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PubMed1993

Acetic acid visualization of the cervix to detect cervical dysplasia.

OBJECTIVE: To determine whether acetic acid visualization of the cervix can identify cervical dysplasia and improve detection of lesions missed by Papanicolaou test screening. METHODS: During a 2-year period, patients attending family planning clinics for regular gynecologic examinations had acetic acid applied to the cervix, followed by gross visualization without magnification. Patients with suspicious acetowhite lesions and normal Papanicolaou tests were referred for colposcopic evaluation. Findings from these examinations and corresponding biopsy results were analyzed retrospectively. RESULTS: Eighty-five women were referred for colposcopy because of abnormal acetowhite areas on the cervix. Thirteen patients (15%) had cervical intraepithelial neoplasia (CIN) (nine CIN I, four CIN II), 22 (26%) had koilocytosis, and 16 (19%) had benign histologic findings. In total, 51 patients had suspicious lesions at colposcopy for which biopsies were performed, and 34 (40%) had normal colposcopic examinations. CONCLUSIONS: Acetic acid visualization of the cervix can detect dysplasia otherwise missed by Papanicolaou test screening. However, further refinements in technique are required to decrease false-positive findings and unnecessary referrals for colposcopy.

Acetates↗
PubMedDate not supplied

Frequency of nondiagnostic findings on colposcopy: implications for management.

BACKGROUND: This study examines the frequency of nondiagnostic findings from colposcopic biopsies at the University of Washington Family Medical Center Colposcopy Clinic and reviews the literature for any current recommendations for management of such cases. METHODS: We reviewed 138 consecutive colposcopy reports covering the period from January 1990 to August 1991 from the Colposcopy Clinic at the University of Washington Family Medical Center. Nondiagnostic results were defined as those negative for dysplasia (atypia, inflammation, hyperkeratosis, and parakeratosis). RESULTS: Of 138 endocervical curettages 25 (18.1 percent) had nondiagnostic findings, while of 206 ectocervical biopsies 104 (50.5 percent) had nondiagnostic findings. Of the 138 patients examined, 41 (29.7 percent) had a nondiagnostic biopsy as the most notable finding. CONCLUSION: Nondiagnostic colposcopic biopsy results occur frequently at the University of Washington Family Medical Center. The meaning of these equivocal results remains unclear. We need a further study of the natural history of such patients to determine appropriate recommendations for management.

Adolescent↗
PubMed1977

Evaluation of abnormal cervical cytology.

The results from cytologic, colposcopic, and histologic studies in 376 patients are analyzed and compared to previous reports. Cytologic results correlated within 1 degree of the histologic diagnosis in only 67% of cases. Colposcopic impression correlated with the final histologic diagnosis in 78% of cases. Directed biopsies were exceedingly accurate (99.3%) when the entire transformation zone was visualized. When the entire zone was not visualized, 7 cases of invasive carcinoma were discovered among 59 cone biopsies. It is concluded that cytology should be used only as a screening tool and colposcopy as a directional aid in obtaining biopsies and defining the need for endocervical curettage. When the entire zone is visualized, directed biopsies are dependable and cone biopsies may be avoided. When the upper zone is not visualized and the endocervical canal is involved by significant dysplasia or carcinoma in situ as diagnosed by directed biopsies and/or endocervical curettage, cone biopsy is mandatory prior to definite therapy.

Biopsy↗
PubMed1993

Cervical intraepithelial neoplasia in HIV seropositive patients.

In order to assess the frequency of cervical intraepithelial neoplasia (CIN) in a high risk population, 32 women infected with human immunodeficiency virus (HIV), with no AIDS-related symptoms, underwent colposcopic, cytologic and histologic examinations of the uterine cervix. In seven cases (21.9%) cervical smears showed dysplasia and in nine cases (28.1%) histologic evaluation indicated CIN. No invasive carcinomas were observed. In seven of the nine women CIN was associated with lesions due to human papillomavirus infection (HPV). These data confirm that HIV-positive women are at increased risk for developing neoplasias in the lower genital tract and are in need of regular and careful cytologic and, in particular, colposcopic and histologic examinations.

