pathology (8 endometrial cancers). Twelve women had coexistent squamous and glandular disease. Forty-five out of 50 women had significant pathology (positive predictive value 90%). Colposcopy was seen to be of limited value in assessment of smears showing glandular dyskaryosis. Only 1 out of 13 glandular lesions was diagnosed by colposcopy. CONCLUSION: Smears showing glandular dyskaryosis are associated with significant pathology in 90% of cases and malignancy in 32% of cases. Hence, women with a smear showing glandular dyskaryosis should be referred urgently to a colposcopy clinic and flagged up as suspected cancer. Glandular dyskaryosis should be included in the national referral criteria for suspected gynaecological cancer.

Adenocarcinoma↗
PubMed1996

Colposcopic and cytologic findings among adolescents referred to two urban teaching hospitals.

STUDY OBJECTIVE: To determine colposcopic findings among adolescents and to determine compliance with management recommendations. DESIGN: Retrospective review of colposcopy logs and patient charts. SETTING: Two urban resident colposcopy clinics. PARTICIPANTS: Low-income, predominantly minority girls 16 years of age or younger referred for evaluation of abnormal cervical cytology. INTERVENTION: Colposcopy with directed biopsy. MAIN OUTCOME MEASURES: Histologic findings in colposcopic biopsies and compliance with management recommendations. RESULTS: Of 62 adolescents evaluated, 17 (27%) had biopsies showing atypia or koilocytosis and 13 (21%) had dysplasia, with grade 2 cervical intraepithelial neoplasia (CIN 2) in 5 (8%). No biopsy showed CIN 3 or invasive cancer. None of 31 endocervical curettings contained dysplasia. Forty-one adolescents (66%) failed to comply with recommendations for surveillance or treatment. CONCLUSIONS: The prevalence of dysplasia among adolescents referred for colposcopy is substantial, and better strategies are needed to ensure proper follow-up.

Adolescent↗
PubMed2004

Management of low-grade squamous intraepithelial lesions of the uterine cervix.

Strategies of management for low-grade squamous intraepithelial lesion (SIL) vary even on a national level. We evaluated the diversity of management algorithms. This should serve as a source to find a common basis for the management of low-grade SIL. A total of 38 representatives and specialists for colposcopy and cervical pathology were contacted to provide national guidelines, recommendations or consensus for the management of patients diagnosed with the cytologic diagnosis of low-grade SIL. In all, 23 addressees (60%) responded. The algorithms provided varied considerably. Three variants of algorithms could be defined. Variant 1 was proposed in 14 countries and recommended colposcopy immediately after cytologic diagnosis of low-grade SIL or at the same time the smear is taken. If available, HPV testing was recommended as a triage option in some countries. Variant 2 is used in three countries and colposcopy is only performed after a repeated abnormal cytologic result within a 6-month interval or after an optional test positive for high-risk HPV. Variant 3, as proposed in six countries, takes into account the socio-economic status of the patient: In patients with poor compliance, 'see and treat' management is recommended; in patients where compliance can be assured, follow-up is carried out by cytology and colposcopy. Global policy of management of patients with low-grade SIL can be summarised in three algorithms. Quality standards and outcome parameters must be defined in order to improve the management of women with low-grade SIL.

Adult↗
PubMed2001

Comparison of three management strategies for patients with atypical squamous cells of undetermined significance: baseline results from a randomized trial.

