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PubMed1980

Plasma hormones in DES-exposed females.

Random blood samples were obtained from 114 women with history of diethylstilbestrol (DES) exposure in utero and were analyzed for follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrone (E1), estradiol (E2), androstenedione (A), testosterone (T), and progesterone (P) by respective radioimmunoassays. Colposcopic examinations of the lower genital tract and biopsies of suspicious areas of vaginal mucosa were performed in every patient. The mean age of these patients was 21.6 +/- 0.3 years (mean +/- SE) and mean age of menarche was 12.6 +/- 1.0 years. The incidence of irregular menses was 16.7%. A positive colposcopic finding was observed in 73.7% of all patients, 69.5% of patients with regular menses, and 94.7% of patients with irregular menses. Histologically confirmed vaginal adenosis was found in 43% of all patients, 46.3% of patients with regular menses, and 42.1% of patients with irregular menses. No significant differences were observed between DES-exposed versus unexposed females with regular menses in all hormones except testosterone. An elevated testosterone level was noted in postovulatory and perimenstrual phases of DES-exposed females. Elevated testosterone was also observed in DES-exposed females with irregular menses. Cross-analysis of hormone levels among the patients with lower genital tract pathology failed to show any statistical differences.

Adolescent↗
PubMed1980

Cytology and colposcopy in the diagnosis and management of outpatients with cervical intraepithelial neoplasia.

One hundred consecutive outpatients seen in the colposcopy clinic of a private hospital had one or more Papanicolaou smears that suggested cervical atypia, dysplasia or carcinoma in situ. Of these 100 patients, 7% underwent a diagnostic cervical cone biopsy; 11% more had therapeutic conization. The accuracy of colposcopic examination with directed cervical biopsy within one level (under or over) of histologic findings was 88%; the cytologic accuracy within one level of histologic findings was 83%. The study showed that patients with cervical atypia at cytologic examination had dysplasia and carcinoma in situ at subsequent colposcopic cervical examination with directed biopsy.

Carcinoma in Situ↗
PubMed1980

Cryosurgical treatment of cervical intraepithelial neoplasia.

This report describes 354 patients treated with cryosurgery for cervical intraepithelial neoplasia (CIN) over an 8-year period. Colposcopic criteria were used to select treatable patients and to perform colposcopically directed biopsies. Treatment failures occurred in 6.2% of 298 patients treated for CIN I and II lesions. Of patients treated for carcinoma in situ, 39% demonstrated persistence of this lesion. Based on this clinical experience, cryosurgery is no longer acceptable for the treatment of severe dysplasia or cervical carcinoma in situ.

Carcinoma in Situ↗
PubMed1995

Prevalence of human papillomavirus infection and HPV DNA among male partners of Israeli women with genital premalignant and human papillomavirus lesions.

The role of the males who are sexual partners of females with genital human papillomavirus (HPV) infection and premalignant lesions is explored in the present study. Within a period of 3 years, 391 females with genital premalignant and HPV-associated lesions were examined and treated at the Cervical Pathology Unit of the Tel Aviv Medical Center. The male partners of all the women were asked to attend this unit, and 322 of them responded. All participants underwent colposcopic examination of the anogenital area followed by colposcopically guided biopsies from the most representative lesions, when present, part of which included in situ hybridization (ISH) of HPV DNA sequences 6/11 and 16/18. The histological prevalence of HPV among the male partners was 86.6% (185 of 213 biopsies). Of the 48 couples who had ISH evaluations, the ISH could not identify any copy of HPV DNA in 58.3% of the males (28 cases) and 41.6% of the females (20 cases). Among the males, HPV 6/11 and 16/18 were found in 17 (35.4%) and 3 cases (6.2%), respectively, and among the females there were 23 (48.0%) and 5 cases (10.4%), respectively. Correlation of HPV DNA sequences 6/11 and 16/18 between the couples was found in six (12.5%) and in one (2.0%), respectively. These data do not support a direct contamination by the current male partner. The question of treating the male partner of a woman with genital HPV and premalignant lesions remains to be evaluated.

Condylomata Acuminata↗
PubMed1994

[Erosion of the uterine cervix in women with primary infertility treated with CO2 laser].

