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PubMed1979

[Combined use of colposcopy and cytology].

The widespread view of the nearly absolute accuracy of cervical cytology in the diagnosis of severe dysplasia, carcinoma in situ and small invasive carcinoma is not correct. The rate of cytologically missed cases computed from the first smear only is more than 10%. Using cytology and colposcopy simultaneously in each single case, the errors of one method will be greatly compensated by the other. Presupposition for the compensation, however, is the independent indication for biopsy. In other words, biopsy must be done based on cytological findings, even when colposcopy is unsuspicious. On the other hand a colposcopically suspected and cytologically unsuspected case must also be biopsied. For the gynecological clinic as well as for the gynecological practice, the additional effort resulting from the combined method is easily realizable. For large screening programs, however, the colposcope can be used only as an instrument for target punch biopsies, indicated by pathologic smears.

Carcinoma in Situ↗
PubMed1977

Observations on the surface area of the abnormal transformation zone associated with intraepithelial and early invasive squamous cell lesions of the cervix.

The apparent area of the abnormal transformation zone (TZ) of the cervix was measured in a total of 104 patients by a simple method with the use of the 1 and 5 mm. diameter circle in the center of the field of the Leisegang colposcope and the field of the colposcope itself. The visible area (mean +/- S.E.M.) of the abnormal TZ for five patients with microinvasive or occult carcinoma of the cervix (180.8 mm.2 +/- 62.2) was significantly larger (p less than 0.01) than that of 64 patients with major intraepithelial lesions (62.5 sq. mm.2 +/- 7.3) and 35 patients with minor intraepithelial lesions (45.8 sq. mm.2 +/- 11.7). The visible area of the abnormal TZ measured over 40 mm.2 in each of the five patients with invasive lesions but in only 42 of 99 (42%) patients with intraepithelial lesions. The TZ extended into the endocervical canal and could not be fully visualized in four (80%) of the patients with invasive lesions, 24 (38%) of patients with major intraepithelial lesions, and 11 (31%) of patients with minor intraepithelial lesions. The implications of these findings are discussed.

Adolescent↗
PubMed1978

[Cervical polyps and diagnostic curettages (author's transl)].

The early detection of carcinoma of the cervix is successful due to the systematic cytologic and colposcopic examination of the largest number of women possible. In cases with endocervical polyps a diagnostic curettage is customarily done along with removal of the polyp. The curettage which requires admission to hospital and carrie a risk of operative complications is an extensive procedure for the diagnosis of a cervical polyp. Because of the high accuracy of cytologic and colposcopic diagnosis it is suggested to omit the curettage in the management of non-bleeding polyps in the premenopausal woman. The asymptomatic polyp should be followed by cytology or office removal with obligatory histologic examination. Follow-up cytology of the cervical canal is necessary.

Adult↗
PubMed1984

Conisation as an important point in the diagnosis and treatment of pre-invasive neoplasy.

110 cases of conisation carried out in the Obstetric and Gynecological Clinic of the University of Padua between 1.1.74 and 31.12.82 have been considered. The operations were always performed on completion of diagnostic assertions comprising colpocytology, colposcopy and biopsy, this last undertaken upon indications from both colposcopic and colpo-cytological examinations. The comparison of the histological sample with the serial on the cone, with the cytological, colposcopical and bioptic ones, correspond in the importance of the lesion in almost 90% of cases. The reliability of the diagnosis by the three methods associated and then integrated by the conisation therefore approaches 100%. Prophylaxis carried out in this way allows a personalisation in the operation which, though respecting radicality, must be as non-demolitary as possible.

Biopsy↗
PubMed1983

[Diagnostic verification of Group III and III D cytological tests with special reference to follow-up].

The diagnostic verification of Pap III and Pap III D-smears from mass screening is described with special regard to the importance of colposcopical and cytological long-term controls. 233 (59.8%) out of 390 patients were verified within one year (1.1.-31.12. 1977). A high percentage (27.5%) of the first control smears was negative or the cytological picture had become normal (19.5%) after vaginal treatment by antibiotics and application of estrogens. 50 women were cured by conization or primary hysterectomy as the cytological diagnosis yielded suspicion of severe dysplasia or carcinoma in situ. Depending on cytological differential diagnosis, individual situations and the developmental tendency of the atypical epithelium 157 patients (40.2%) were observed for several years. The great diagnostical-therapeutical importance of colposcopy for the early recognition of cervical intraepithelial neoplasia (CIN) is demonstrated. A direct microbiopsy controlled by colposcopy is a valuable completing method if there are differences between colposcopical and cytological findings during a long-term control of the cases. A slight or moderate dysplasia can be observed for about 2 or 3 years, as most regressions are seen in this period. In problematic cases (young nullipare, patients treated because of infertility or sterility, pregnant women, old women) with severe dysplasia/carcinoma in situ it is possible and justifiable to control the patient temporarily in short distances. All cases which are suspicious of an early stromal invasion call for a definite diagnosis and therapy without any delay. Primary hysterectomy is preferred in patients aged 35 years or more.

