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PubMed1985

Colposcopic screening of women with atypical Papanicolaou smears.

A retrospective study was done on 575 patients with atypical Papanicolaou smears obtained during a ten-year period (1974-83) at Bellevue Hospital-New York University Medical Center. The smears were classified into three categories. The first consisted of 463 patients (81%) with inflammatory atypia specifically treated for Trichomonas, Monilia, Chlamydia, Gardnerella and atrophic vaginitis. Of them, 162 patients (35% of the group) had persistent inflammatory atypia 90 days after the beginning of therapy and were subjected to colposcopic examination. The second group consisted of 86 patients (15%) with squamous atypia. That group underwent colposcopic examination. The third group, 26 patients (4%), had endocervical atypia and underwent colposcopy and endocervical curettage. Overall, of 162 patients with persistent inflammatory atypia, 36 (22%) were found to have cervical intraepithelial neoplasia (CIN); of 86 with squamous atypia, 60 (70%) had CIN; and of 26 with endocervical atypia, 15 (58%) had CIN. Fifty-eight (28%) of all the patients with CIN had lesions of severity greater than CIN 1. It appears that all patients with persistent inflammation or squamous or endocervical atypia would benefit from colposcopic screening.

Biopsy↗
PubMed1978

Comparison of histologic and colposcopic findings in DES-exposed females.

A study was undertaken to evaluate the histologic alterations associated with two of the most abnormal colposcopic findings, mosaicism and punctation, that are commonly found in the vaginas and cervices of young women who have been exposed prenatally to diethylstilbestrol (DES). Four-fifths of 215 biopsy specimens from 171 exposed subjects with mosaicism or punctation disclosed metaplastic squamous epithelium, the presence of which is thought to reflect the repair of vaginal adenosis and cervical ectropion. Hyperkeratosis was observed in one-fifth of the specimens and was more frequent in lesions colposcopically graded I than II. Mild dysplasia was encountered in only one specimen. The findings indicate that the presence of squamous cell dysplasia cannot be predicted by the finding of Grade I or II mosaicism or punctation in the DES-exposed female despite the fact that these abnormal colposcopic patterns are associated with dysplasia in about 10% of cases when encountered in the cervix of the unexposed woman.

Colposcopy↗
PubMed1982

Colposcopic patterns and their histopathologic correlation.

White epithelium, mosaicism, punctation, and atypical vessels are internationally used colposcopic terms describing an atypical transformation zone. Other morphologic findings are surface contour, clarity of demarcation, and tone of whiteness with or without atypical vessels. In the State University of New York at Buffalo affiliated hospitals, 665 cervical and vaginal atypical colposcopic patterns of 552 patients were matched with their histologic findings. Mosaicism, punctation, and white epithelium correlated with the histologic diagnosis of vaginal intraepithelial neoplasia and cervical intraepithelial neoplasia in 43%, 55%, and 42% of the cases, respectively. When white epithelium accompanied the mosaicism or punctation, the incidence of histologically confirmed vaginal and cervical intraepithelial neoplasia raised to 66% and 68%, respectively. In patients with prenatal DES exposure, mosaicism rarely (17%) correlated with the histologic findings of vaginal and cervical intraepithelial neoplasia. Overall, there was a great variability in the correlation depending on the specific colposcopic abnormalities.

Cervix Uteri↗
PubMed1981

[Colposcopically "suspicious" and atypical findings from portio vaginalis uteri of women in pregnancy (author's transl)].

Described in this paper is the phenomenon of "suspicious" colposcopic findings and their histomorphological relevance, with reference being made to colpophotographic follow-up checks of pregnant women over several years. Colposcopy has been upgraded, in recent time, and it is against this background that its potential efficacy and limitations are assessed and compared to cytological techniques, on the basis of "suspicious" colposcopic findings. A general assessment also is made of the diagnostic expectations which can be hinged on either method of tracing. Twenty in 450 cases of carcinoma in situ and severe dysplasia were combined with processes of pregnancy, between 1962 and 1979, among them four cases which had been under colposcopic and cytological monitoring. In two of these cases constant behaviour of the epithelium was established up to postpartal or postabortal confirmation by cytograms, while the other two cases were thought to be attributable to gestational developments, with tissue being suspicious or progressive growth.