Adult↗
PubMed1995

Cervical intraepithelial neoplasia and human papillomavirus related lesions of the genital tract in HIV positive and negative women.

Two hundred and twenty one women at high risk for HIV (intravenous drug users and/or those with infected partners) were investigated, through a self-filled questionnaire and gynaecological examination, to define the relationship between genital Human Papilloma Virus (HPV) infections, preneoplastic cervical intraepithelial lesions (CIN) and behavioural risk factors. In the 121 HIV positive women, 58 (47%) had HPV lesions at colposcopic and/or cytologic examination and, out of these 58, 23 (40%) had CIN 1, CIN 2 or CIN 3. Six out of the 16 cases with CIN 1 and CIN 2 (37%) followed-up showed a rapid progression of the lesion to CIN 3; in 3 women the interval was 6 months, in the other 3 about 12 months. Only 5 (7%) of the remaining 66 women without HPV lesions had a CIN lesion, with an obviously significant difference on comparison with HPV positive subjects. Sixty two women out of the 121 (52%) had a previous diagnosis of condylomata. In the 100 HIV negative women, 23 (23%) had HPV lesions and, among these 23, 6 (26%) had CIN 1, CIN 2 or CIN 3; 1 of them had rapid progression from CIN 1 to CIN 3 within a year. Only 5 (3%) without HPV infection showed any kind of CIN. 33 women out of 100 (33%) had a previous clinical history of condylomata. Our findings strongly suggest that HIV infection is associated with HPV lesions and that cervical cytological abnormalities develop in this situation. There is a need for short interval cytological and colposcopic follow-up for women at high risk of HIV infection.

Adult↗
PubMed1996

The minimally abnormal Papanicolaou smear.

The Bethesda system has helped to standardize the nomenclature for cervical cytology. Previously used cytologic classification systems failed to define modern histopathologic concepts. The Bethesda system also has dramatically increased the number of Papanicolaou smears classified as minimally abnormal. While high-grade squamous intraepithelial lesions (cervical intraepithelial neoplasia 2 and 3) clearly require colposcopic evaluation, the minimally abnormal Pap smear may not always require colposcopic assessment. Common minimally abnormal cytologic categories include atypical squamous cells of undetermined significance, low-grade intraepithelial lesions and atypical glandular cells. New guidelines propose a conservative and expectant approach for these mild abnormalities. Understanding the meaning of these Pap smear reports and instituting appropriate treatments will improve patients care, reduce clinician anxiety and help ensure the best care for patients.

Carcinoma in Situ↗
PubMed1996

[Atypical cervix uteri smears--consequences?].

Among 37,992 cervical smears (725 (1.9%)) were found to be atypical. All atypial smears were referred for colposcopically guided biopsies and cervical abrasio within three months. This is an expensive and cumbersome procedure. In order to obtain a more differentiated follow-up procedure the atypical smears were divided into two groups without knowledge of the later histological diagnosis on biopsy: "Atypia, probably reactive" and "atypia, probably CIN (cervical intraepithelial neoplasia)". In the latter group the subsequent biopsies showed significantly more CIN than in the former (60.4% against 15.7%). We find it useful to divide the atypical smears into two groups in our daily routine work with a different follow-up procedure: "Atypia, probably reactive" to be followed by a repeat smear and "atypia, probably CIN" to be followed by colposcopically guided biopsies and cervical abrasio.

Biopsy↗
PubMed1995

[The relationship between genital chlamydial infection and the presence of cervical intraepithelial neoplasia].

A study was carried out on 128 women with clinical signs of cervicitis. Direct immunofluorescence was used for the diagnosis of genital chlamydial infection. 46 (of total 128) were positive for C. trachomatis. (35.9%). Abnormal colposcopic findings were found in 38 women cervical biopsies were taken in 52 women. 8 women were positive for C. trachomatis in the group with abnormal colposcopic findings. 24 were positive for C trachomatis in the group, where cervical biopsies were taken. Comparing the results it was found that genital chlamydial infection did not influenced directly the development of cervical intraepithelial neoplasia.

Adolescent↗
PubMed1995

[Incidence of HPV and CIN in HIV positive women].