Adolescent↗
PubMed1984

[Characteristics of the restructuring of the microcirculatory bed of the cervical mucosa in cancer].

Complex colposcopic and macro-microscopic examination of the microcirculatory bed ( MCB ) of the normal uterine cervix and at various stages of the neoplastic process is performed. It is established that MCB undergoes restructuration in the presence of focal epithelial alterations and takes place in the formation of the colposcopic picture. The general view of MCB different parts, their distribution, pleomorphism, peculiarities of their combinations may serve as certain tests in the provisional diagnosis of epithelial displasia, preinvasive and invasive carcinoma. Specific MCB alterations are manifested in marked hemocapillaries proliferation of the subepithelial plexus in precancerous conditions with its enhancement, deformation and atypia in intra-epithelial carcinoma. The restructuration of other MCB components in epithelial displasias and preinvasive carcinoma is stereotype.

Carcinoma in Situ↗
PubMed1978

[Diagnosis and treatment of intra-epithelial carcinoma of the uterine cervix. About 124 cases (author's transl)].

The means for diagnosis, treatment and long follow-up of intra epithelial carcinomas of the uterine cervix are assessed by the authors, about 124 cases seen at the Hotel-Dieu de Paris. The diagnosis is given by cytologic means and mostly by colposcopic examination. When the cylindro-pavimental junction (usual initial focus) is seen in totality, direct biopsies always gave an accurate diagnosis. When the junction is not seen, only a diagnostic--conisation can allow a definitive answer. Two types of surgical treatment were applied: amputation of the cervix conservative of menstrual and/or reproductive functions and, hysterectomy led by vaginal or abdominal route. The patients were followed from 1 to 16 years by the triple cytologic, Schiller test and colposcopic examination: none of them showed any recurrence either of intra-epithelial or of invasive type.

Biopsy↗
PubMed1982

Treatment of cervical intraepithelial neoplasia with the carbon dioxide laser: report of 543 patients.

Five hundred forty-three patients with cervical intraepithelial neoplasia were treated with the carbon dioxide laser and 441 have been seen for follow-up. The success rate was 76.4% after 1 treatment and 98% after 2 treatments. Many patients who returned with apparent minor abnormalities at the first follow-up visit had normal colposcopic results and Papanicolaou smears 6 months later. The complication rate was low, and no significant problems were caused by pain or bleeding at the time of treatment. Postoperative hemorrhage requiring hospital admission occurred in 1% of patients. Laser treatment should be carried out only in departments with colposcopic expertise.

Adolescent↗
PubMed1983

An in-service registrar-training programme in colposcopy at Groote Schuur Hospital. Reliability and results.

A scheme for the in-service training of registrars in colposcopic techniques was evaluated in a prospective study. The colposcopic interpretation was satisfactory in 79% of the 721 patients examined, and inappropriate treatment was avoided by utilizing the specified protocol of management. The value of cytological screening of the population is emphasized by the fact that in 95,7% of patients referred for colposcopy the pre-invasive cancer was not suspected on the basis of symptoms or the results of clinical examination.

Colposcopy↗
PubMed1981

Colposcopy and cytology in young women up to the age of 20: an analysis of 401 cases research for a new screening programme.

The Authors have observed by colposcopy and cytology, 401 patients under the age of 20 and have compared the results obtained with those of a similar control group with ages ranging from 20 to 25. They observed the incidence of normal cervix and of other colposcopic reports. From the comparison between the colposcopic and cytologic data emerged that the cytopathologic diagnosis does not put the cervical alterations of inferior level than dysplasia in evidence, in a large number cases as colposcopy does. There is a very close relation between the incidence of pathologic cervical lesions and sexual activity. Correlation between cervical pathology and use of hormonal contraceptives and presence of cervico-vaginal phlogosis, was not possible in this type of survey. The Authors therefore propose a new type of mass screening, which should substitute the actual one, that is substantially based on cytology and on early diagnosis rather than prevention.

Adolescent↗
PubMed1982

Screening with colposcopy in a prepaid health center.

The early detection of cervical cancer by widespread application of the Papanicolaou (Pap) smear has produced a decrease in U.S. mortality rates from this disease. Colposcopy is a useful adjunct in evaluating patients with an abnormal Pap smear. The author's five years of experience using the colposcope for primary screening detected 146 patients with cervical lesions, 30 with moderate dysplasia or worse and 116 with minimal or mild dysplasia. Estimated incidence by type of appointment showed the highest incidence of significant pathology (approximately one lesion per 115 patients) in patients who were seen without appointments. In 19 patients their disease would have been missed by routine Pap smear but was detected by the colposcope. Gynecologists who are trained in the use of this instrument should use it in conjunction with the Pap smear to help detect pathology in new patients.

