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PubMed1999

The costs, clinical benefits, and cost-effectiveness of screening for cervical cancer in HIV-infected women.

BACKGROUND: Women with HIV infection have a higher risk for cervical squamous intraepithelial lesions than do women without HIV infection, and the optimal regimen for cervical cancer screening in these women is uncertain. OBJECTIVE: To assess the net health consequences, costs, and cost-effectiveness of various screening strategies for cervical neoplasia and cancer in HIV-infected women. DESIGN: A cost-effectiveness analysis from a societal perspective done by using a state-transition Markov model. Values for incidence, progression, and regression of cervical neoplasia; efficacy of screening and treatment; progression of HIV disease; mortality from HIV infection and cancer; quality of life; and costs were obtained from the literature. SETTING: Simulated clinical practice in the United States. PATIENTS: HIV-infected women representative of the U.S. population. INTERVENTION: Six main screening strategies--no screening, annual Papanicolaou smears, annual Papanicolaou smears after two negative smears obtained 6 months apart (recommended by the Centers for Disease Control and Prevention), semiannual Papanicolaou smears, annual colposcopy, and semiannual colposcopy--were considered. MEASUREMENTS: Quality-adjusted life-years (QALYs), lifetime costs, and incremental cost-effectiveness. RESULTS: Annual Papanicolaou smear screening resulted in a 2.1-month gain in quality-adjusted life expectancy for an incremental cost of $12,800 per QALY saved. Annual Papanicolaou smear screening after two negative smears obtained 6 months apart provided an additional 0.04 QALYs at a cost of $14,800 per QALY saved. Semiannual Papanicolaou smear screening provided a further 0.17 QALYs at a cost of $27,600 per QALY saved. Annual colposcopy cost more but provided no additional benefit compared with that given by semiannual Papanicolaou smear screening, and semiannual colposcopy exceeded $375,000 per QALY saved. Results were most sensitive to the rate of progression of neoplasia to invasive cancer. CONCLUSIONS: In HIV-infected women, cervical cancer screening with annual Papanicolaou smears after two negative smears obtained 6 months apart offers quality-adjusted life expectancy benefits at a cost comparable to that of other clinical preventive interventions.

Algorithms↗
PubMed1999

[Colposcopic verification of cytologic smears containing atypical squamous cells of undetermined significance].

The aim of the study was the estimation of significance of smears containing Atypical Squamous Cells of Undetermined Significance (ASCUS) and presentation the own management of that cases. The study group consisted of 73 non-pregnant women (aged from 21 to 54 years) with ASCUS. The control group included 113 non-pregnant patients (aged between 20 and 57 years) with unsuspected cytology findings. Chi square test and Fisher test were used to compare the colposcopy findings in the two groups. Colposcopic pictures indicating a presence of dysplasia were significantly more often in study group. 14 cases (19.18%) of mild dysplasia and 8 cases (10.96%) of moderate and severe dysplasia were found in the group of patients with ASCUS. During the 18 month follow-up of the remaining patients in that group persistence of ASCUS was found in 2 cases (3.92%), progression to mild and moderate dysplasia was observed in 6 women (11.76%). Regression to normal smear occurred in 43 women (84.31%). Progression to dysplasia referred to women with suspected colposcopy findings. Until further research resolve all the questions regarding ASCUS smears or new more precise diagnostic methods are invented, colposcopy remains the method of choice in verification of ASCUS smears. Colposcopy together with cytology is the optimal mode of observation of such patients.

Adult↗
PubMed2000

Endocervical curettage in evaluating abnormal cervical cytology.

OBJECTIVE: To determine the role of endocervical curettage (ECC) in the evaluation of women with abnormal cervical cytology and following treatment for cervical intraepithelial neoplasia. STUDY DESIGN: A retrospective chart review using the records of 2,126 patients who were seen at the Colposcopy Clinic, Baylor College of Medicine, between 1980 and 1995. All patients were referred because of an abnormal cervical smear and underwent repeat Pap smear, colposcopic examination in each case with biopsies as indicated, endocervical curettage and treatment, consisting of either cryotherapy, laser vaporization or a LOOP electrosurgical excision procedure. Following treatment, Pap smears were performed on a scheduled basis, and ECC was performed annually. RESULTS: The ECC was negative in 1,849 (87%) of the women. It was abnormal in 33% of women with unsatisfactory colposcopy and 10% of women with satisfactory colposcopy. ECC was abnormal in 21% of patients with a negative biopsy result and 42% of patients who did not have a biopsy performed. There was a significant increase in abnormal ECC results with increasing age. ECC had a high positive predictive value for ectocervical disease (86%) and a high negative predictive value for endocervical disease (90%). One year following treatment, < 4% of patients with a negative cervical smear had a high grade lesion detected on ECC. CONCLUSION: The use of ECC is helpful in detecting disease missed by routine colposcopy and biopsy and is most likely to detect ectocervical disease rather than true endocervical disease. Following treatment, ECC does not appear to be significantly more reliable than the Pap smear in detecting the presence of significant residual disease.