Cervical intraepithelial lesions associated with genital human papilloma virus (HPV) infection occur with increased frequency and severity among women with immunodeficiency. In this study, we considered 24 HIV-seropositive and 12 HIV-seronegative women. Each woman was interviewed and underwent a cytologic and colposcopic evaluation. Then colposcopic and cytologic findings were correlated with histologic and differences between HIV-seropositives and seronegatives were analyzed. Ten (41%) of 24 HIV-seropositive and one (9%) of 12 HIV-seronegative women had human papilloma virus infection. Among seropositives, eight (34%) had cervical intraepithelial (CIN): of those eight, 5 had CIN I, 2 CIN II and 1 CIN III. There (24%) of the 12 HIV-seronegative had CIN: two had CIN I and one CIN II. Six of the HIV-seropositive women were found to have multicentric disease (two or more sites). The objective of this study is to determine the relationship between human immunodeficiency virus (HIV) and human papilloma virus infection, sexual habits, reproducive history, and risk of cervical intraepithelial neoplasia (CIN). The results of this study suggest that cervical intraepithelial neoplasia is a common finding in HIV-infected women. Papanicolaou tests should be effective for detecting cervical disease in this population.

AIDS-Related Opportunistic Infections↗
PubMed1996

Disappearance of DNA HPV in sequential specimens of occult cervical infection in a "normal" population.

OBJECTIVE: The behaviour of occult infection in the uterine cervix was studied over one year in 175 women randomly selected, to determine if the infection persisted, disappeared or if the viral genotype became modified. STUDY DESIGN: An earlier study of the prevalence of HPV cervical infection detected 11 (6.2%) occult infections. Of these the infectious genotype could only be identified in five. One year later the infected women were subjected to further colposcopical examination and molecular hybridization testing. RESULTS: In seven of the 11 cases with cervical occult infection, the DNA HPV genome was found to be completely absent at year-end. Colposcopic and cytological studies remained negative in all women. CONCLUSIONS: The loss of DNA HPV in seven of the 11 previously positive women is probably due to variability in the number of cells that became infected in a situation where small numbers of copies are made. The high proportion of occult infection with uncharacterized viruses supports the view that this type of infection is often due to new genotypes, presently non-classifiable.

Adolescent↗
PubMed1997

Treatment of chronic cervicitis: the loop electrosurgical excision procedure.

The effectiveness and morbidity of excisional biopsy of cervical tissue using the electrosurgical excision procedure for the treatment of chronic cervicitis was investigated. In this study, loop diathermy was used in the treatment of one hundred patients with chronic cervicitis. Before the procedure, cervical smear and colposcopic examination were done. Then the loop diathermy was performed under local anesthesia. All the removed specimens were evaluated histopathologically. The mean operation time was 6.34 +/- 1.37 minutes. The complication of bleeding and secondary infection were 5% and 4%, respectively. All the patients had normal cervical smear (Papanicolaou class I or II). In the microscopic evaluation, thermal damage of the removed specimens were negligible. Six cases (6%) with CIN (CIN I = 4, CIN II = 2) were determined and the others (94%) were reported as chronic cervicitis in the histopathologic examinations of the removed specimens. After the operation, these cases with CIN were followed up for one year with cervical smears and colposcopic examinations. One of the six patients with CIN had recurrence and underwent cold-knife conization. This new technique is simple, quick and cheap. It can be used confidently to provide both diagnosis and treatment with minimal thermal tissue injury in cases with chronic cervicitis.

Biopsy↗
PubMed1997

Validity of colposcopy to identify and grade squamous intraepithelial lesions among Venezuelan women.

To assess the validity of colposcopy to correctly detect and grade squamous intraepithelial lesions (SIL) in Venezuelan women, we did a prospective, nonrandomized and cross sectional study on patients referred with low-grade and high-grade SIL. After a second cervical smear, they were colposcopically evaluated and biopsied. The outcome measures were interobserver variation, sensitivity, specificity, and predictive values. Ninety-nine patients were evaluable. Colposcopy had poor agreement with repeat cervical smears, and moderate to good agreement with conization biopsy (kappa = 0.55; 95% C.I.: 0.45 to 0.65), with a sensitivity of 0.87, a specificity of 0.69, a positive predictive value of 0.85 and a negative predictive value of 0.71 for high-grade SIL. The criterion of colposcopic vascular atypias was accurate enough to detect and grade SIL, showing good agreement with histopathology. Because of the disparity of results in previous reports, only a carefully designed, randomized study will settle this question.