Carcinoma in Situ↗
PubMedDate not supplied

Ovestin vaginal cream and suppositories for the treatment of menopausal vaginal atrophy.

Eighty-two postmenopausal women with vaginal atrophy and associated symptoms were treated with either Ovestin vaginal cream (54 women) or vaginal suppositories (28 women) containing 0.5 mg of E3/dose, daily for 3 weeks. A maintenance dose of 0.5 mg of E3 twice weekly was applied by all patients for 5 weeks, and by 27 of them for up to 16 weeks. Variables studied were clinical and colposcopic findings, the Maturation Index (MI) and Maturation Value (MV), cervical mucus ferning (F) and spinnbarkeit (S) and endometrial biopsies (obtained pretreatment and after 3 weeks in 15 of the patients). Furthermore, the bio-availability of circulating unconjugated E3 for up to 8 hours following a single dose of Ovestin cream was studied in 10 of the patients. Clinical and colposcopic findings indicated that the treatment had a very favourable effect in all patients. This was reflected in the pronounced change in vaginal smears, indicating a strong oestrogenic effect. There was a slight to moderate effect on cervical mucus. Endometrial biopsies showed that endometrium remained atrophic in all 15 patients in whom biopsies were obtained. A maintenance dose of 0.5 mg of E3 twice weekly appeared to be sufficient to maintain the beneficial effect. Tolerance was good, and patients commented favourably on the treatment.

Adult↗
PubMed1980

[A scanning electron microscope study of the fine angioarchitecture of "punctation" and "atypical vessels" (author's transl)].

The present study was aimed to evaluate the correlation of histologic findings with colposcopic findings of "punctation" and "atypical vessels". The stereoscopic angioarchitectures of "punctation" and "atypical vessels" were observed clearly by scanning electron microscope, utilizing cast formation technique of blood vessels on hysterectomy specimens. Scanning electron microscopy revealed following characteristic findings. 1) The angioarchitecture of "punctation" is composed of three strata. (a) subepithelial capillary network, (b) capillaries rise into the stromal papillae from subepithelial capillary network. (c) stromal vessels ending in subepithelial capillary network. 2) Stratum (b) is observed as "punctation" on colposcopy. 3) Stratum (b) alterate morphologically as follows; hairpin-like capillaries correspond to "punctation" in inflammation, gathered & twisted hairpin-like capillaries in dysplasia, asparagus-like vessels in C.I.S., cauliflower-like vessels in early invasive cancer, respectively. 4) The mesh of stratum (a) become denser as the lesions advance, and in early invasive cancer, the destruction of stratum (a) begin to appear. 5) The branchings of stratum (c) increase as the lesions advance. 6) Chaotic angioarchitecture is observed in invasive cancer, with complete destruction of stratum (a). 7) The morphologic alteration of stratum (b) is the most remarkable in three strata. Colposcopically, these alterations of angioarchitecture are observed as follows; in "punctation", "red spot" become larger and irregularity increase both in size, shape and arrangement, as the lesions advance, in "atypical vessels", "vascular pattern" increase irregularity both in shape, caliber, continuation and arrangement. As a result, by analysing these scanning electron microscopic pictures and comparing them with their colpophotographs and histologic findings, it can be emphasized that, it might be possible to make histologic diagnosis merely by colposcopy.

Capillaries↗
PubMed1980

[Diagnostic colposcopy of adenocarcinoma of the cervix uteri (author's transl)].

Although frequency rate of adenocarcinoma of the cervix is about 5% or over in cervical carcinoma, colposcopical studies of this lesion have never been reported systematically. We observed the colposcopic findings of 52 cervical adenocarcinoma cases. Resemblances in the findings between colposcopy of the lesion and hysteroscopy of corpus carcinoma were examined in order to confirm diagnosis. And the points differentiating the lesion from other lesion with similar findings were noted. In early cases, papillary findings (Cad), transformation-like findings (Tad), mixed findings, granulation-like findings (Gr), columnar epithelium (C) and atypical vessels (aV) were observed. The lesion tended to bleed and secrete mucus. Glomerulus and tendrilous vessels were seen in the papillaries, and roo-like, wastethread-like, tendrilous and corkscrew-like vessels outside the papillaries. In advanced cases, the lesions tended to necrotic mass and the surface collapsed. White epithelium, mosaic and punctation were not observed in the pure adenocarcinoma cases but were observed in some adeno-squamous carcinoma cases. These surface and capillary characteristics resembled the hysteroscopic findings of corpus carcinoma. The papillary findings resembled some squamous carcinoma findings, papilloma and columnar epithelium. We differentiated the lesion by color, luster, degree of alteration after application of acetic acid, shape of papillaries, nature of bleedings, secretion of mucus, formation of necrotic mass, surface degeneration and vessel types.