BACKGROUND: More than 2 million U.S. women receive an equivocal cervical cytologic diagnosis (atypical squamous cells of undetermined significance [ASCUS]) each year. Effective colposcopy triage strategies are needed to identify the minority of women who have clinically significant disease while avoiding excessive follow-up evaluation for others. METHODS: The ASCUS/LSIL (i.e., low-grade squamous intraepithelial lesion) Triage Study (ALTS) is a multicenter, randomized trial comparing the sensitivity and specificity of the following three management strategies to detect cervical intraepithelial neoplasia grade 3 (CIN3): 1) immediate colposcopy (considered to be the reference standard), 2) triage to colposcopy based on human papillomavirus (HPV) results from Hybrid Capture 2(TM) (HC 2) and thin-layer cytology results, or 3) triage based on cytology results alone. This article summarizes the cross-sectional enrollment results for 3488 women with a referral diagnosis of ASCUS. All statistical tests are two-sided. RESULTS: Among participants with ASCUS, the underlying prevalence of histologically confirmed CIN3 was 5.1%. Sensitivity to detect CIN3 or above by testing for cancer-associated HPV DNA was 96.3% (95% confidence interval [CI] = 91.6% to 98.8%), with 56.1% of women referred to colposcopy. Sensitivity of a single repeat cytology specimen with a triage threshold of HSIL or above was 44.1% (95% CI = 35.6% to 52.9%), with 6.9% referred. Sensitivity of a lower cytology triage threshold of ASCUS or above was 85.3% (95% CI = 78.2% to 90.8%), with 58.6% referred. CONCLUSIONS: HC 2 testing for cancer-associated HPV DNA is a viable option in the management of women with ASCUS. It has greater sensitivity to detect CIN3 or above and specificity comparable to a single additional cytologic test indicating ASCUS or above.

Adult↗
PubMed1990

Management of low-grade cervical dysplasia during pregnancy.

Fifty-five pregnant patients referred to my colposcopy service from 1985 to 1990 for biopsy-proven mild dysplasia were entered into a program of serial evaluations, including Pap test, colposcopy, and directed biopsy if indicated. The evaluations were done every 12 weeks during pregnancy and at 6 weeks postpartum to rule out new or occult invasive cervical cancer. By the time the postpartum biopsy was done, no such cancer had been detected. All 55 patients had mild dysplasia or less. I conclude that pregnant patients with biopsy-proven mild cervical dysplasia who have had adequate expert colposcopy and results of Pap test consistent with biopsy require only one antepartum colposcopy prior to postpartum reevaluation and treatment. Multiple interval cytologic and colposcopic studies with or without biopsy are unnecessary. The likelihood of invasive cervical cancer developing in these patients during pregnancy is negligible.

Adolescent↗
PubMed2004

The quality of community colposcopic practice.

OBJECTIVE: To estimate the quality of community colposcopic practice in British Columbia through an assessment of the degree of correlation between colposcopy, cytology, and histology. METHOD: We reviewed all new-patient colposcopies in British Columbia during 2001 by 37 gynecologists in 24 hospital-based clinics. RESULTS: Colposcopic impression closely mirrored the referral cytology diagnosis in 89.8% of cases. As with cytology-biopsy comparisons, discordant cases were more likely to be overestimates of disease rather than underestimates, 18.8% versus 1.8%. Overestimates were usually biopsy sampling errors rather than false positive cytology. The overall correlation between cytology and biopsy was considered satisfactory in 79.4% of cases. Satisfactory agreement between the colposcopic diagnosis and accompanying biopsies occurred in 86.8% of patients. Five colposcopists had performance scores below this standard. Colposcopy with a sensitivity of 90.3% and a specificity of 57.3% as practiced in this provincial program would appear to be of a satisfactory level. The rate of intraepithelial or invasive disease increased from 40.6% in patients with low-grade squamous intraepithelial changes to 91.9% in patients with suspicious or malignant cytology. The value of the colposcopic impression to identify disease correlated best with the higher the grade of disease predicted (64.6% to 92.6%). CONCLUSION: A measure of the colposcopic proficiency in the community can be estimated by comparing the level of agreement between the presenting cytology, colposcopic impression, and corresponding directed biopsies. The results of this study would indicate that 5 individuals had practice standards that were below average. An integrated cytology-colposcopy program facilitates the assessment and identification of below-average practice standards in a community.

Adult↗
PubMed2006

Screening for cervical cancer in high-risk populations: DNA pap test or Hybrid Capture II test alone?

