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PubMed2001

Colposcopy 101: a didactic curriculum to complement the clinical experience.

The family medicine faculty who perform colposcopy at the University of Missouri-Columbia have developed an innovative didactic curriculum that is used as an adjunct to the clinical experience in teaching family practice residents about colposcopy. The curriculum is taught weekly during a colposcopy conference that is held in the family practice center and includes core topic lectures, pathology-correlate lectures, and a journal club. The core lecture series has 26 topics that range from basic to advanced colposcopy. Pathology-correlate lectures combine pathologic evaluation with the clinical colposcopic examination. The journal club systematically reviews and evaluates the colposcopy literature.

Clinical Competence↗
PubMed1992

Colposcopy in a family practice residency. The first 200 cases.

BACKGROUND: The incidence of abnormal Papanicolaou smears has increased dramatically in the last decade. Many family physicians now find it necessary to perform colposcopies themselves to provide optimal care for their patients. There is little literature that evaluates the performance of this procedure by family physicians. METHODS: The findings of the first 200 colposcopies performed in a community hospital-based family practice residency program are reported. Descriptive data were prospectively gathered between August 1987 and December 1989. RESULTS: The median age of the patients was 25 years, the median number of sexual partners was three, and the median age at the time of first sexual intercourse was 17 years. The majority had colposcopy performed because of a class III Papanicolaou smear (108 [54%]). Twenty-five (12.5%) were pregnant at the time of colposcopy; for this reason a biopsy was not performed on 19 of the patients. An average of three distinct cervical lesions were seen in each patient. The most frequent histologic finding was some degree of dysplasia (116 of 181 biopsied [64%]). Twenty-two cases of severe dysplasia (carcinoma in situ) were found. However, no cases of invasive carcinoma were found. CONCLUSIONS: High-quality colposcopy and effective treatment with appropriate referral can be done at the primary care level for most patients. Many patients failed to return for follow-up evaluation after treatment, indicating the need for better tracking of patients.

Adolescent↗
PubMed2004

Does improving communication and information for women increase attendance at colposcopy in an inner city clinic? A randomised controlled trial.

PURPOSE: To establish whether information leaflets and appointment reminders improve attendance for diagnostic colposcopy. DESIGN & SETTING: Randomised controlled trial in an inner city colposcopy clinic. PARTICIPANTS: 500 women newly referred to the colposcopy clinic with abnormal cervical screening smear results were randomly assigned to an intervention or control group using computer-generated numbers. INTERVENTION: 233 women referred for colpoposcopy were sent a comprehensive information leaflet with their appointment details and additionally were sent reminder letters regarding their appointment 7-10 days prior to their appointment date. CONTROL: 267 women were sent the standard basic information prior to their appointment. MAIN OUTCOME MEASURE: Attendance and default rates for diagnostic colposcopy. RESULTS: Default in the intervention arm was 42 out of 233 (18%) compared with 93 out of 267 (35%) in the control arm. CONCLUSION: Improved communication and information in the form of a detailed leaflet and a reminder letter for women with a recently abnormal smear result increased attendance for initial colposcopy assessment.

Adult↗
PubMed2005

Findings and outcome of teenage women referred for colposcopy at Christchurch Women's Hospital, New Zealand.

AIM: To determine the colposcopic findings, treatment, and follow up of 15-19 year old women referred to a large public colposcopy clinic. METHOD: A retrospective review of the colposcopy database and clinical records between 1995 and 2001. RESULTS: 243 women or 4.7% of new referrals were aged 15-19 years. Referral smears were high-grade squamous lesions (HGSL) in 15%, and low-grade squamous lesions (LGSL) or atypical squamous cells of uncertain significance (ASCUS) in 82%. Following colposcopy, 21% had biopsy proven high-grade abnormalities but only 4% had grade 3 cervical intraepithelial neoplasia (CIN3). Of those with LGSL or ASCUS smears, 2% had biopsy-proven CIN3; and of those with HGSL smears, 14% had biopsy proven CIN3. Women underwent a mean of 4.1 colposcopy sessions; 67% underwent treatment and 26% were discharged without treatment. Sixteen percent of the women were lost to follow-up. Treatment failure occurred in 8% of those treated. For women undergoing observation, 25% were discharged after the first follow-up and less than 3% progressed to CIN3. CONCLUSIONS: The rate of CIN3 in women under the age of 20 referred to colposcopy at Christchurch Women's Hospital is low. Screening teenage women results in invasive investigation and treatment without proven benefit and is not recommended. A conservative approach to the management of young women with low-grade squamous intraepithelial abnormalities is also advocated.

