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PubMed1988

Colposcopy is superior to cytology for the detection of early genital human papillomavirus infection.

Of 2232 women with no cytologic evidence of intraepithelial neoplasia, 250 (11.2%) were positive for human papillomavirus deoxyribonucleic acid (DNA) by filter in situ hybridization. In 150 of those human papillomavirus-positive patients, an adequate colposcopic examination of the cervix was possible; human papillomavirus infection was diagnosed in 104 women (70%). Cervical cytology showed evidence of human papillomavirus infection in only 23 patients (15%). The following colposcopic features were most common: acetowhite epithelium (29%), punctuation (18%), acetowhite spikes (17%), and mosaicism (9%). Colposcopy was essentially normal in 27%. In 64 hysterectomized patients, vaginal colposcopy showed evidence of human papillomavirus infection in 38 women (59%). Vaginal cytology showed signs of human papillomavirus infection in only 9% (N = 6). Acetowhite spikes were seen in 52%, acetowhite epithelium in 5%, punctuation in 3%, and normal findings in 40%. Histologic examination of 25 biopsy specimens (cervical, N = 15; vaginal, N = 10) showed mainly a lack of glycogenation, acanthosis, and elongation of rete pegs. Koilocytosis and dyskeratosis were seen only in a few cases as rare foci, hence the negative cytology. We conclude that colposcopy is far more sensitive than cytology for the detection of cervical and vaginal human papillomavirus infection.

Adult↗
PubMedDate not supplied

Urethral cytology of Cytobrush specimens. A new technique for detecting subclinical human papillomavirus infection in men.

Cytologic examination of urethral smears prepared with the Cytobrush and colposcopic examination of the penis were performed in 53 male partners of women with cervical human papillomavirus (HPV) infections and in 14 healthy controls. A diagnosis of HPV infection was recorded in 28 subjects (52.8%). Cytology was positive in 26 cases (49%) and colposcopy was positive in 5 cases, with both tests positive in 3 cases. No controls were positive by cytology or colposcopy. These findings suggest that urethral cytology and colposcopic examination should be routinely performed in partners of women with HPV infections to detect inapparent infections. The Cytobrush should be employed for the urethral cytologic sampling; smears prepared by other techniques (urine collection or urethral swabbing) yield lower detection rates.

Colposcopy↗
PubMed1988

Pregnancy, human papillomavirus and cervical intraepithelial neoplasia.

Human papillomavirus (HPV) has been implicated in the development of cervical intraepithelial neoplasia (CIN). To test the hypothesis that the known relationship between HPV and CIN might be modified by the altered immune status of pregnancy the cytologic, colposcopic and histologic findings in 176 pregnant and 515 nonpregnant patients referred to a colposcopy clinic were prospectively compared. No difference between the two groups was found regarding the frequency with which CIN and HPV were detected cytologically, colposcopically and histologically. Confidence intervals for the probability of CIN in the presence of HPV for the two groups were calculated. At the 80% confidence interval the two groups were reassuringly similar. Pregnancy did not alter the relationship of CIN to HPV. Despite the relatively small size of our study population, it is unlikely that a larger study would demonstrate a difference. Interestingly a 3% cervical carriage rate of HPV in pregnancy was demonstrated. What, if any, effect this has upon the unborn child is unknown at this time.

Adult↗
PubMed1985

Electron microscopic assessment of cervical punch biopsies in women followed-up for human papillomavirus (HPV) lesions.

Cervical punch biopsies from 102 women prospectively followed-up for HPV (Human papillomavirus) lesions (flat, inverted and papillomatous condylomas) were assessed on transmission electron microscopy (TEM) for the presence of HPV particles. The virus discovery rate was correlated with the other characteristics of significance to the clinical behaviour (natural history) of these lesions, i.e. the colposcopic pattern, expression of papillomavirus genus specific structural antigens (demonstrated by an indirect immunoperoxidase, IP-PAP technique), as well as the degree of HPV-associated cervical intraepithelial neoplasia (CIN). Virus particles were disclosed with equal frequency in all three types of HPV lesions. Noteworthy, and so far unreported, was the discovery of HPV particles in 56 and 64% of the biopsies derived from the epithelium without colposcopic or histological evidence (cytopathic effects) of HPV lesions, respectively. The degree of CIN was without influence on the virus discovery rates. Viral particles were present with equal frequency (57 and 60%, respectively) in the lesions expressing HPV antigens and in those which did not. The highest frequency (89%) of viral particles was found in lesions presented with warty or mosaicism pattern in colposcopy. The implications of these findings to understanding the biology of HPV infections in the uterine cervix is discussed, and the importance of TEM in the follow-up of these lesions is emphasized.