Adolescent↗
PubMed2000

Diagnostic reliability of prebioptic methods in the prediction of a histological basis of cervical lesions and its correlation with accuracy of colposcopically directed biopsy in patients with cervical neoplasia.

OBJECTIVE: High incidence of cervical cancer in the Czech Republic leads us to look for an optimal model of screening. The evaluation of the realiability of prebiopsy (cytology and colposcopy) and of punch biopsy is an important diagnostic step. MATERIAL AND METHODS: In a prospective study we examined 308 women detected by cytological screening who afterwards underwent surgery for a cervical lesion. Punch biopsy before the operation, most frequently by conization, was performed in every patient after assessing the prebioptic prediction (colposcopy and cytology). RESULTS: Reliable cytological screening associated with good colposcopy permits a correct diagnosis with high reliability. The rate of errors which increase the risk (threatening of health or the life of women) was 2.9% by prebioptic methods (high reliability) and 4.4% by punch biopsy. CONCLUSION: These good results are achieved in centers led by trained physicians and experts in cytology and skilled in colposcopy.

Adolescent↗
PubMed2002

Management of the low-grade abnormal Pap smear: What are women's preferences?

OBJECTIVE: To evaluate preferences among ethnically diverse women for the management of a low-grade abnormal Pap smear result: early colposcopy or observation with repeat Pap smears. STUDY DESIGN: Structured interviews were conducted with 170 women of diverse ethnic backgrounds to assess their preferences. Trained personnel conducted standardized interviews. A standard description of all tests and procedures was read to participants. The participants were presented with scenarios of contrasting management approaches for a hypothetical low-grade abnormal Pap smear result-observation with repeat Pap smear vs. immediate colposcopy. POPULATION: Study participants were recruited from the waiting rooms of 5 family planning clinics in Northern Californiaamprsquos Central Valley. OUTCOMES MEASURED: The primary outcome measures for each scenario were utilities (quantified preferences for specific health states) measured by the Standard Gamble. RESULTS: The range in utilities was large for all scenarios. Mean utilities (SD) for observation: 0.96 ( 0.13) followed by resolution; 0.93 ( 0.17) followed by cryotherapy; 0.91 ( 0.21) followed by cone biopsy. Mean utilities for early colposcopy: 0.93 ( 0.20) followed by resolution; 0.95 ( 0.14) followed by cryotherapy; and 0.92 ( 0.16) followed by cone biopsy. Subject characteristics explained less than 20% of the variance in utilities. Decision analysis gave a slightly higher overall utility for early colposcopy (0.940 vs 0.932 for observation), but was sensitive to small changes in branch utilities. CONCLUSIONS: Womenamprsquos preferences for management of a low-grade abnormal Pap result vary widely. Clinicians should adopt a flexible approach to the management of low-grade abnormal Pap smears to incorporate individual preferences.

Adolescent↗
PubMed2002

[The effectiveness of photodynamic diagnosis method in diagnosis of cervical lesions].

OBJECTIVES: The aim of this study was to evaluate Photodynamic Diagnosis (PDD) effectiveness among patients with cervical lesions and comparison to effectiveness of colposcopy. MATERIAL AND METHODS: 68 patients with cervical lesions underwent cytologic examination, colposcopy and PDD which were followed by histologic examination. RESULTS: In 41 patients with Pap smear gr. II or IV the result of Pap smear, colposcopy, PDD and histologic result were correlated. Among 27 patients with Pap smear gr. III the conformity of the final pathologic result with colposcopic examination was 55.6% and positive fluorescent effect during PDD was 63% in patients with Pap smear gr. III. CONCLUSION: The efficacy, specificity and sensitivity of PDD are similar to those of colposcopy in diagnosis of Pap smear gr. III patients.