Adult↗
PubMed1997

The HPV determinants of CIN I.

Correlates of HPV amongst a cohort of women with a CIN I detected by a screening Pap test were investigated. Co-incident CIN II/III lesions were identified and their influence on the HPV status and HPV determinants of screening detected CIN I was assessed. Based on both the colposcopic impression and repeat Pap test, 537 women referred for examination of a Pap test classified as CIN I were triaged into two groups. Group A lesions were assessed as </= CIN I; n = 342 (63.7%) and group B as >/= CIN II; n = 195 (36.3%). Clinical, demographic, reproductive, and risk factor for cervical cancer correlates were collected. HPV typing of cervical scrapes collected at the colposcopic examination was done by PCR amplification using seven sets of type specific and one set of consensus primers. HPV positivity was identified in 47% of all scrapes; types 16/18 (28%), 31/33/35 (10%), 6/11 (2%), and unknown (7%). The HPV status of the cohort and group A were very similar. Group B had a slightly higher rate of HPV positivity (52%) due to an increase in types 16/18. Statistically significant correlates of HPV prevalence or type were not identified either for the entire group or both triage groups, however in each group, HPV positive women tended to be younger and to have more sexual partners. Co-incident CIN II/III spuriously increased the HPV prevalence rate of CIN I detected by a screening Pap test. The HPV appears to be sexually transmitted both in low and high grade lesions and explains why the HPV determinants of the entire cohort were unaffected by the co-incident CIN II/III.

Adolescent↗
PubMed1997

Overcoming unsatisfactory colposcopy. Use of osmotic dilators.

OBJECTIVE: To evaluate the usefulness of osmotic dilators as an alternative to diagnostic cone biopsy. STUDY DESIGN: Women who had an unsatisfactory colposcopic examination were offered repeat examination after use of osmotic dilators as part of an interventional, nonrandomized study. The physician selected the type, size and duration of use of the dilator. RESULTS: Twenty-nine of 32 women (91%) underwent a satisfactory repeat examination. Diagnostic cone biopsy was avoided in all women. Twenty-one women did not require further treatment, and four women had the lesion removed by the colposcopically directed biopsy. Six women underwent electrosurgery, and one woman underwent cryotherapy. CONCLUSION: The use of osmotic dilators can decrease the need for diagnostic cone biopsy.

Adult↗
PubMedDate not supplied

On-site colposcopy services in a family practice residency clinic: impact on physician test-ordering behavior, patient compliance, and practice revenue generation.

BACKGROUND: Using colposcopy as a model, we examined the impact of introducing a new diagnostic technology into the ambulatory primary care setting. METHODS: Records of patients with abnormal findings on Papanicolaou smears were reviewed from three study periods: 1 year before, 1 year after, and 5 years after initiation of on-site colposcopy services. Data analyzed include physician management decisions, site of colposcopic service, and patient compliance. Practice revenue estimates were based upon patterns of physician management and patient compliance found during each study period. RESULTS: Management of low-grade squamous intraepithelial lesions varied during each study period. By period 3, however, most patients were undergoing colposcopy (P = 0.03). High-grade squamous intraepithelial lesions were uniformly managed with colposcopy during all study periods (P < 0.001). Introduction of on-site colposcopic services resulted in a rapid shift to the on-site location for evaluation of low-grade squamous intraepithelial lesions and a more gradual shift to the on-site location for evaluation of high-grade squamous intraepithelial lesions. Patient compliance was not affected by the introduction of on-site services. On-site colposcopy resulted in a nearly 100 percent transfer of revenue to the practice, but the economic benefit was quite modest. CONCLUSIONS: Although offering on-site colposcopy services might have had some impact on physician management of low-grade squamous intraepithelial lesions, the lack of benefit regarding patient compliance, the relatively small patient volume for this procedure, and its modest impact on practice revenue cause us to question the value of including colposcopy in everyday practice.