Animals↗
PubMed1986

Deceptive vulvar papillomavirus infection. A possible explanation for certain cases of vulvodynia.

Use of the colposcope for vulvar and vaginal examination in four cases of long-standing vulvodynia led to the identification of lesions with an unusual appearance. In the vulvar vestibule, epithelial projections resembling cactus, camel humps or stony colonial pavement were observed. In the vagina, the lesions looked more like cerebral folds. Biopsies of these lesions showed histopathologic changes diagnostic of human papillomavirus infection, scored according to Reid's criteria. In one case, capsid antigen was detected with the peroxidase technique in the nuclei of the superficial cells. Past history and positive findings in the sexual partners of some of the patients suggested long-standing herpesvirus activity in the lower genital tract. In some cases of recalcitrant vulvodynia, colposcopic examination of the vulva and vagina may lead to a viral explanation for symptoms previously considered psychosomatic in origin.

Adult↗
PubMed1987

Human papillomaviruses in women with a history of abnormal Papanicolaou smears and in their male partners.

Human papillomavirus infection of the genital tract was identified by the filter in situ hybridization test. Exfoliated cervical cells were tested separately for the prevalence of human papillomavirus 6/11 and 16/18. Human papillomavirus deoxyribonucleic acid (DNA) was identified in 70 and 92% of specimens of U.S. and West German women, respectively, who showed concurrent cytologic and colposcopic abnormalities, and in 50 and 54% of women, respectively, who showed neither cytologic nor colposcopic abnormalities at the time of examination. In the cytologic categories of condyloma, mild to moderate dysplasia (cervical intraepithelial neoplasia I/II), and severe dysplasia-carcinoma in situ (cervical intraepithelial neoplasia III), the overall DNA detection rate of human papillomavirus 6/11 and 16/18 varied between 75 and 83%; but human papillomavirus 16/18 was recovered relatively more frequently from the more severe lesions. Forty-eight West German women were monitored cytologically over a period of three to 24 months; progression to carcinoma in situ (cervical intraepithelial neoplasia III) was correlated with initial isolation of human papillomavirus 16/18. The vagina and vestibule were found to be frequent sites of human papillomavirus infection with the same virus type as in the cervix. In an investigation of male partners of 40 human papillomavirus-positive women, human papillomavirus was identified in exfoliated cells from 26; in 19 instances, the males harbored the same human papillomavirus types as their female partners.

Autoradiography↗
PubMed1987

Diagnostic problems of cervico-vaginal infections by HPV.

The diagnostic problems of cervico-vaginal infections by HPV have been considered. The colposcopic and cytological diagnoses have been compared with the histological one in order to evaluate the diagnostic reliability of the two methods of screening, and to seek evidence of those colposcopic and cytological aspects which, even if not pathognomic, are suggestive of HPV infection. The association between viral changes and CIN and the correlated problems have also been examined. The importance is underlined of screening and following up of HPV infections by the integrated use of colpocytology and colposcopy and of eventual aimed histologic checking as an improved prognostic evaluation, considering the potentiality of the evolutive risks of such infections.

Adolescent↗
PubMed1988

[Conservative treatment of grade 3 intra-epithelial cervical neoplasms. Comparative study of CO2 laser vaporization, laser conization and cold scalpel conization].