Adult↗
PubMed2003

The triage of squamous cell abnormalities of cervical cytology by human papilloma virus screening.

OBJECTIVE: The aim of the study was to determine the presence of human papilloma virus (HPV) infection in cervical swabs by the use of the Digene Hybrid Capture assay in a cohort of patients with squamous cell abnormalities found in cervical cytologic screening. MATERIALS AND METHODS: Thirty-four (0.3%) of 1,100 patients who came for their routine cervical cytologic screening and diagnosed as having squamous cell abnormalities were enrolled in the study. Colposcopy-directed biopsy was obtained from all study patients. HPV DNA was sought in cervical swab specimens placed in Digene transport medium by the use of the Digene Hybrid Capture assay. The findings of cervical cytology, colposcopy-directed biopsy and HPV screening were compared. RESULTS: In a total of 34 women who were diagnosed as having squamous cell abnormalities in their routine cervical cytologic screening, 15 women had atypical squamous cell lesions of undetermined significancy (ASCUS), 16 women had low-grade cervical intraepithelial lesions (LGSIL), and three women had high-grade cervical intraepithelial lesions (HGSIL). Five (15%) of these women tested positive for HPV screening in cervical swabs where four women had infection with high-risk and one woman had infection with low-risk subtypes. None of the patients with koilocytotic changes of the squamous cells in the class of LGSIL histopathologically tested positive for HPV screening. In addition, one patient diagnosed as having invasive cervical carcinoma histopathologically tested negative for HPV screening. Atypical vascularization was seen colposcopically in this 37-year-old woman who had ASCUS cytologically. CONCLUSION: HPV screening seems to have value in the triage of patients with ASCUS with no clear advantage to colposcopy-directed biopsy. The routine performance of HPV screening for the triage of patients with squamous cell abnormalities has no advantage over colposcopy-directed biopsy.

Adult↗
PubMed2004

Correlation of colposcopic anogenital findings and overall assessment of child sexual abuse: prospective study.

OBJECTIVE: To examine the relationship between colposcopic anogenital findings and overall assessment of sexual abuse. DESIGN: Prospective study. SETTING: Regional hospital, Hong Kong. PATIENTS: Seventy-seven children (mean age, 6.5 years; range, 6 months-16 years) referred consecutively for sexual abuse evaluation between July 1999 and June 2002 were included. MAIN OUTCOME MEASURES: Colposcopic anogenital findings (categorised as normal, non-specific, concerning for abuse, or clearly abnormal) were correlated with the overall assessment of likelihood of abuse (classified as no evidence of abuse, possible abuse, probable abuse, or definite abuse). The sensitivity and specificity of clearly abnormal findings in detecting definite abuse were computed, and the diagnostic impact of colposcopy findings were expressed as likelihood ratios. RESULTS: Anogenital findings were normal in 45% of patients, non-specific in 29%, concerning for abuse in 13%, and clearly abnormal in 13%. Seven of the 16 confirmed cases of sexual abuse had normal or non-specific findings. Overall assessment showed that 46% of all patients had no evidence of abuse, 20% had cases of possible abuse, 13% had cases of probable abuse, and 21% had cases of definite abuse. The sensitivity and specificity of abnormal anogenital findings in detecting definite abuse were 56.3% and 98.4%, respectively. Colposcopy showed a fair correlation with the overall assessment of abuse (weighted kappa, 0.245). The diagnostic impact of normal, non-specific, concerning, and clearly abnormal findings in terms of likelihood ratios were 0.23, 1.12, 0.00, and 34.30, respectively. CONCLUSIONS: Anogenital findings are often normal or non-specific in sexual abuse. In general, colposcopy examination findings do not directly reflect the final diagnosis. A category-4 finding on colposcopy is very helpful in confirming definite abuse, whereas other findings do not rule out the diagnosis.

Adolescent↗
PubMed2004

Management of patients with two consecutive ASC-US smears.