Adenocarcinoma↗
PubMedDate not supplied

[Cervical clefts as a possible etiologic factor in sterility].

Follow-up gynecological and colposcopic examinations performed in 81 patients after the puerperium have shown that out of 15 sutured ruptures only 9 (60%) healed. The follow-up colposcopic examination revealed 19 unstitched clefts of which 13 did not heal and 6 healed leaving a scar (31.5%). The ectopy of the cervical mucosa was found 5 times (33.3) in the group of stitched clefts and 8 times (47.3%) in the group of unstitched clefts, among which there was also leukoplakia in one case. In the group without the injury of the cervix, ectopia was observed in 11 cases (23.4%). In the course of 1979, at the Gynecology Department, cerclage was performed 474 times. Out of these cases, 20 women (4.2%) underwent cerclage owing to the cleft of the uterine cervix and previous spontaneous abortions. The authors recommend a careful surgical treatment of the cleft and consider the revision of the cervix after each delivery absolutely necessary, both these measures being meant to serve as prevention against sterility and infertility.

Cervix Uteri↗
PubMed1981

Topical 5-fluorouracil treatment of vaginal intraepithelial neoplasia.

In a prospective study, 27 patients with intraepithelial vaginal neoplasia diagnosed by colposcopically directed biopsies were treated with topical 5-fluorouracil. The cream was applied daily to the entire vagina until mucosal irritation occurred (5 to 10 days). Courses were repeated every 2 weeks for a total of 2 to 3 courses, which were considered 1 treatment, before response was evaluated. Those found to have persistent neoplasia as designated by positive vaginal cytology and/or colposcopically directed biopsies received a second 3-course treatment and were evaluated again. Except for 2 patients (1 who died from intercurrent disease during the treatment and another, evaluated prematurely after the first course of therapy, who was found to have persistent disease and was treated by other means), all patients responded with complete regression of vaginal intraepithelial neoplasia. Three patients developed reactivation of disease within 1 year, were retreated, and are currently completely free of disease. The authors believe the results of this study are very encouraging.

Administration, Topical↗
PubMed1981

Colposcopy and cytology in young women up to the age of 20: an analysis of 401 cases research for a new screening programme.

The Authors have observed by colposcopy and cytology, 401 patients under the age of 20 and have compared the results obtained with those of a similar control group with ages ranging from 20 to 25. They observed the incidence of normal cervix and of other colposcopic reports. From the comparison between the colposcopic and cytologic data emerged that the cytopathologic diagnosis does not put the cervical alterations of inferior level than dysplasia in evidence, in a large number cases as colposcopy does. There is a very close relation between the incidence of pathologic cervical lesions and sexual activity. Correlation between cervical pathology and use of hormonal contraceptives and presence of cervico-vaginal phlogosis, was not possible in this type of survey. The Authors therefore propose a new type of mass screening, which should substitute the actual one, that is substantially based on cytology and on early diagnosis rather than prevention.

Adolescent↗
PubMed1981

Combination of cytology and colposcopy in diagnosis of cervical intraepithelial neoplasia.

A 12-month study of 276 patients with erythroplakia investigated the use of colposcopy in combination with cytology to increase findings of cervical intraepithelial neoplasia (CIN). Colposcopic, cytologic, and histologic findings were compared, and and patients were evaluated in relation to age and parity. In 100 detected cases (36.2%), CIN was diagnosed in 44.7% of patients aged 30-33 years and in 46.9% of patients with parity 3; it was also found in patients with parity 0. Abnormal colposcopic findings were observed with abnormal cytology in 32 of 39 cases, with inflammatory cytology in 107 of 161 cases, and with normal cytology in 41 of 76 cases. In these respective groups, CIN I (very mild and mild dysplasia) was diagnosed in 7, 36, and 15 cases; CIN II (moderate dysplasia), in 10, 13, and 4 cases; CIN III (severe dysplasia and carcinoma in situ) in 5, 3, and 1 cases. Eighty-three of 85 CIN cases (97.6%) treated by cryosurgery had good results with follow-up period of 6-12 months. It was concluded that colposcopy was effective as an instrument for collection of specimens with observed abnormalities, and that normal and inflammatory cytology alone were no guarantee of a cervix free of dysplasia. Colposcopy in combination with cytology permitted increased ability to detect CIN.

Adolescent↗