Adolescent↗
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↗
PubMed1990

Colposcopy as a method of management strategy in CIN and microinvasive cancer.

During nearly 40 years of using colposcopy, an original management strategy in CIN and early cervical cancer was developed and confirmed in 2 study groups of cervical lesions containing respectively 1228 and 6001 cases. This approach is based on colposcopy as the main method in early detection of CIN and cancer, with supplementary cytology in necessary cases, and on a coloposcopic-histological staging of these lesions for treatment qualification. Colposcopy alone is a fairly adequate method for diagnosis of 60% of examined cases, and coloscopy with directed biopsy in the next 20% of colposcopically highly suspect findings. Only in the remaining 20% of colposcopically less suspect findings and in the cases of "unsatisfactory colposcopy", supplementary was cytology required. In this study colposcopy findings connected with histological evaluation of the specimens provided a basic way for determining the advancement of processes and the selection method for the appropriate type and extent of treatment. CIN 1 and 2 and small focuses of CIN 3 including CIS entirely visible on the ectocervix, in childless young women were treated by cryosurgery. In all remaining cases of CIN 3, the basic therapeutic method was cold-knife conization. In exceptional cases simple hysterectomy can be a more adequate treatment. Depending on our colposcopic-histological staging, in Stage IA1--conization, whereas in Stage IA2--a moderately extended hysterectomy should be optionally performed. The management strategy introduced is an economical, fully effective and quick way of detection and selection of the method for the treatment of CIN and early cervical cancer.

Biopsy↗
PubMed1987

Positive endocervical curettage in patients with satisfactory and unsatisfactory colposcopy: clinical implications.

We studied a total of 177 patients with cervical intraepithelial neoplasia or invasive carcinoma to evaluate the clinical implications of a positive endocervical curettage. All patients underwent cervical conization. One hundred and ten women had unsatisfactory colposcopy; 67 had satisfactory colposcopy. Patients with unsatisfactory colposcopy had a higher frequency of invasive lesions in the endocervix (9 versus 1.5%, P less than .05) and involvement of internal cone margins (12 versus 0%, P less than .01); they were also more likely to require additional, frequent treatment for persistent or recurrent disease (9 versus 1%, P less than .05) than patients with satisfactory colposcopy. Histologic review of the cone specimens in patients with satisfactory colposcopy revealed no lesion deeper in the endocervical canal than was predicted by colposcopic examination. These observations suggest that selected patients with positive endocervical curettage may be managed without diagnostic conization, if they had a satisfactory colposcopic examination.

Biopsy↗
PubMed1993

Microcolposcopy vs colposcopy in evaluating abnormal Pap smear. Comparison with histological findings.

Microcolposcopy is a microscopic examination which permits the observation of in vivo normal and dysplastic cells. A comparison was made between colposcopy and microcolposcopy in terms of sensitivity, specificity and predictive value in the diagnosis of cervical intraepithelial neoplasia. Seventy-eight patients with abnormal cervical smears were submitted to colposcopy, microcolposcopy and one or more biopsies on the microcolposcopically suspected areas. Currents classifications were used for the colposcopy and microcolposcopy. A comparison was made between the colposcopic description of abnormal transformation zone, and the microcolposcopic grade 2. The findings suggests that microcolposcopy is more sensitive and has more diagnostic accuracy than colposcopy in the diagnosis of cervical intraepithelial neoplasia. Microcolposcopy is a good alternative to colposcopy in evaluating abnormal cervical cytology.

Adult↗
PubMedDate not supplied

"I hope I don't have cancer": colposcopy and minority women.

PURPOSE: To determine what women scheduled for colposcopy knew about the procedure and to understand their concerns about the test and its implications. DESIGN: Descriptive, exploratory, qualitative. SAMPLE AND SETTING: All women scheduled for colposcopy in a three-month period (n = 29) in an inner-city academic center in the northeast United States. The sample consisted of African American (66%), Hispanic (31%), and white (3%) women ranging in age from 17-59 years (x = 39 years). METHODS: Women were interviewed on the telephone or in person and were asked seven open-ended questions about why they were referred and what they expected would happen at the appointment. Interviews were content analyzed. FINDINGS: Four themes common to the women's responses emerged from the interview data: fear about their health, apprehension about the colposcopy, uncertainty about the meaning of the Pap test, and pervasive lack of knowledge. CONCLUSIONS: These results suggest that women in this study scheduled for colposcopy had little factual information about the test or its implications, were anxious about the appointment, and wanted more complete information. IMPLICATIONS FOR NURSING PRACTICE: Nurses cannot assume that women understand the reasons for their referral for colposcopy or the implications of the test. These study results imply that lengthened appointment time might be required to provide appropriate education and help alleviate women's anxiety. Future nursing research should examine the effect of anticipatory counselling and education for this group of women.