Carbon dioxide laser was used in 79% of the 141 conservative treatments carried out for grade 3 cervical intra-epithelial neoplasia (CIN III) between the years 1982 and 1986 (41% vaporized and 38% coned out by using the laser as against 21% that were treated by scalpel conisation. The mean age of the women treated in this way by the laser was low (28.5 years of age and 32.5 years as against 38.1). Their parity was also low (0.8 and 1.2 as against 2.2). The lesions were very often spread out on the ectocervix and sometimes going into the vagina (26 and 9% as against 26%) or associated with koilocytosis (65.5 and 47.2% as against 41.3%). In one out of two cases vaporisation of the lesion is contra-indicated and the three diagnostic methods that are used (an ecto and endocervical smear, colposcopy and multiple directed small biopsies) do not make it certain that there is no underlying invasion of the tissues. Vaporisation and conisation are easily carried out under colposcopic control and are associated with widespread lesions at the squamo-columnar junction. These treatments sometimes have to be repeated; then they give a cure rate of 92-96% as against 96%. They are more reliable than conventional surgery for widespread lesions and they do make it possible to keep to the morphology of the cervix and thus make it possible for the cervix that is treated to behave more physiologically. It is also much easier and more reliable in these cases to carry out follow-up for carcinoma. This follow-up should be carried out on two occasions. The triple diagnostic method should be carried out again at the third month (2 smears, colposcopy and colposcopically directed small biopsies). This makes it possible to diagnose and treat early the cases where there has been failure of the original treatment. Then ecto and endocervical smears should be repeated at 3-monthly intervals, then at 6-monthly intervals and finally annually to screen for recurrences of these neoplastic conditions, and for koilocytosis which sometimes repeat themselves in an extensive manner.

Adult↗
PubMed1988

[Colposcopy of adenocarcinoma of the cervix].

Colposcopic findings of 17 cases of adenocarcinoma of the cervix are analyzed with cytology and patho-histology. One of the highly differentiated mucinous adenocarcinoma of the cervix is presented in detail for the knowledge of colposcopy of that cancer. The colposcopic findings of this tumor are characterized by increase and abnormal distribution of gland openings on the surface and high grades of its white surrounding rings. In addition, abnormal vascularization may be present. It is pointed out that these findings should be considered during colposcopy of adenocarcinoma of the uterine cervix.

Adenocarcinoma↗
PubMed1987

Correlation of colposcopy and histology findings in pre-clinical neoplasia of the cervix.

The histology findings of pre-clinical neoplasia of the cervix at cone biopsy were compared with the previous colposcopic assessment in fifty-eight patients. In 84.5% of cases colposcopy prediction was within one grade of the histology findings. This close correlation is important where suitability for local ablative therapy depends on accurate colposcopic assessment prior to tissue destruction.

Biopsy↗
PubMed1987

A critical evaluation of the endocervical curettage.

A prospective study was undertaken to critically evaluate the endocervical curettage. The study group consisted of 261 patients with colposcopically identifiable cervical lesions that had not been previously biopsied and were not macroscopically suspicious for invasive cancer. In 210 patients, the entire lesion, transformation zone, and squamocolumnar junction were visible (satisfactory colposcopy), and in 51 patients, the full extent of the lesion was not visualized colposcopically (unsatisfactory colposcopy). We used a method of examination not previously described. Colposcopy was performed before and after the endocervical curettage, but before the ectocervical biopsy. This method of examination allowed us to identify potentially contaminated endocervical curettages and to test the null hypothesis that a positive endocervical curettage in patients with satisfactory colposcopy is not the result of contamination. Twenty of 210 endocervical curettages in patients with satisfactory colposcopy were potentially contaminated, as suggested by an ectocervical lesion disrupted by the endocervical curettage. No patient with a positive endocervical curettage had an intact ectocervical lesion. Therefore, the null hypothesis was rejected (P less than .005). Of the 51 patients with unsatisfactory colposcopy, 39 (76%) underwent cone biopsy. Invasive cancer was diagnosed by cone biopsy in two patients when both ectocervical biopsy and endocervical curettage demonstrated only dysplasia. We also confirmed that patients with unsatisfactory colposcopy occasionally benefit from having an endocervical curettage. However, basing the treatment plan for any lesion short of invasive cancer solely on the results of colposcopy, ectocervical biopsy, and/or endocervical curettage could lead to significant undertreatment of some patients.

Biopsy↗
PubMed1986

[Morphologic criteria in genital herpesvirus infections. Their value in diagnosis, their place in therapeutic indications].

A series of 155 observations has been made of uterocervical intraepithelial neoplasias treated by conization and examined by serial section. From the data obtained the author shows that colposcopic and microlposcopic criteria can be used to give a good evaluation of the participation of viruses of the HPV group in the histogenesis of infra-clinical lesions of the uterine neck. The specificity of the colposcopic and microcolposcopic method seems equal to that of exfoliative cytology, and its sensitivity is greater. Increased application of colposcopy and microcolposcopy is recommended in the screening of infraclinical lesions of the uterine neck.

Biopsy↗
PubMed1986

Abnormal Pap smear: colposcopy and cryosurgery.