The authors described the results of treatment of erosions of the uterine cervix in 78 women with primary sterility with CO2-laser vaporisation in Department of Reproduction, Institute of Gynecology and Obstetrics, Academy of Medicine, Poznań. The results were estimated through clinical, cytological and colposcopical examinations in the term of 6 weeks and 3 months after therapy. The Insler's cervical mucus test was done in all women after 3 months. In all women the healing was achieved and five of them were needed for second laser therapy because of superficial endometriosis. The authors think that CO2-laser vaporisation (under colposcopical control) of erosions of the uterine cervix in women with primary sterility is the reliable method. The wound's healing after laser therapy is quick and without any complications. Laser therapy causes no trauma of the cervix structure and does not disturb in excretion of mucus by cervical glands.

Adult↗
PubMed1995

A comparison of the reliability of repeat cervical smears and colposcopy in patients with abnormal cervical cytology.

BACKGROUND: To determine the reliability of repeat cervical smears (Papanicolaou smears) in patients who have had an abnormal initial smear, prospective data were collected on patients being followed up for a previously abnormal cervical smear. METHODS: All 428 patients who were referred for colposcopy because of abnormal cervical smears underwent simultaneous cervical smears and coloposcopy with directed biopsy. Patients with colposcopic evidence of invasive carcinoma or a history of prior colposcopy were excluded. Cervical smear results were compared with the histologic findings on colposcopically directed biopsy. The ability of cervical smears to identify cervical intraepithelial neoplasia (CIN) and high-grade lesions (CIN 2 and 3) were also calculated for the repeat cervical smear. RESULTS: The sensitivity of repeat Papanicolau screening for CIN was 48%. When differentiating high-grade lesions from low-grade and benign biopsies, the sensitivity of the repeat cervical smear was only 25%. Of 110 patients with biopsy-proven high-grade lesions, 68% had low-grade initial cervical smears and 73% had low-grade or benign repeat cervical smear cytology. CONCLUSIONS: This study demonstrates that repeated Pap smears often fail to identify high-grade lesions and that the sensitivity of a repeat cervical smear is very low in patients with low-grade abnormalities found on routine screening examinations. Using follow-up cervical smears to monitor patients who have low-grade squamous intraepithelial lesions (LGSIL) carries unacceptable risks. A more reliable diagnostic test such as colposcopy is indicated.

Adolescent↗
PubMed1994

Colposcopy, colpocytology and the vaginal ecosystem. Oncological, bacteriological and hormonal evaluation in a series of 400 women.

The Authors retrospectively considered colpocytological and colposcopic findings in a series of 400 women, aged 16 to 83 years, presenting for the first time at the Oncological Gynaecology Unit of the Institute of Gynaecology and Obstetrics of Padua University between 1991 and 1992. In addition to oncological evaluation, the bacteriological profile and hormone status of cytological samples were formulated in all cases. The most common oncological finding was a cell morphology within normal limits (67%), followed by reactive and reparative changes (19%) and low-grade squamous intraepithelial lesions (SIL, 12%). Histological findings correlated well with the cytological diagnosis, though low-grade SIL was over-estimated. As for the bacteriological profile, a mixed flora was most frequent (56.7%) followed, especially in fertile age, by Döderlein's bacillus (20%) and vaginosis (15.5%). Colposcopy most frequently revealed ectopia and/or a normal transformation zone (50.7%) and dystrophic mucosa (21%). An abnormal transformation zone was more common among women with a moderate-to-abundant flora. Fifteen male partners were also checked: cellular changes typical of human papilloma virus infection were found in 40% and colposcopic findings compatible with said virus were observed in 26.6% of cases. These results confirm that colpocytology provides a complete and simultaneous evaluation not only of cell morphology, but also of the bacterial population and hormones in the vaginal ecosystem. It is therefore the method of choice in screening for cervical and vaginal neoplasms and an effective means for simultaneously evaluating vaginal flora and hormone status.

Adolescent↗
PubMed1994

Systemic interferon therapy for female florid genital condylomata.