INTRODUCTION: To determine whether aggressive or expectative management of patients after two consecutive smears with atypical squamous cells of undetermined significance is preferable. To determine whether triage with high-risk human papillomavirus will identify all patients with cervical intraepithelial neoplasia grade 2 and 3. METHODS: 140 of 282 patients referred for colposcopy with two consecutive smears with atypical squamous cells of undetermined significance were only treated when abnormalities suggestive of high-grade cervical intraepithelial neoplasia were present at colposcopy. The other 142 patients underwent excision of all detected colposcopic abnormalities. Both groups were compared regarding the final cytological follow-up, the number of diathermy loop excisions, and the detection of cervical intraepithelial neoplasia. Retrospectively, the outcome of triage with high-risk human papillomavirus in the first group was investigated. RESULTS: There was no significant difference in final cytological follow-up between patients managed by expectative or by aggressive colposcopic management. Significantly less diathermy loop excisions (p < 0.001) are performed in case of expectative management. The sensitivity, specificity, negative- and positive predictive values of triage with high-risk human papillomavirus detection were comparable with those of colposcopy alone. CONCLUSIONS: Patients referred with two consecutive ASC-US smears may be followed with an expectative colposcopic management and cytological follow-up. Triage with high-risk human papillomavirus will reduce the number of referrals and colposcopies, but (cytological) follow-up remains necessary in all high-risk human papillomavirus negative patients as well.

Colposcopy↗
PubMed2006

[Evaluation of clinical management strategies for atypical squamous cells of undetermined significance in cervical cytology].

OBJECTIVE: To evaluate the 3 different clinical management strategies for patients with cervical cytological atypical squamous cells of undetermined significance (ASC-US) recommended by the guideline of The 2001 Bethesda system and the 2001 American Society for Colposcopy and Cervical Pathology (ASCCP). METHODS: 1394 patients with a cytopathological diagnosis of ASC-US by use of liquid-based thin-layer preparation were managed by three different clinical strategies, and evaluated by the percentage of histological diagnosis > or = high-grade intraepithelial lesion (HSIL), i.e., cervical intraepithelial neoplasia (CIN2 and 3) as standard. 421 patients in Group A underwent colposcopically directed cervical biopsy, 475 patients in Group B were followed-up after 6 months by cytology, colposcopy and biopsy were performed if the results were > or = ASC-H or ASC-US and HPV-DNA (+). 498 patients in Group C: underwent HC-II test, colposcopy and biopsy were performed on those aged > or = 30 and with the HPV-DNA (+), if the patients were aged < 30 and with the HPV-DNA (+), HC-II test and cytology would be performed after 6 months; colposcopy and biopsy were performed on those with the results > or = ASC-H or HPV-DNA (+). RESULTS: (1) The results of histological diagnosis > or = CIN2 were found in 27 cases (6.41%) of Group A, 26 cases (5.78%) of Group B, and 34 cases (6.91%) of Group C. There was no statistically significant difference among these 3 groups (all P > 0.05). (2) Convenience was significantly different among these 3 groups (P < 0.01). The workloads for the doctors and the discomfort resulting from biopsy for the patients were the greatest in Group A. The patient's compliance of Group B was low because of the necessity to wait for follow-up six months later. The cost of Group C was relatively higher. (3) In Group C, 66% of the ASC-US patients with HPV-DNA (+) were aged > or = 30. The percentage of histological diagnosis > or = CIN2 was 5.69% in those aged > or = 30 and was 1.22% in those aged < 30. CONCLUSION: Both protocols B and C are practical for clinical management of ASC-US in China. HPV infection is the necessary cause of cervical carcinoma, so the protocol C (cytology and HC-II test) is better for cervical lesion screening. The ASC-US patients aged > or = 30 and with HPV-DNA (+) are at high risk.

Adult↗
PubMed1991

Colpophotography systems: a review.

Colpophotography and video colposcopy systems are useful for pathology documentation purposes, patient education, and colposcopy training. A wide variety of colposcopic visual media components are available to enhance routine colposcopy. Colpophotographic systems supplied by eight colposcope manufacturers were critically evaluated by a colposcopist and a medical photographer. Components were independently and objectively analyzed. Photographic examination considered color, illumination uniformity, and coverage of illumination at all possible colposcopic magnifications. Photographs were developed by a standardized technique. The investigation results clearly demonstrated variability between different colpophotographic systems. Quality colpophotography is dependent on certain colposcope features and potential modifications. Colpophotography and video colposcopy systems complement the standard colposcopic procedure.

Colposcopes↗
PubMed1994

Evaluation of the atypical cytologic smear. Validity of the 1991 Bethesda System.