This study was designed to evaluate whether Hybrid Capture II (HC2) test alone refer women to colposcopy as appropriately as DNA Papanicolaou (Pap) test, in the context of a high-risk group of women using the recently validated DNACitoliq LBC system. Women with suspected cervical disease were included in this cross-sectional study at a tertiary center in São Paulo, Brazil, for further workup. All women had cervical material collected for LBC and HC2 for high-risk human papillomavirus (hrHPV)-DNA test. Irrespective of cytology and HC2 results, colposcopy, and cervical biopsy when applicable, was systematically performed. All tests were performed blindly. Sensitivity, specificity, positive and negative predictive values, and overall accuracy of both methods were computed in relation to histology. A total of 1,080 women were included: 36.4% (393/1080) had ACUS+, 10.2% (110/1080) were high-grade squamous intraepithelial lesions (HSIL) or cancer. Mean age was 33.5 years. All women underwent colposcopy, and cervical biopsies were performed in 38.4% (415/1080): 33% (137/415) of the biopsies were negative, 14.4% (155/415) were low-grade squamous intraepithelial lesions (LSIL), 10.7% (116/415) were HSIL, and 0.6% (7/415) were cancer. HC2 sensitivity to diagnose biopsy-proven HSIL was 100%. Because all HSIL cases had a positive HC2 test, sensitivity could not be improved by adding LBC. Specificity and positive and negative predictive values of DNA Pap were not significantly different from HC2 test alone when considering LSIL+ histology as "gold standard" and HSIL+ histology. As a screening strategy for women with high-risk for cervical cancer, DNA Pap test does not seem to add substantially to HC2 alone in terms of appropriately referring to colposcopy.

Adolescent↗
PubMed2006

Cervical screening in HIV-positive women: characteristics of those who default and attitudes towards screening.

OBJECTIVES: To determine the characteristics of HIV-positive women who undergo cervical screening and to identify negative attitudes and experiences of these women to screening and the factors associated with these. METHODS: We compared the Royal Free Cohort data from 59 newly diagnosed HIV-infected women, 31 of whom did and 28 of whom did not attend for cervical screening in 2001, and from 227 women under active cervical screening follow-up (at least one cervical screen since June 2001) and 88 HIV-infected women lost to follow-up (not screened since January 2001). Attitudes to screening were investigated with the aid of a questionnaire given to all women attending clinic who had had a previous colposcopy. RESULTS: Of the 59 newly HIV diagnosed women, 31 (53%) underwent cervical screening. These 31 women were more likely to be heterosexual (100 vs 89%, P=0.05), to have lower median viral loads (< 50 vs 3210 HIV-1 RNA copies/mL) and to be receiving antiretrovirals (ARVs) (74 vs 54%, P=0.1) than those not screened. Of the 315 women who had at least one screen, 72% returned for further follow-up. There were no differences in age or ethnicity between these groups. Those under active follow-up had a higher CD4 count (P=0.04) and lower viral load (P=0.0001) at their last visit. They were also more likely to be on highly active antiretroviral therapy (HAART) (68 vs 52%, P=0.006). A total of 78 of 104 questionnaires (75%) were returned. Women participating in the questionnaire study were mainly of back ethnicity (68%), did not speak English as their first language (59%) and were taking ARVs (76%). Most agreed that regular smears and colposcopy were valuable. Women of white ethnicity, and those speaking English as a first language, were more likely to dislike colposcopy compared with those of nonwhite ethnicity (87 vs 25%, respectively, P=0.0007) and not speaking English as a first language (74 vs 26%, respectively, P=0.002). Those of white ethnicity were more likely to find smears and colposcopy painful (60 and 73%) compared with those of black ethnicity (46 and 51%, P=0.47 and 0.28, respectively). CONCLUSIONS: Our results suggest that women on HAART with better disease control, older women, and those of black African ethnicity are more likely to take up cervical screening. Cervical screening experience varies by ethnicity and language.

Adult↗
PubMed1992

The cytological detection of persistent cervical intraepithelial neoplasia after local ablative treatment: a comparison of sampling devices.