A prospective randomized study comparing systemic interferon therapy with placebo in women with florid genital condylomata was carried out. A first group of 22 patients received alpha-interferon (Alfaferone: Alfa-Wassermann Bologna, Italy). 3 x 10(6) IU by i.m. injection every other day for four weeks (total of 12 injections). A second group of 20 patients was treated with a placebo. All patients, before therapy, were submitted to a colposcopic and vulvoscopic examination, a Pap smear and biopsy, in order to confirm the clinical diagnosis. Controls were carried out on all patients as a distance of three, six and twelve months from the end of treatment using colpocytologic, colposcopic and vulvoscopic examinations. One year after the termination of the therapy with interferon 45.4% of patients had a complete recovery compared with 10% of spontaneous recovery in the control group (p = 0.028). The systemic side effects of alfa-interferon, though very frequent, did not limit the use of the product. Our results suggest that systemic alfa-interferon treatment is effective in female genital condylomata, above all in those patients with multifocal florid lesions, both in terms of complete remission and number of relapses.

Adolescent↗
PubMed1994

Potential contribution of human papillomavirus testing to cervical cancer screening.

A prospective study was carried out to assess the clinical value of HPV DNA identification in terms of cases missed by either cytology or combined cytology and colposcopy screening methods, 231 exfoliative cytology specimens and forty-one cervical tissue samples were analysed for the presence of HPV 6, 11, 16 and 18 DNA sequences using filter in situ and Southern blot hybridisation methods, 36% of cytology specimens examined by filter in situ hybridisation method were found to carry HPV DNA sequence. Forty-nine (27%) out of 184 cases without cytological evidence of neoplasia had a positive HPV test. Simultaneous colposcopic examination of these patients showed no abnormality in 17 cases. The relevance of HPV investigations was based on the characteristic HPV prevalence in preneoplastic and normal cervical tissue samples. The results suggest that traditional cervical screening may be improved by simultaneous HPV testing. According to the presented data, only a very small portion of a random patient population can be expected to carry HPVs without cytologic or colposcopic abnormalities.

Blotting, Southern↗
PubMed1994

[Chlamydia infection and CIN].

Under the hypothesis that a chronic infection of the cervical epithelium leads to a reduction in the immunological response, a study was carried out to compare the possible relationship between chlamydial infection and CIN. 187 patients were referred to hospital for histological confirmation because of a cytological smear result (PAP III and IV a). Smears were examined for chlamydia antigens using immunofluorescence. The presence of antichlamydial IgA and IgG was performed in serum using an indirect immunohistochemical method. These tests confirmed CIN in 163 patients. The infection rate with chlamydia was 52.9%, 15.9% of CIN patients showing an active chlamydial infection. Inclusion of topographical findings, together with differential evaluation of colposcopic results, with reference to the transformation zone, allow for a separation between inflammation and dysplasia. The confirmation of a positive chlamydial infection and colposcopic criteria may help to reduce the high percentage of false-positive findings in the problem-group of PAP III patients. It appears that reservations about smear controls after doxycyclin therapy--including treatment of sexual partners--is justified.

Antibodies, Bacterial↗
PubMed1994

[Correlation of clinical and virologic diagnosis of cervical infection with human papillomaviruses].

The presented investigation is concerned with contemporary diagnostic possibilities of HPV Infection of the Cervix. The authors present the results of virological examinations of 228 female patients in the Centre for Oncological Prevention. The examination was made by hybridization techniques, using probes specific for HPV 6, 11, 16 and 18 and by serological methods where IgG antibodies were assessed against synthetic peptides, corresponding to several HPV epitopes, as antigens. 156 women (68.4%) were virologically positive, 72 (31.6%) were negative. Subsequently the authors investigated the diagnostic accuracy of HPV changes of the cervix by clinical methods, i.e. colposcopy and cytology, as compared with virological methods. On colposcopic examination uncertain--i.e. insignificant--results were recorded in 24.6%, on cytological examination in 19.7%. In patients where these methods gave unequivocal results (either + or-) a correct forecast of the presence of HPV during colposcopic examination was recorded in 71.1%, in cytological examinations in 66.9%. At least one of the clinical methods assessing papilloma virus infection was prognostically correct in 90.4%. From the investigation ensures that prebioptic methods provide the clinician with relatively reliable information on the presence of HPV infection and enable him to select a therapeutic and dispensarization procedure adequate to the finding. However, they cannot replace virological examination among other reasons also because they cannot assess the HPV type.