Adult↗
PubMed1976

Recurrent carcinoma in situ of the vagina in patients previously treated for in situ carcinoma of the cervix.

Sixty-six patients were seen at the Mayo Clinic from 1950 through 1974 with in situ carcinoma of the vagina following various forms of treatment for a similar lesion of the cervix. Sixty-three patients have remained free of recurrent disease. One patient has been lost to followup, 1 patient required a second local excision, and 1 patient had recurrent carcinoma that progressed to invasive vaginal malignant disease. The recurrent malignant disease was usually asymptomatic; its presence was suggested by an abnormal Papanicolaou smear and confirmed by Schiller stain or colposcopically directed biopsy. Colposcopic examination of the vagina has greatly facilitated delineation of the lesion; this may allow relatively simple definitive therapy in some instances--that is, local excision or partial vaginectomy. Total vaginectomy, with or without skin graft vaginal reconstruction, must be carried out in patients who have multicentric lesions. The use of vaginal radium or external beam therapy should be limited to the elderly patients or those to whom a functional vagina is unimportant.

Adult↗
PubMed1997

[The detection of papillomavirus by in situ hybridization. Clinico-pathological and virological correlation in patients with squamous intraepithelial lesions of the uterine cervix].

BACKGROUND: Clinical usefulness of human papillomavirus (HPV) detection by molecular techniques is not well established. The aim of the study is to determine, by in situ hybridization, HPV DNA in patients with cervical intraepithelial neoplasia (CIN), assessing the prevalence rate, the association with epidemiologic factors and the correlation with classic diagnostic procedures (cytology, colposcopy and histology). PATIENTS AND METHODS: Among 138 patients diagnosed with CIN, HPV was determined in 75 treated by excisional procedures. All cases underwent pap-smear, colposcopy, and colposcopically directed biopsy. RESULTS: Histologic diagnosis was as follows: 1 cervical condyloma (1.3%); 31 CIN-I (41.3%); 23 CIN II (30.7%), and 20 CIN-III (26.7%). HPV was detected in 31 cases (41.3%), being more frequent in higher histologic grades (35.5%) CIN-I, 43.5% CIN-II and 45% CIN-III). No association between cytologic, colposcopic and histologic diagnoses and HPV positivity was observed. HPV detection in patients with false negative cytologies was lower than in positive ones (p = 0.021). Smoking was the only epidemiologic factor significantly associated to HPV presence (chi 2 for trend = 4.022; p = 0.045). CONCLUSIONS: Clinical usefulness of in situ hybridization for HPV detection remains controversial because of its low sensitivity, and the scarce relationship between its results and those obtained by cytology, colposcopy and histology. Smoking is associated with a higher detection rate of HPV in patients with squamous intraepithelial lesions of the uterine cervix.

Adult↗
PubMed1998

Risk factors for high-grade cervical intraepithelial neoplasia in patients with mild cytological dyskaryosis: human papillomavirus testing versus multivariate tree analysis of demographic data.

The objective of this study was to compare the use of molecular hybridization by hybrid capture methodology for human papillomavirus (HPV) with the use of demographic and lifestyle variables as intermediate triage in patients with cytological mild dyskaryosis. The study was designed as a prospective study using regression tree analysis of demographic data in consecutive patients who were subjected to colposcopic evaluation at the colposcopy clinic at the First Department of Obstetrics and Gynaecology, University of Milan (Milan, Italy). A total of 177 women were subjected to colposcopy because of a single routine Pap smear showing mild dyskaryosis. A structured interview, sampling for HPV testing for the detection of viral DNA by hybrid capture methodology, and colposcopic evaluation with cervical biopsies were performed for each subject. The accuracies of molecular hybridization for HPV and of the classification model based on the demographic and lifestyle variables in predicting patients with histologically high-grade cervical intraepithelial lesions were measured. The classification model based on the demographic and lifestyle variables showed comparable results with molecular hybridization for HPV (specificity, 0.75 versus 0.73; sensitivity, 0.61 versus 0.67, respectively). The use of demographic and lifestyle variables appears to be a simple and economic possibility for triaging patients with mild dyskaryotic smears in a screening program.

Adult↗