Adolescent↗
PubMed1997

[Colposcopy and cervical biopsy in patients with routine Papanicolaou smear].

The objective of this report was to assess the sensitivity and specificity of Pap smear and to evaluate if routine colposcopy can improve cervical screening. One hundred and fifty patients undergoing routine cervical cytologic screening in our outpatient clinic were randomly selected. All patients were evaluated by colposcopy and cervical punch biopsy. Pap smears and biopsies specimens were interpreted independently. Colposcopy was performed and interpreted without knowledge of cytologic or histologic findings. The statistical analysis was carried out with a chi square (chi 2) test. A P value of less than 0.05 was considered significant. Twenty three patients (15.3%) who had biopsy proved to have cervical pathology. Pap smear identified only 4/23 (17%) of these patients. Colposcopy noted atypical transformation zones in 20/23 (97%), P < 0.001). Fifteen of 27 patients (55.5%) with negative Pap smears had colposcopic anormalities and histologically proved cervical intraepithelial neoplasia (CIN). We concluded that it is necessary to improve sensitivity and that colposcopy may enhance cervical screening particularly in women with otherwise negative Papapnicolaou smears.

Adult↗
PubMed1976

Colposcopy screening for cervical cancer in a family planning program.

A brief history is presented of colposcopy in the United States and at Louisiana State University. Incorporation of colposcopy screening as a part of the cervical cancer screening program in the Louisiana Family Planning Program is discussed, and the reasons for the need of "in house" colposcopy service are outlined. Data of the Louisiana Family Planning Program Colposcopy Service for the three-year period 1972 through 1974 are presented. Analysis of these data reveals that cytology when used without colposcopy fails to reveal the presence of major cervical pathology in 30.2% of patients. It is concluded that colposcopic screening must be a part of all family planning and cervical cancer detection programs.

Colposcopy↗
PubMed1998

Natural history of false-negative papanicolaou smears: a prospective study using screening colposcopy in addition to cytology.

The regular Papanicolaou (Pap) smear is cornerstone of women's preventive healthcare. The introduction of the regular Pap smear as a screening tool for cervical cancer has markedly decreased the number of deaths from cervical cancer. During the past decade, however, the rate of death from cervical cancer has remained relatively static. This screening method is known to have a high rate of false-negative results; therefore, serial examinations are necessary for optimal sensitivity. The sensitivity of the routine pelvic examination is further increased with the addition of colposcopy to cytologic screening. Patients identified as having disease by colposcopy and biopsy but not by Pap smear (false-negative), are followed up, and the progression of their disease is documented until the Pap smear reflects the known change. A total of 276 patients whose Pap tests showed "no abnormal cells" and mild dysplasia (CIN-1 [cervical intraepithelial neoplasia]) by colposcopy and biopsy, who opted not to be treated, were followed up as a function of time. The results of the Pap test on the 276 patients progressed to a low-grade squamous intraepithelial lesion (LGSIL) or higher within 42 months. In this study, false-negative Pap tests that were identified by simultaneously performed colposcopy became positive within 42 months; therefore, careful repetitive screening is necessary. The author argues that a definitive, prospective study on the addition of colposcopy or similar adjunct procedure to the routine pelvic examination, in selected cases, is needed.

Biopsy, Needle↗
PubMed2003

Is it clinically useful to repeat a pap smear at colposcopy?

OBJECTIVE: To assess the role of repeating a Pap smear at the time of colposcopy performed within 6 months of a referent Pap smear. MATERIALS AND METHODS: A clinical database was queried to identify colposcopies performed within 6 months of a referent abnormal squamous Pap smear at which time a repeat Pap smear was obtained. All Pap smears and cervical biopsy specimens were interpreted at an affiliated hospital laboratory. Referent Pap smears, repeat Pap smears, colposcopic cervical biopsy results, patient age and ethnicity, and the interval since the referent Pap smear were tabulated. A hierarchy of Pap smear results was defined a priori to characterize the relative differences between the referent and repeat Pap smears. Results of repeat smears and cervical biopsies were contrasted with the referent Pap smears. An assessment was made of the clinical usefulness of the repeat Pap smear. RESULTS: Four hundred ninety-eight patients contributed 536 colposcopies with repeat Pap smears within 6 months of the referent smear. Pap smears obtained at colposcopy predominantly were either of lower severity (52.2%) or unchanged (42%). Management of 8 of 498 patients (1.6%) was influenced by the results of the repeat Pap smear. The outcomes for six recommendations for a loop electrosurgical excision procedure included three cases of diagnoses of potentially reversible conditions. CONCLUSIONS: The evidence for the clinical usefulness of repeating a Pap smear at colposcopy for a squamous cytologic abnormality under the defined study parameters is noncompelling. Continued surveillance is a critical component of management.