Adult↗
PubMed1993

[The combined colposcopic index as a diagnostic method in human papillomavirus infection and cervical intraepithelial neoplasia].

This is a prospective, comparative study of 142 patients of combined colposcopic index according to Reid's criterium and the index used at the Clinics of Colposcopy, Gyn-Ob Hospital "Luis Castelazo Ayala", IMSS. Seventy two patients were studied with the Hospital Index, and 70 with the CCI. This constituted by neatness of peripheral edges, the color, characteristics of vessels and iodine tinction; a score of 0, 1, 2 was given, the sum of which gave a final qualification, and it was traspolated to a colposcopic diagnosis. The CCI correlated with the histological diagnosis in 64 patients (91.42%); while for the Hospital Index it was in 61 cases (84.7%). The indexes showed a good sensitivity (0.95), a high positive predictive value (0.95 vs 0.88), and adequate accuracy (0.91 vs 0.84), as well as a good prevalence (0.90 vs 0.85). It is concluded that the CCI is reliable for the colposcopic diagnosis of human papillomavirus and for CIN.

Colposcopy↗
PubMed1977

[Diagnostic conization of the uterine cervix. II. Comparison of histological diagnoses with cytological and colposcopic tentative diagnoses].

This report presents colposcopic and cytologic misinterpretations in cases with a cervical intraepithelial neoplasia or early invasive carcinoma and benign cervical lesions and the accuracy of these two methods of screening for cervical cancer. The accuracy of the cytology and of the colposcopic impression in predicting the degree of cervical intraepithelial neoplasia and early invasive carcinoma was over 93 per cent. In patients showing benign cervical lesions the cytology is more accurate in predicting the correct histologic change with 94,2 per cent than the colposcopic impression with 63,1 per cent. The suspicious smears (Papanicolaou III) are discussed.

Carcinoma in Situ↗
PubMed1976

Vaginal adenosis. Factors influencing detection in a colposcopic evaluation.

In a colposcopic evaluation of DES-related genital abnormalities, biopsy-proven adenosis was detected in the vaginal walls or hood in 84.5% of 220 women. Patient selection (DES history only vs prior examination) did not significantly influence the detection rate for adenosis. However, the detection rate of adenosis in the vaginal walls showed highly significant correlations with the presence of cervical ectopy and/or hood and with the colposcopic appearance of the area biopsied. Using colposcopy, the columnar pattern had a diagnostic accuracy of 94.4%; mosaic pattern, 85.5%; and white appearance, 68.0%. Differences in the histologic features of mucosal surface glandular tissue, squamous metaplasia, and nonglycogenated squamous mucosa were related to specific colposcopic patterns and helped to account for the variation in the accuracy of the three appearances in detecting adenosis. Biopsy specimens of the hood were not necessary to achieve a high yield of adenosis although we obtained evidence that the hood contains microscopic features typical of vaginal adenosis. Epithelial atypicality in the vagina (moderate squamous cell dysplasia) was demonstrated in only 1 patient.

Adolescent↗
PubMed1990

Endocervical curettage by Vabra aspiration as part of colposcopic evaluation.

Endocervical curettage as routine part of colposcopic examination in patients with abnormal cervical cytology is recommended by many experts. Endocervical curettage (ECC) by Vabra aspiration has never been reported in literature. The results of Vabra ECC in 103 patients are analyzed and compared to the results of a second endocervical specimen, obtained by conventional curettage, cone biopsy, or hysterectomy. An accordance of over 98% is demonstrated and the difference is discussed. In 88% and 71% adequate Vabra ECC specimens were available for cytological and histological examination, respectively. In any patient at least one result was present. Both cytological and histological specimens are of reliable quality. No cases of invasive (adeno)carcinoma were missed. In addition, the results are compared to literature data concerning Vabra aspiration for endometrial disease and ECC by other techniques. Vabra ECC is considered an efficient, safe, and well-tolerated diagnostic outpatient method and recommended as a standard part of colposcopic evaluation.