Colposcopy↗
PubMed1994

Electroconization of the cervix with a fine-needle electrode.

OBJECTIVE: To obtain electroexcised specimens in which the endocervical margin of the lesional tissue is devoid of thermocoagulation injury, facilitating accurate histologic interpretation of early stromal invasion. METHODS: Using local anesthesia, we performed electroexcision with fine-needle electrodes and a tonsillar snare wire; no sutures to the lateral vessels were required. We tried to obtain cylindrical specimens. The procedure was performed in 38 women with deep canal involvement by squamous intraepithelial lesions, without colposcopically visible endocervical margins. RESULTS: The mean duration of the procedure was 12 minutes (range 8-26). Complications occurred in seven of 38 patients (18%): four cases of perioperative bleeding, one of delayed bleeding, and two of asymptomatic stenosis of the external os. All cases were managed on an outpatient basis. Two cases of unsuspected microinvasive carcinoma were discovered. CONCLUSION: In nonpregnant women in whom the endocervical limit of a lesion cannot be visualized with a colposcope, fine-needle electroconization is an attractive alternative to loop electroexcision. With this technique, cervical specimens can be collected without thermal damage to the endocervical margins.

Adult↗
PubMedDate not supplied

Management of suboptimal cytologic smears. Persistent inflammatory smears.

In this study, cytologic smears from 161 women presenting with persistent inflammation were reviewed and the cytologic diagnoses compared with the colposcopic and biopsy findings. When colposcopy was performed and information was available for evaluation (102 cases), 62.7% (64 cases) had abnormal colposcopic findings requiring treatment. The similar figure for biopsy was 76.2% (64 of 84 cases). Of significance was the proportion of major advanced abnormalities requiring immediate treatment. Colposcopy and biopsy, respectively, revealed 7.9% and 19.1% of cases with high grade squamous intraepithelial lesions (CIN 2) or worse. These striking data reinforce the importance of recommending colposcopy as a means of managing persistent inflammation in cytologic smears.

Adolescent↗
PubMed1994

Examination findings in legally confirmed child sexual abuse: it's normal to be normal.

BACKGROUND: Studies of alleged victims of child sexual abuse vary greatly in the reported frequency of physical findings based on differences in definition of abuse and of "findings." This study was designed to determine the frequency of abnormal findings in a population of children with legal confirmation of sexual abuse, using a standardized classification system for colposcopic photographic findings. METHODS: Case files and colposcopic photographs of 236 children with perpetrator conviction for sexual abuse, were reviewed. The photos were reviewed blindly by a team member other than the examiner, and specific anatomical findings were noted and classified as normal to abnormal on a scale of 1 to 5. Historical and behavioral information, as well as legal outcome was recorded, and all data entered into a dBase III program. Correlations were sought between abnormal findings and other variables. RESULTS: The mean age of the patients was 9.0 years (range 8 months to 17 years, 11 months), with 63% reporting penile-genital contact. Genital examination findings in girls were normal in 28%, nonspecific in 49%, suspicious in 9%, and abnormal in 14% of cases. Abnormal anal findings were found in only 1% of patients. Using discriminant analysis, the two factors which significantly correlated with the presence of abnormal genital findings in girls were the time since the last incident, and a history of blood being reported at the time of the molest. CONCLUSIONS: Abnormal genital findings are not common in sexually abused girls, based on a standardized classification system. More emphasis should be placed on documenting the child's description of the molestation, and educating prosecutors that, for children alleging abuse: "It's normal to be normal."

Child↗
PubMed1994

Cervical intraepithelial neoplasia in women infected with human immunodeficiency virus: prevalence, risk factors, and validity of Papanicolaou smears. New York Cervical Disease Study.