Journal Article↗
PubMed2003

The clinician's view: role of human papillomavirus testing in the American Society for Colposcopy and Cervical Pathology Guidelines for the management of abnormal cervical cytology and cervical cancer precursors.

The American Society for Colposcopy and Cervical Pathology (ASCCP) National Consensus Conference for the Management of Women With Cervical Cytological Abnormalities and Cervical Cancer Precursors was held on the National Institutes of Health campus in Bethesda, Md, September 6-8, 2001. The conference was attended by 121 representatives from 29 national organizations interested in cervical cancer screening issues. For the first time, guidelines for the management of women with abnormal cervical cytology, developed from evidence-based literature, were presented to delegates from the majority of organizations with interest in cervical cancer screening, voted on, and revised when necessary to achieve a majority two-thirds approval. This development of consensus-approved guidelines is likely to be considered one of the most important milestones to date in the management of women with abnormal cervical cytology. The timing of this Consensus Conference resulted from the convergence of many different factors, including new cytologic terminology developed at the Bethesda 2001 workshop and publication of the enrollment data from the National Cancer Institute's Atypical Squamous Cells of Undetermined Significance (ASC-US)/Low-Grade Squamous Intraepithelial Lesions (LSIL) Triage Study, otherwise known as ALTS. Additionally, new preliminary longitudinal ALTS data provided much of the information on the natural history of abnormal Papanicolaou tests and cervical intraepithelial neoplasia (CIN), as well as data on the performance of both new liquid-based cytology and human papillomavirus (HPV) DNA testing in the management of women following colposcopy. The result was a large database of new information that provided the foundation for the ASCCP Consensus Conference. This article covers only the recommendations of the ASCCP Guidelines that were based in large part on the results of the ALTS trial. Therefore, the focus is on the management of women with equivocal (ASC-US) and low-grade (LSIL) cytologic abnormalities. Management of women with these cytologic abnormalities has been particularly problematic, because individually these women are at least risk for CIN 3 and cancer, yet their sheer numerical dominance ensures that they account for the majority of high-grade CIN detected in the United States in the follow-up of abnormal cervical cytology. Data from ALTS confirmed that women with ASC-US could be safely managed by any of the conventional approaches (repeat Papanicolaou test, immediate colposcopy, or HPV testing), but that the preferred management approach for women having an ASC-US report from liquid-based cytology was to assess the patient's risk by testing for HPV. Additionally, longitudinal ALTS data determined that repeat liquid-based cytology at 6 and 12 months and an HPV test at 12 months were nearly equivalent options in the follow-up of women referred for HPV-positive ASC or LSIL, yet not found to have CIN 2+ at initial colposcopy. Therefore, all follow-up recommendations for women with CIN 1 or lower postcolposcopy findings include these 2 options. The data and the recommendations for the management of ASC-US, ASC cannot exclude high-grade squamous intraepithelial lesion, and LSIL are discussed.

Colposcopy↗
PubMed1976

Colposcopy.

The main clinical value of colposcopy in modern gynecology is in the clinical diagnosis of patients with abnormal cytology. In colposcopically directed biopsies it is possible for an experienced colposcopist to sample with a high degree of accuracy the most advanced histopathologic changes. This significantly decreases the frequency of diagnostic conization. Colposcopy can efficiently select patients for outpatient treatment of cervical intraepithelial neoplasia, since it precisely defines the size and localization of epithelial changes. A new application of colposcopy is in the evaluation of young girls who have been exposed to stilbestrol in utero. In these patients colposcopy can improve the diagnosis of changes in cervical-vaginal epithelium.

Adenocarcinoma↗
PubMed2006

Role of P16(INK4a) expression in identifying CIN2 or more severe lesions among HPV-positive patients referred for colposcopy after abnormal cytology.