Adult↗
PubMed1996

The colposcopic examination.

A well-organized and complete colposcopic examination is a vital component of the evaluation of a patient with an abnormal Papanicolaou smear. The properly administered colposcopic examination requires patient preparation, correct equipment and an experienced colposcopist. Under magnified illumination, the cervix is examined for abnormalities. Visualization of premalignant and malignant changes guides the colposcopist in the choice of cervical biopsy sites. The severity and extent of disease can then be histologically determined, and appropriate treatment initiated.

Biopsy↗
PubMed1996

Correlation between colposcopically directed biopsy and cervical loop excision.

Colposcopy is standard for diagnosis of cervical cancer precursors, but the development of diathermy loop electrodes for excision of the cervical transformation zone offers a technique for validation. Loop excision of the transformation zone was performed for 47 consecutive women with dysplasia in colposcopically directed biopsies using 20 x 8-mm electrodes. Specimens were marked for orientation and serially sectioned. All pathology material was reviewed. Although 28% of women had disappearance of dysplasia at the biopsy site, only 9% had no dysplasia in the transformation zone. Half of the women with CIN 1 on directed biopsy had high-grade lesions found in loop excision specimens. Significant discrepancies may be found between the results of colposcopically directed biopsy and loop excision.

Adult↗
PubMed2001

The correlation between colposcopically directed cervical biopsy and loop electrosurgical excision procedure pathology and the effect of time on that agreement.

OBJECTIVE: The goal of this study was to evaluate whether colposcopically directed cervical biopsy accurately predicts histopathology found on loop electrosurgical excision procedure specimen and to assess whether this correlation was affected by a delay in treatment of greater than 12 weeks. METHODS: A retrospective review was performed of all cervical biopsy and loop electrosurgical excision procedure pairs performed at University of Arizona Medical Center between March 1992 and March 2000. Agreement was assessed by kappa statistics and Spearman rho coefficients. A subgroup analysis was performed to assess the effect of a delay greater than 12 weeks between cervical biopsy and loop excision on the histopathologic correlation. RESULTS: An 84% agreement was found between cervical biopsy histopathology and loop electrosurgical excision procedure histopathology when compared to within 1 degree (kappa = 0.78, P < 0.0001; Spearman rho = 0.40, P < 0.0001). This agreement remained strong (87%) even when loop electrosurgical excision procedure was delayed greater than 12 weeks (kappa = 0.81, P = 0.01). CONCLUSION: Colposcopically directed cervical biopsy correlated strongly with loop specimen histopathology. A delay in loop electrosurgical excision procedure greater than 12 weeks does not negatively affect this correlation. This delay of 12 weeks may be used safely in the future to test chemotherapeutic dysplasia treatments.

Adolescent↗
PubMed1975

Colposcopic evaluation of the abnormal Papanicolaou test in pregnancy.

Colposcopy, including colposcopically directed biopsies in selected cases, was employed to evaluate over 300 pregnant patients with abnormal Papanicolaou tests suggestive of mild dysplasia or worse (Class III to V). Over half of the patients had benign disorders determined by colposcopic examination. All cases of invasive disease were diagnosed by colposcopy and biopsy, and the patients were treated accordingly. Only 3 diagnostic conizations were necessary in the antepartum period. The majority of patients with cervical intraepithelial neoplasia were seen post partum, and appropriate therapy was instituted. In the pregnant patient with an abnormal Papanicolaou test, colposcopy has proved to be a reliable and safe method of evaluation and has virtually eliminated the need for conization.

Biopsy↗
PubMed1986

An analysis of the factors involved in the colposcopic evaluation of 2194 patients with abnormal Papanicolaou smears.

Two thousand one hundred ninety-four patients with abnormal Papanicolaou smears were evaluated by colposcopy without endocervical curettage in the initial part of the series but with routine endocervical curettage in the latter part. Forty-two cases of microinvasion-invasion were all accurately diagnosed with no postcryotherapy occurrence of these lesions. Evaluation of the Papanicolaou smear, colposcopic biopsy specimens, squamocolumnar junction location, and use of surgical removal for severe dysplasia-carcinoma in situ appeared to be most important in the successful outcome. Endocervical curettage played a minor role. Multiple positive cross correlations between Papanicolaou smear severity, colposcopic biopsy specimen severity, squamocolumnar junction nonvisualization, positive results of endocervical curettage, increased lesion size, increased age, and microinvasion-invasion occurrence were all demonstrated.