OBJECTIVE: To determine whether the cytological detection of persistent cervical intraepithelial neoplasia (CIN) after local ablative treatment is improved by the use of sampling devices other than the Ayre's spatula. DESIGN: A randomized controlled study. SETTING: Lothian Area Colposcopy Clinic. SUBJECTS: 856 patients who had received local therapy (CO2 laser or cold coagulation) for CIN II or III between 9 and 30 months earlier. INTERVENTION: Each patient had three consecutive cervical smears taken, one with the Ayre's spatula, one with either the Aylesbury, the Rocket or the Multispatula device, and finally one with the Cytobrush. The allocation of which spatula and the order of the first two was randomized. Each patient had a colposcopic examination immediately after the smears were taken. MAIN OUTCOME MEASURES: A comparison of the detection of histologically proven persistent CIN by the Ayre's spatula with the detection of persistent disease by alternative sampling devices. RESULTS: Of the 856 patients 130 had histologically proven persistent CIN. Another 98 had suspicious findings on colposcopy but punch biopsies reported as histologically normal. Of the remaining patients with normal colposcopy 130 were randomly selected to form a control group. The cervical smears from these 358 women were reported. Significantly fewer Ayre's samples contained endocervical cells than Aylesbury samples (47% vs 59%, difference 12%; 95% CI 3%-21%; P less than 0.001), Rocket samples (47% vs 67%; difference 20%, 95% CI; 12%-32%; P less than 0.001) or Multispatula samples (47% vs 76%; difference 29%, 95% CI 19-38%; P less than 0.001). When punch biopsies contained CIN, dyskaryotic cells were seen in 10% of Ayre's samples, 4.3% of Aylesbury samples, 8.3% of Rocket samples, and in no smear taken with the Multispatula. Obtaining a third smear with the Cytobrush did not substantially improve the detection rate of dyskaryosis. Neither the order of use of the spatulas, the form of initial treatment nor the size of the transformation zone had any apparent effect on the cytological detection of persistent CIN. CONCLUSIONS: We recommend that surveillance of patients who have received local ablative therapy for CIN should be by both cytology and colposcopy, and that cytological samples should be obtained using the Ayre's spatula.

Carcinoma in Situ↗
PubMed1997

Investigation of 100 consecutive negative cone biopsies.

OBJECTIVE: To investigate the reasons for cone biopsies reported as not containing intraepithelial or invasive malignancy and thereby find ways to decrease their incidence. DESIGN: One hundred cone biopsies reported as negative were identified out of a total of 436 consecutive cone biopsies. The patients' cytology, colposcopy and histology reports and cytology and histology slides were reviewed. Further opinions in cases of doubt were obtained in cytology and histology. In cone biopsies still considered negative after reviews, deeper levels were cut, exhausting all paraffin blocks. Follow up cytology, colposcopy and histology were reviewed. SETTING: Gynaecological oncology unit in a university teaching hospital. RESULTS: After re-evaluation the final diagnoses of cone biopsies initially reported as negative were positive (n = 21), unsatisfactory (n = 27) and true negative (n = 51), with one case excluded because of insufficient material for review. The positive cases were diagnosed on review (n = 11) or extra levels (n = 10). The unsatisfactory cases were all due to denudation. The 51 true negative cases were divided into those which never had had histologic confirmation by punch biopsy or endocervical curettage (n = 47) and those with a previously confirmed histological abnormality (n = 4). CONCLUSIONS: The number of negative cone biopsies can be reduced by: 1. taking Pap smears after correction of atrophy and inflammation; 2. more scrupulous colposcopy aimed at reducing the number of unsatisfactory colposcopies or misinterpreted colposcopic findings; this through examination should include the vagina and vulva; 3. confirmation of smear and colposcopic findings by biopsy prior to cold-knife conisation and performing a large loop excision of the transformation zone (LLETZ) for cases where there is a discrepancy between the smear abnormality and colposcopy/biopsy findings; 4. good quality cone biopsies using a technique that does not handle the mucosa and is performed after the mucosa has had time to regenerate following the colposcopic investigations; and 5. exhausting all blocks with multiple levels before reporting a cone biopsy as negative.

Adult↗
PubMed1999

Human papillomavirus type 16 and 18 detection in the management of mild dyskaryosis.