BACKGROUND: p16 is strongly overexpressed in dysplastic cervical cells because of the transforming activity of the E7 oncogene of all high-risk human papillomavirus (HR-HPV) types and may be easily revealed by immunochemistry: p16 may, therefore, be considered a surrogate marker for the activated oncogene expression of HR-HPV in dysplastic cervical cells. METHODS: HPV and p16(INK4a) testing were performed in a consecutive series of 283 patients with abnormal cytology referred to colposcopy assessment or follow-up. Triage of patients to colposcopy by HPV or HPV and p16 testing was simulated, and the relative sensitivity, specificity, and positive predictive value (PPV) of HPV and p16 testing for > CIN2 lesions was determined as well as the cost balance of the two triage types. RESULTS: Compared to current protocol, triage by HPV testing reduced the number of colposcopies by 44.2%, but also reduced the > CIN2 detection rate by 10.7%, and was associated with a cost of euro 54.16 per assessed woman and of euro 613.20 per > CIN2 detected. Compared with current protocol, triage by HPV and p16 testing combined reduced the number of colposcopies by 73.1%, but reduced > CIN2 detection rate by 21.5%, and was associated with a cost of euro 54.73 per woman assessed and of euro 704.09 per > CIN2 detected. CONCLUSIONS: Triage by HPV and p16 improves considerably the PPV of diagnostic assessment, but decreases > CIN2 detection rate, and is associated with substantially higher costs. Further decrease of molecular immunochemistry testing due to technological progress may allow HPV and p16 testing to become a cost effective procedure in the future.

Adult↗
PubMed2000

Contribution of human papillomavirus testing by hybrid capture in the triage of women with repeated abnormal pap smears before colposcopy referral.

OBJECTIVE: The purpose of this work was to evaluate the ability of testing for high-risk human papillomavirus (HPV) types using the hybrid capture technique to predict the presence of cervical intraepithelial neoplasia (CIN) II,III in patients with repeated atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesion (LGSIL) on Pap smears. METHODS: Hybrid capture testing and tissue biopsy were performed on 503 consecutive women with ASCUS or LGSIL on repeated Pap smears who were referred for colposcopy. RESULTS: A highly significant association (P < 0.0001) was found between a positive test for high-risk HPV types and CIN II,III, with an 87.0% positive predictive value and a 95.7% negative predictive value. In 226 women with ASCUS on repeated Pap smears, a positive test for high-risk HPV types had a 85.7% sensitivity and a 97% specificity for CIN II,III. In 277 patients with LGSIL on repeated Pap smears, a positive test for high-risk HPV types had an 88.2% sensitivity and a 94.7% specificity for CIN I,II. Reserving colposcopy examination for women who were positive for high-risk HPV types would have reduced the number of referrals for colposcopy to 24.6% and maintained a sensitivity of 87.0% for CIN II,III. CONCLUSIONS: A positive hybrid capture test for high-risk HPV types was highly sensitive and specific for the presence of CIN II,III in patients with ASCUS and LGSIL on repeated Pap smears. We believe that improved methodology will eventually enable more selective colposcopy referrals without affecting patient safety among these women.

Adolescent↗
PubMed2001

Expanded cytological referral criteria for colposcopy in cervical screening: comparison with human papillomavirus testing.

OBJECTIVE: The goal of this study was to investigate whether expanded cytologic referral criteria for colposcopy or the addition of human papillomavirus (HPV) testing on cervical screening could improve the rates of detection of cervical intraepithelial neoplasia (CIN). METHODS: HPV testing by semiquantitative polymerase chain reaction/ELISA was performed in 1000 women who were self-referred for routine Pap smear. They underwent colposcopy following an abnormal smear result or a positive HPV test. As abnormal smear results were considered reports of low- or high-grade squamous intraepithelial lesion, atypical squamous cells of undetermined significance, and even HPV-associated reactive cellular changes (mild koilocytosis, mild dyskeratocytosis, hyperchromatic nuclei, bimultinucleation, and cleared cytoplasm). Loop excision of the transformation zone was performed in women with cytology and colposcopy indicative of CIN, as well as in women with normal cytology but positive HPV test and colposcopic impression of CIN. RESULTS: The Pap test was abnormal in 89% of the cases of CIN 1 (34/38) and 96% of CIN 2/3 (27/28) diagnosed in our population. HPV testing picked up four additional cases of CIN 1 (11%) and one case of CIN 2/3 (4%). Overall the HPV test detected 95% of the cases of CIN 1 (36/38) and 89% of the cases of CIN 2/3 (25/28). CONCLUSION: HPV testing does not appear to add significantly to cytology in terms of positive predictive value or detection rate, if extended cytologic indications for colposcopy are used.

Adolescent↗