The 1991 Bethesda System states that atypical squamous or glandular cells of undetermined significance should be further classified as reactive or premalignant/malignant. The validity of this qualification for identification of patients with cervical intraepithelial neoplasia (CIN) was tested. One hundred twenty-four cytologic smears with squamous atypia were reviewed retrospectively by two cytopathologists blind to the colposcopy results. The smears were classified as favoring either reactive or premalignant/malignant processes. Subjective criteria used in the classification were based on the pathologists' experience. All patients underwent colposcopy and selected biopsy under the direction of a gynecologic oncologist. Of the 124 atypical smears, 69 were classified as favoring reactive processes and 55 as favoring premalignant/malignant processes by cytopathologist 1. Cytopathologist 2 classified 68 as reactive and 56 as premalignant/malignant. Colposcopy and selected biopsy revealed the following lesions: 34 cases of human papillomavirus (27.4%), 17 of CIN 1 (13.7%), 4 of CIN 2 (3.2%), 2 of CIN 3 (1.6%) and 67 without pathology (54.0%). All six patients with squamous atypia and underlying CIN 2 and 3 lesions had their cytology classified as premalignant/malignant by the cytopathologists. In these patients this qualification had high sensitivity (100%) and negative predictive value (100%). The 1991 Bethesda System classification above, when applied to patients with squamous atypia, was effective in identifying patients with serious pathologic cervical lesions. If used as a triage method, colposcopy should be reserved for atypical lesions classified as premalignant/malignant, potentially decreasing the cost of health care without decreasing the quality of that care.

Adult↗
PubMed1994

[Discrepancy between histopathological diagnosis based on guided biopsy and cone biopsy of the cervix uteri: analysis of 346 cases of laser conization].

The conservative management of cervical intraepithelial neoplasia (CIN) essentially depended on the introduction and improvement of colposcopy. This technique, allowing to locate the lesion, to estimate its extension and to perform multiple punch biopsies, becomes discriminant in therapeutic choice. Whether colposcopy reveals endocervical involvement or abnormal transformation zone (ANTZ) may be only partially explored, excisional conization should be preferred to ablative therapy since the former advantageously can verify histopathologic diagnosis, confirm completely excision of lesion and rule out invasive carcinoma. The literature shows that cases of invasive lesions can be underestimated and therefore inadequately treated by ablative therapy, emphasizing colposcopy and punch biopsy limitations about suspect and diagnosis of microinvasion. We analyzed data concerning preliminary diagnostic investigations and results of 346 CO2 laser excisional conizations performed between 1984 and 1993. Histopathologic diagnosis on punch biopsy, performed in 111 cases of ANTZ1 and in 235 cases of ANTZ2, shows an agreement with cone biopsy in 30.8% of the cases of CIN1, of 40.9% in cases of CIN2 and of 66.3% in cases of CIN3. Whereas the lesion is overestimated in 30.6% of cases, in which it is likely that punch biopsy has removed the epicenter of the lesion or the lesion in toto, we had an underestimation in 15% of cases, particularly in 4 cases of CIN2, in 38 cases of CIN3 and in all microinvasive processes. The rate of invasive lesions previously ignored and detected only by histopathologic diagnosis on cone biopsy is 2.9%. In only one of these cases colposcopy, even if attributing to each of these the higher grading, shows the suspicion of invasion, whereas the detection of invasive processes is missed in every case by punch biopsy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

The effect of educational brochures on knowledge and emotional distress in women with abnormal Papanicolaou smears.

OBJECTIVE: To determine whether an educational brochure about abnormal Papanicolaou smears could reduce psychological distress and concerns about cancer and future health, and increase knowledge about dysplasia and the investigation, treatment, and recommended follow-up. METHODS: One hundred twenty-five consecutive women with dysplasia on a Papanicolaou smear referred to a colposcopy clinic for their first examination were alternately assigned to receive a mailed educational brochure the same day or to receive no brochure. At the colposcopy clinic, consenting women were given the Brief Symptom Inventory, specific questions about feelings regarding an abnormal smear, and a knowledge quiz about dysplasia, colposcopy, and the recommended follow-up. RESULTS: Women who received the brochure were significantly less distressed on the Brief Symptom Inventory and were less anxious about the abnormal Papanicolaou smear, the fear of cancer, and their future health than were women not receiving the brochure. Study women also performed significantly better on knowledge questions about dysplasia, colposcopy, and the recommended follow-up. CONCLUSION: Given the low cost, ease of delivery, and usefulness of educational brochures in reducing psychological distress and increasing knowledge specific to the condition, an educational brochure should routinely accompany or immediately follow notification about an abnormal Papanicolaou smear.