Colposcopic evaluation of patients with abnormal Papanicolaou smears permits the physician to visualize cervical lesions and determine the extent of intraepithelial neoplasia. Through the use of colposcopy with cryotherapy, many patients with cervical intraepithelial neoplasia may avoid a more invasive form of treatment. Family physicians should become familiar with colposcopic technique so that they can select patients who are suitable for local treatment with cryotherapy.

Cervix Uteri↗
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↗
PubMed1985

Outpatient management of cervical intraepithelial neoplasia. A summary of 279 cases.

Two hundred seventy-nine patients with cervical condylomas or cervical intraepithelial neoplasia (CIN) were treated as outpatients with cryotherapy. Every patient followed received a Papanicolaou smear, colposcopic evaluation, cervical biopsy and endocervical curettage four months following treatment. The treatment failure rates for CIN 1/condyloma, CIN 2 and CIN 3 were 2.9%, 5.7% and 4.3%, respectively. The percentage of patients eventually requiring conization was 0.7, 1.6 and 2.7, respectively. No patient who had a negative clinical and histologic examination at four months subsequently had a recurrence. The mean follow-up was 23.1, 26.0 and 35.0 months for CIN 1/condyloma, CIN 2 and CIN 3, respectively. Proper triage is important with CIN 3, and a complete colposcopic examination at the initial follow-up visit is valuable for predicting outcome.

Ambulatory Surgical Procedures↗
PubMed1985

RO-TAGE biopsy. An improved method of endocervical evaluation.

The colposcopic management of patients with abnormal Papanicolaou smears relies on correlating the examination findings with the cytology and biopsy results. Failure to adequately sample the endocervical canal introduces a possible source of error and could allow an invasive lesion to be missed. In 300 patients subjected to both endocervical curettage and RO-TAGE biopsy (Proto Med Incorporated, Boulder, Colorado), significantly fewer inadequate samples were obtained with RO-TAGE biopsy (1%) or the use of both methods (0.3%) than with curettage alone (4.3%). Therefore, we conclude that RO-TAGE biopsy should be added to every colposcopic examination.

Biopsy↗
PubMed1985

[Enhancement of irradiation effect in carcinoma of the uterine cervix with the administration of protein-bound polysaccharide kureha (PS-K)].

The combined effect of PS-K, a protein-bound polysaccharide, and radiation therapy has been studied in patients with cancer of the uterine cervix. Thirty cases (study group) were administered daily 3g. of PS-K throughout the course of radiation. Sixty cases (control group) were treated with external cobalt-60 irradiation alone. All cases were evaluated at the dose of 1,400 rads and 3,000 rads histologically and colposcopically. Histological evaluations were performed on the punch-biopsied specimen in view of Oboshi-Shimosato's classification and the rate at which the cancer cell population diminished in the tissues. Tumor sizes were measured on the photographs obtained from the colposcopic observations. These 3 parameters were recorded, summed up and evaluated. In the control group, there was found a good, 31.7%, response, 41.7% moderate response and 26.7% poor response in the phase of 3,000 rads. However, those figures were calculated to be 60.0%, 36.7% and 3.3% respectively in study group. Hence, the administration of PS-K rendered the enhancement of the irradiation effect statistical significant (p less than 0.01). Patients were classified into two groups: very responsive and less responsive groups. Transition of immunological reactivity was analyzed. Peripheral and tissue lymphocytes counts and immunological skin test were suppressed in both groups. This can be attributed to the immuno-suppression of irradiation exceeding the enhancing effect of PS-K. The LMIT (leucocyte migration inhibition test) of the very responsive group was maintained up to the completion of the treatment in contrast to the less responsive group where it was somewhat suppressed.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibiotics, Antineoplastic↗
PubMed1979

Management of abnormal Papanicolaou smears in pregnancy.

All pregnant patients with abnormal cervical cytologic smears were evaluated as outpatients in the colposcopy clinic. Of the 131 patients, 84% had colposcopically directed biosies. Initial biopsy diagnosis of severe dysplasia/carcinoma in situ was noted in 16% of patients with class II smears and 43% of patients with class III smears. Two patients underwent conization and 2 had modified conizations because they failed to meet our criteria for adequate colposcopic evaluation. Of the 110 patients available for postpartum follow-up, all had either the same or a lesser degree of cervical intraepithelial neoplasia. Invasive carcinoma was not detected in any patient who underwent subsequent hysterectomy or conization. No abortions or premature labors could be directly attributed to the procedure.

Biopsy↗