OBJECTIVE: To determine if semi-quantitative human papillomavirus (HPV) types 16 and 18 detection by polymerase chain reaction can increase the sensitivity and specificity of repeat cytology alone for underlying high grade cervical intraepithelial neoplasia (CIN). DESIGN: Prospective randomised study of immediate treatment and surveillance. SETTING: A dedicated colposcopy clinic serving a regional population. SAMPLE: Three hundred and four women with smears reported as mild dyskaryosis. METHODS: Repeat cytology, HPV 16 and 18 tests, and colposcopy were performed at study entry. Women were randomised to either immediate treatment or surveillance with repeated tests at 6 and 12 months. Unless all study smears were negative, women were treated at study exit by large loop excision of the transformation zone. MAIN OUTCOME MEASURES: Sensitivity and specificity of HPV testing for types 16 and 18 in conjunction with cytology for high grade CIN. RESULTS: Combining repeat cytology with HPV 16 and 18 testing had a sensitivity of 94% and a specificity of 26%, a positive predictive value of 71%, and a negative predictive value of 71%, for underlying high grade CIN. If used to secondary screen in conjunction with repeat cytology for mild dyskaryosis, 88% of women would have been referred for colposcopy on the basis of either test being positive. CONCLUSION: Combining repeat cytology and HPV 16 and 18 detection would result in the majority of women being referred for immediate colposcopy. Taken with an overall default rate of 17%, immediate referral of all women with mild dyskaryosis for colposcopic assessment still appears to be a more effective clinical strategy.

Colposcopy↗
PubMed2004

Colposcopic and histologic findings in women with a cytologic diagnosis of atypical squamous cells of undetermined significance.

BACKGROUND: The optimal method for managing a patient diagnosed with atypical squamous cells of undetermined significance (ASCUS) has not yet been established. The interim guidelines published by the National Cancer Institute suggest that a patient should be referred for colposcopy after the second ASCUS diagnosis within 2 years. AIM: To assess the significance of ASCUS in predicting the presence of underlying squamous intraepithelial lesion (SIL) of the uterine cervix. STUDY POPULATION: Women undergoing colposcopy for ASCUS cytology at a teaching hospital in Tehran University, in the years 1998-2001, considered eligible to enter this retrospective study. RESULTS: Of the 266 patients who underwent colposcopy, 28 (11%) had low-grade squamous intraepithelial lesion (LSIL), 16 (6.3%) had high-grade squamous intraepithelial lesion (HSIL) two (0.8%) had squamous cell carcinoma (SCC), and 48 (18.8%) had flat condyloma. CONCLUSION: Atypical squamous cells of undetermined significance (ASCUS) on a cervical smear is a good marker for detecting underlying SIL and condyloma. Thus, immediate colposcopy and directed biopsy are appropriate follow-up procedures.

Adult↗
PubMed1993

Outcome of cold coagulation for the treatment of cervical intraepithelial neoplasia in a department of genitourinary medicine.

OBJECTIVE: To evaluate the outcome of "cold coagulation" as a treatment modality for major grade cervical pathology, cervical intraepithelial neoplasia (CIN 2 and 3) in a department of genitourinary medicine. DESIGN: Prospective programme trial with 18 month follow-up of patients undergoing "cold coagulation" of the cervical transformation zone following colposcopic assessment and biopsy. SETTING: A genitourinary medicine colposcopy clinic. PATIENTS: 125 female patients with histologically proven major cervical pathology (CIN 2 and 3). The mean age of the patients was 24.5 years; 73% were unmarried, 43% currently smoked and 62% had a history of exposure to the human papilloma virus. MAIN OUTCOME MEASURES: Eradication of cervical abnormality with cytological findings at 4, 8 and 12 months and colposcopy at 18 months, with intervention colposcopic assessment if follow-up cytology was abnormal. RESULTS: Eradication of CIN was achieved in 96.5% of patients, the majority of treatment failures being detected at first cytology. Attendance for follow-up was good, with only a 16% default rate. Final colposcopy yielded five treatment failures. No major complications were noted. CONCLUSION: These results confirm that "cold coagulation" provides an acceptable, efficient and effective, low cost consumer friendly treatment for CIN 2 and CIN 3 in an out-patient genitourinary medicine colposcopy clinic.

Adolescent↗
PubMed2002

Role of the vaginal microbiological ecosystem and cytokine profile in the promotion of cervical dysplasia: a case-control study.