Adult↗
PubMed1996

[Management of pregnant women with abnormal cervical smears. A series of 146 patients].

OBJECTIVES: Evaluation of the value of colposcopy and directed biopsy in the follow-up of pregnant women presenting with abnormal cervical smear. MATERIAL AND METHODS: Retrospective study of 146 patients examined by colposcopy during pregnancy between January 1985 and December 1994. RESULTS: Colposcopy was satisfactory in 86% of patients. Colposcopic impression was concordant with the final diagnosis, overestimated and underestimated in 69%, 18% and 13% of the cases, respectively. Directed biopsies were performed in 115 patients. In one case, bleeding necessitated vaginal packing for 24 hours. Directed biopsy correlated well with the final diagnosis in 87% of low grade CIN and in 90% of high grade CIN. In 4 patients, conisation was performed between 10 and 16 weeks of gestation without subsequent obstetrical complications. CONCLUSION: Colposcopy with directed biopsy is a reliable tool to evaluate abnormal smear during pregnancy.

Adolescent↗
PubMedDate not supplied

[Colposcopic monitoring of primary chemotherapy in patients with locally advanced cancer of the uterine cervix].

OBJECTIVE: To evaluate colposcopy in the monitoring of patients affected by locally advanced cervix cancer treated with primary chemotherapy. MATERIALS AND METHODS: Eight patients (42-54 years old) affected by squamous cervical cancer locally advanced (stage FIGO IIa "bulky"/IIb/III) were treated with primary chemotherapy (cisplatin 50 mg/m2 vincristin 1 mg/m2 bleomicin 30 UI in 24 hours continuous infusion q 7 days for 3 cycles). Colposcopy was performed before chemotherapy, after the second cycle and at the end of chemotherapy. RESULTS: Two pathological complete responses, 5 partial responses and one case of stable disease were observed. Patients with complete and partial response were treated with radical hysterectomy. In responding patients we observed a typical sequence of colposcopic findings. Regression of distinctive malignancy feature, reduction of atypical vessels, gradual disappearance of peripheral lesions and centripetal reepilization of the cervix were sequentially registered. At the end of treatment the cervix appeared with a colposcopy imaging as well as a centripetal squamous complete or incomplete metaplasia, open--for most part--glandular exit and weak acid-iodic positivity. CONCLUSION: In responding patients we observed a typical sequence of colposcopy finding, useful in order to evaluate the effects of chemotherapy and to programme the surgical approach.

Antineoplastic Agents↗
PubMed1997

[CIN and pregnancy. Apropos of 16 cases and review of the literature].

AIM: To assess the means to diagnose grade 3 cervical intraepithelial neoplasia (CIN 3) during pregnancy, with special consideration to the risk of overlooking invasive lesions. STUDY DESIGN: a retrospective study on 16 cases of CIN 3 over 4 years and a literature review. RESULTS: Smear tests were indicative of low-grade lesions in 8 cases. Colposcopy always was suggestive and accompanied by biopsy. No conisations were performed during pregnancy but one was performed after delivery in 15 of 16 cases. After delivery, comparing conisation results with those of recent biopsies revealed that some lesions were less severe and others more severe than during pregnancy. So, a CIN 3 and a microinvasive carcinoma observed during pregnancy changed into CIN 2 and CIN 3, respectively, after delivery. In contrast, two pregnancy CIN 2 were seen as CIN 3 in post-partum and three CIN 3 as MIC. Such variations have been described in the literature and have several causes. In particular, improvements may sometimes reach "normalisation" in post partum although, recurrences remain possible. CONCLUSIONS: when the smear tests performed during pregnancy are indicative of cervical intra-epithalial lesions, whatever the severity, colposcopy with biopsies are mandatory. If a CIN 3 is detected, early MIC should be removed, which may require specific treatment according to the invasive degree. Colposcopy with guided biopsies is a safe and reliable diagnostic means. After delivery, the cervix should always be reexamined, preferably by conisation, even if smears or colposcopy were normal.

Biopsy↗