Adolescent↗
PubMed1990

The relative significance of colposcopic descriptive appearances in the diagnosis of cervical intraepithelial neoplasia.

Four hundred and seventy seven colposcopic appearances have been analysed in 252 patients to determine their histopathological correlation and clinical efficiency in the diagnosis of cervical intraepithelial neoplasia (CIN). Immature metaplasia, cervical ectopy and cervicitis produced a considerable quotient of abnormal colposcopic appearances. Acetowhite epithelium had the highest sensitivity (92%), lowest specificity (25%) and a positive predictive value of 61%. Mosaicism and punctation were less sensitive (30 and 38%), but more specific (89 and 85%), respectively and had superior positive predictive values.

Biopsy↗
PubMed1991

Grading colposcopic appearance: paired comparison between two methods for differentiating benign papillomaviral infection from high-grade dysplasia of the uterine cervix.

Histologic features of 134 cases of human papilloma virus (HPV) cervical infection and cervical intraepithelial neoplasia (CIN) were reviewed and correlated with colposcopic diagnosis on the basis of two different grading methods: International Nomenclature for Colposcopy showed 79.1% predictive accuracy and Reid's improved colposcopic index 86.6% of accurate predictions (significant difference at P less than 0.05). Overestimation difference was the most significant, with 23 overestimates in International Classification and 11 in Reid's score (P less than 0.01).

Cervix Uteri↗
PubMed1989

Colposcopic and cytologic detection of chronic lymphocytic leukemia.

We report the finding of chronic lymphocytic leukemia (CLL) in the cervix and vulva diagnosed during a gynecologic work-up of postmenopausal bleeding. Cervical cytology showed atypical lymphocytes. Colposcopic examination of the cervix identified an abnormal area. A colposcopically directed punch biopsy revealed a lymphoproliferative infiltrate consistent with CLL.

Aged↗
PubMed1990

Colposcopic diagnosis and treatment of cervical dysplasia at a single clinic visit. Experience of low-voltage diathermy loop in 1000 patients.

In a study of 1000 women referred over 20 months with abnormal smears and in whom the entire transformation zone could be seen the aim was to test the feasibility of colposcopic assessment and treatment at one visit to the clinic. 897 women needed only one visit. This was achieved by using a modification of the large loop diathermy excision technique and by careful attention to the timing of the clinic visit. 103 required further visits, for the following reasons: incomplete excision on histology and/or subsequently abnormal smear (85), secondary haemorrhage (6), microinvasion or invasive carcinoma (9), biopsy specimens unusable (3). Further treatment was given in 4.1% of the cervical dysplasias. All patients treated in a single visit preferred this approach to the alternative of colposcopic assessment and biopsy followed, after histological examination, by local ablation by laser, excision by loop biopsy technique, or cone biopsy.

Biopsy↗
PubMed1991

Interpretations of colposcopic photographs: evidence for competence in assessing sexual abuse?

Accurate assessment of physical findings for child sexual abuse is medically and legally important. This study evaluated (1) interobserver reliability of clinicians rating colposcopic photographs, and (2) correlates of reliable interpretations. Seventy physicians and two nurse practitioners, divided by professional levels, assessed colposcopic photographs and completed a questionnaire. Ratings by a professional with extensive experience in this field were used as an accuracy standard. Leaders in the field of child sexual abuse assessment made significantly more "accurate" assessments than pediatricians, pediatric and family practice residents, and intern physicians. Leaders made fewer "inaccurate" interpretations than interns. Predictors of agreement with standard assessments, although weak, were knowledge of female perineal anatomy and professional level. Total number of sexual abuse examinations conducted and knowledge of sexually transmitted diseases as acquired by children were not significant predictors of accurate assessment. The findings are interpreted as to their potential relevance to actual sexual abuse evaluations of children.

Child↗