OBJECTIVE: To identify alterations in the cytokine profile and microbial ecosystem of the vagina in association with cervical dysplasia. METHODS: Demographics, lifestyle variables and Papanicolau (Pap) smear results of subjects presenting to the same site for gynecologic complaints, obstetric visits or colposcopy were prospectively recorded. Vaginal smear for Gram stain, aerobic and anaerobic culture, pH, and wet mount and KOH examination for Trichomonas vaginalis, Gardnerella vaginalis and yeast organisms were performed. Vaginal lavage specimens were centrifuged, and the pellets and supernatants were assayed for human papillomavirus (HPV) by polymerase chain reaction and for cytokines interleukin (IL)-1beta IL-6, IL-10 and IL-12 by enzyme-linked immunosorbent assay (ELISA) respectively. Subjects with abnormal Pap smears underwent colposcopy and biopsy as indicated. RESULTS: Of 51 patients, 32 were referred for colposcopy, 12 presented with gynecologic needs, and seven presented for obstetric visits. Median age was 24 years. Demographics did not differ significantly between the dysplasia and control groups except for a trend towards more sexual partners in the dysplasia group. Biopsies were performed in 81% (26/32) of patients presenting for colposcopy and 17 revealed cervical intraepithelial neoplasia. IL-1beta, IL-6, IL-10, and IL-12 levels were elevated in 63% (20/32), 38% (15/39), 4% (2/49), and 0% of samples respectively. Elevated vaginal lavage IL-1beta was associated with a 6.1 odds ratio (95% confidence interval 1.06-35) of cervical dysplasia. Alterations in other variables studied were not associated with cervical dysplasia. CONCLUSIONS: Elevated IL-1beta, possibly representing a complex host inflammatory response to multiple pathogens, was demonstrated in patients with cervical dysplasia.

Adolescent↗
PubMed2001

Adolescents with ASCUS: are they a high risk group?

Population demographics, risk behaviors, and compliance rates for the management of an ASCUS (atypical squamous cells of undetermined significance) diagnosis are not well studied in the adolescent population. From June 1994 to December 1996, 1,175 Papanicalou (pap) smears were performed in an urban adolescent clinic on patients age 12 to 18. Of these, 124 (10.5%) were diagnosed with ASCUS or ASCUS with a qualifying statement. A retrospective chart review (n=83) and telephone interview was performed on patients with ASCUS. Ninety-nine percent of enrollees were African American. Comparisons were made between those patients with normal pap smears and those with ASCUS. No statistically significant difference existed pertaining to age at pap smear, age at menarche, age at first coitus, and education level. A positive association was found in the ASCUS group for the presence of sexually transmitted diseases (P < 0.001), number of sexual partners (P < 0.0007), and pregnancy (P < 0.001). Of the 80% of patients who had an ASCUS diagnosis and were referred for colposcopy (n = 62), only 61% attended their appointment (n = 38). Thirty-nine percent of these patients were aware of an abnormal diagnosis after colposcopy. For those that attended colposcopy, 56% were accompanied by a parent. For those who were not compliant with attendance, none cited parental consent for the procedure as a barrier to obtaining treatment. Adolescent females in an urban setting with multiple sexual partners, history of sexually transmitted diseases, and prior pregnancy are at a greater risk for ASCUS on cervicovaginal smear when compared to their age-matched controls. In addition, the adolescent compliance rate for colposcopy is low. We, therefore, recommend that these adolescent females be observed diligently.

Adolescent↗
PubMed2005

Evaluation of a digital store-and-forward colposcopic system--a pilot study to assess usability for telemedicine.

We evaluated the diagnostic reliability of cervical examination using digital colposcopy compared with conventional binocular colposcopy. A total of 315 patients were examined and diagnosed by a colposcopist on-site. During the colposcopic examination, digital camera images were stored on a PC (median five pictures per patient). A second physician, experienced in colposcopy, re-evaluated the initial diagnostic findings using the stored digital images. The primary and secondary findings in each patient were categorized according to the Rome classification system. There was agreement between the primary and secondary examiners in 69% of cases (kappa=0.60). There was no systematic bias in terms of under- or over-rating. The proportion of non-assessable colposcopic examinations was 9%. Digital colposcopy was reliable and provided advantages in terms of a better follow-up examination and internal quality control of the diagnosis. The pilot study suggests that telecolposcopy may provide better training and further education for physicians and students, and may also improve the diagnostic possibilities in gynaecology.

Adult↗