OBJECTIVE: To define the prevalence of cervical intraepithelial neoplasia (CIN), the validity of Papanicolaou tests, and the associations between CIN and risk factors for cervical disease in human immunodeficiency virus (HIV)-infected women. METHODS: In this cross-sectional study, we enrolled 398 HIV-seropositive and 357 HIV-seronegative women from two HIV-AIDS clinics, two sexually transmitted disease clinics, a methadone clinic, and a clinic for participants in an HIV heterosexual transmission study. Each woman was interviewed and underwent a cytologic and colposcopic evaluation, and was tested for human papillomavirus (HPV) DNA. RESULTS: Eighty (20%) of the 398 HIV-seropositive women compared to 15 (4%) of the 357 seronegative women had colposcopically confirmed CIN (odds ratio 5.7; P < .001). No invasive cancers were found. The sensitivity and specificity of Papanicolaou tests in seropositive women were 81 and 87%, respectively. By multiple logistic regression analysis using a model that included behavioral and biologic risk factors for CIN, CIN was independently associated with HPV infection (odds ratio 9.8), HIV infection (odds ratio 3.5), CD4+ T-lymphocyte count less than 200 cells/microL (odds ratio 2.7), and age greater than 34 years (odds ratio 2.0). CONCLUSIONS: Cervical intraepithelial neoplasia is a common finding in HIV-infected women. However, the results of this study suggest that Papanicolaou tests should be effective for detecting cervical disease in this population.

Adolescent↗
PubMedDate not supplied

Papanicolaou smear discrepancy: resolution by review.

BACKGROUND: Discrepancy between Papanicolaou smears and colposcopically directed biopsies often creates a treatment dilemma, especially when the cytologic specimen suggests a higher grade lesion than the histologic specimen. A method of side-by-side review using the Bethesda System was evaluated as a means of resolving this discrepancy between cytologic and histologic specimens. METHODS: By means of a retrospective chart review, we selected 150 patients undergoing colposcopic evaluation for abnormal cytologic findings. Thirty-eight patients had higher grade lesions on cytologic examination than on histologic examination. Twenty-four of these patients had both cytologic and histologic slides available, and these specimens were evaluated in a blinded review by a single pathologist using the Bethesda System of classification. RESULTS: Reevaluation yielded resolution of discrepancy in 19 of 24 cases, a 79.2 percent resolution. CONCLUSION: Review of cytologic and histologic specimens by an experienced pathologist using the Bethesda System can resolve many of the cases in which the cervical lesion is considered to be of a higher grade by cytologic examination than by histologic examination.

Biopsy↗
PubMed1993

Cervicography: an intermediate triage test for the evaluation of cervical atypia.

BACKGROUND: A substantial number of abnormal Papanicolaou (Pap) smears are reported as demonstrating "cytologic atypia." This finding may actually represent premalignant cervical disease. Some of these patients may not be able to afford definitive colposcopic examinations, and simply repeating cytologic testing may result in missed treatable disease. The purpose of this study was to evaluate the use of cervicography as an intermediate triage test for women with atypical cervical cytology. METHODS: Women with a recent smear demonstrating cytologic atypia were evaluated using colposcopy, biopsy, and cervicography. RESULTS: Colposcopically directed cervical biopsies were obtained from 224 of 685 women with cytologic atypia. The histologic specimens confirmed evidence of cervical dysplasia for 166 women. Of these women, cervicography detected 74.7% of those who had mild dysplasia, 87.5% of those who had moderate dysplasia, 75% of those who had severe dysplasia, and the one patient who had cervical cancer. Most (93%) of the women with dysplasia that was undetected by cervicography had mild dysplasia. CONCLUSIONS: Cervicography may be an effective intermediate triage test for the evaluation of young women with Pap smears demonstrating cytologic atypia.

Acetates↗
PubMed1993

Colposcopy of adenocarcinoma in situ and invasive adenocarcinoma of the cervix.

Colposcopy is most useful in evaluating squamous lesions of the lower genital tract. Its usefulness in evaluating glandular abnormalities of the uterine cervix now are limited. There are abnormal features in invasive adenocarcinoma of the cervix that allow the colposcopist to make that diagnosis with directed punch biopsies. The biopsy specimens should be large enough to allow the pathologist to make the diagnosis of invasion. At the present time, the colposcopic features of adenocarcinoma in situ are not well recognized. It must be stressed that where adenocarcinoma in situ is suspected colposcopically or by cytology, the definitive diagnostic procedure remains cone biopsy.

Adenocarcinoma↗