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PubMed1998

A population-based study of human papillomavirus deoxyribonucleic acid testing for predicting cervical intraepithelial neoplasia.

OBJECTIVE: Our purpose was to determine the predictive values of primary or secondary screening for cervical human papillomavirus infection for cytologic detection of cervical intraepithelial neoplasia. STUDY DESIGN: Most of the 254 women referred for colposcopy in Västerbotten County in Sweden during October 1993 through December 1995 and 320 age-matched women from the general population were screened for human papillomavirus deoxyribonucleic acid by nested general-primer polymerase chain reaction. RESULTS: Ninety-six percent of women with high-grade cervical intraepithelial neoplasia had human papillomavirus, compared with 4% of women with normal findings (odds ratio 606; 95% confidence interval 137 to 5607). Thirty-seven percent of referred women and 48% of referred women >39 years old had mostly minor cytologic abnormalities with no human papillomavirus. The human papillomavirus-associated positive predictive value for cervical intraepithelial neoplasia was 76% in the colposcopy group and 11% in the general population, whereas the negative predictive value was >97% in both populations. CONCLUSION: Testing for human papillomavirus deoxyribonucleic acid seems diagnostically useful among women referred for colposcopy.

Adult↗
PubMed2001

Colposcopic evaluation after a repeat atypical squamous cells of undetermined significance (ASCUS) smear.

OBJECTIVES: Management of patients with atypical squamous cells of undetermined significance (ASCUS) remains controversial. We chose to repeat the Pap smear after four months. If ASCUS persisted in this second test, the patient was advised to undergo colposcopy. Our objective is to determine the clinical significance and the prediction of neoplasia among these patients through a colposcopic examination. METHODS: Of 29,827 patients who had a Pap smear, ASCUS were detected in 1387 (5%) and persisted in the repeat smear of 225 (16%). Colposcopy and an additional Pap smear were performed on 186 patients. RESULTS: Out of 186 colposcopic evaluations, 91 (49%) were normal and the patients had a negative Pap smear. Colposcopy was abnormal in 95/186 patients (51%) (Table 1). Histology of the directed biopsies revealed 38 (21%) low-grade squamous intraepithelial lesions (LSIL) and 17 (9%) high-grade squamous intraepithelial lesions (HSIL). Forty patients (21%) with normal biopsies had ASCUS for the third time in the Pap smear. CONCLUSIONS: Colposcopic evaluation after a repeated Pap smear with ASCUS is an appropriate cost-effective management. Finding 30% of LSIL or HSIL justifies this additional investigation.

Adolescent↗
PubMed1998

Conservative treatment of low grade squamous intraepithelial lesions (LSIL) of the cervix.

OBJECTIVE: To assess the accuracy of the cervical smear and colposcopy in diagnosing low grade squamous intraepithelial lesions (LSIL), and the natural history of LSIL. METHOD: The cytological, colposcopic and histological findings of 145 patients with a smear diagnosis of LSIL were compared, and the final outcome studied. RESULTS: The diagnosis of LSIL either by cytology alone or in combination with colposcopy was associated with a rate of overdiagnosis of 11.7% and 6.9%, respectively, and a rate of underdiagnosis of 31.0% and 26.2%, respectively. Spontaneous regression of lesions occurred in 81.1% of patients with proven LSIL, with regression within 24 months in 4/5 of cases. CONCLUSIONS: The degree of dysplasia shown in the cervical smear correlated poorly with histology. All patients with cervical smear showing LSIL should have colposcopy and colposcopic-directed biopsy to exclude the presence of more advanced lesions. In the absence of some serious lesions, it is then acceptable to observe the patient for 24 months before adopting definite treatment, as spontaneous regression is common.

Adult↗
PubMed2002

Liquid-based Papanicolaou smears without a transformation zone component: should clinicians worry?

OBJECTIVE: To evaluate whether ThinPrep smears without versus those with a transformation zone component were more likely to have falsely negative cytology findings. METHODS: Women aged 18-50 (N = 4389) attended one of three Planned Parenthood clinics between 1997 and 2001 for screening by ThinPrep Papanicolaou and polymerase chain reaction-based human papillomavirus (HPV) DNA testing. Women with 1) any cytologic abnormality, 2) high-risk HPV types, and 3) a random sample with normal Papanicolaou and negative HPV tests were offered repeat cytology, colposcopy, and biopsy. Cytology and biopsy diagnoses at the colposcopy visit were reviewed according to the presence (n = 3689) or absence (n = 700) of a transformation zone component at screening. RESULTS: Among women with normal cytology at screening, histologic detection of at least cervical intraepithelial neoplasia grade 2 (odds ratio 1.3, 95% confidence interval 0.5, 3.3) at colposcopy did not differ significantly between transformation zone-positive and zone-negative smears. Histologically confirmed cervical intraepithelial neoplasia grade 1 was detected more often among smears lacking a transformation zone component (odds ratio 2.0, confidence interval 1.0, 3.8). Transformation zone-negative smears were more common among older women, current oral contraceptive users, those past the 14th day of their last menstrual period, and those negative for high-risk HPV types. CONCLUSION: Absence of a transformation zone component in a screening ThinPrep Papanicolaou test was not associated with missed high-grade lesions. Based upon our data, we do not recommend repeat screening of reproductive-aged women with negative liquid-based tests and no cytologic evidence of a transformation zone component.

Adolescent↗
PubMed1997

A randomized controlled trial to evaluate the use of the endocervical brush after endocervical curettage.

OBJECTIVE: To determine if using the endocervical brush after curetting the endocervix will increase the yield of endocervical tissue retrieved for an endocervical curettage (ECC) specimen. METHODS: Between March 1, 1995, and June 30, 1996, we recruited for participation patients with abnormal Papanicolaou smears referred for colposcopy. Exclusion criteria were pregnancy, previous hysterectomy, and a history of diethylstilbestrol exposure. Colposcopy and biopsies were performed by residents under direct supervision of the attending staff. Endocervical curettages were performed using the Kevorkian endocervical curette. The subjects were then assigned randomly to one of two ways of collecting the ECC tissue: with either a curette or an endocervical brush. Specimens were reviewed by pathologists, who were blinded to the method of ECC collection. RESULTS: During the study period, 124 patients agreed to participate; 62 were assigned to the control group, and 62 to the study group. Six subjects had missing data, leaving 118 patients available for analysis. In the control group, six of the 58 ECC samples obtained contained insufficient endocervical tissue for pathologic diagnosis. None of the 60 samples from the endocervical brush group was insufficient. The difference between the two groups was statistically significant (P = .01). CONCLUSION: The addition of the endocervical brush to endocervical tissue sampling at colposcopy in the study decreased the number of insufficient samples. The endocervical brush method of collection of an ECC specimen from the canal after the Kevorkian curette is used is a valuable addition to this diagnostic tool. We recommend its use in obtaining an ECC specimen.

Adult↗
PubMed1999

Influence of specialty on pathology resource use in evaluation of cervical dysplasia.

OBJECTIVE: Colposcopy is performed by different providers, including nurse practitioners, family physicians, and gynecologists. The training and experience of these providers vary. The fiscal impact of provider type is unknown. This study evaluates pathology resource use by gynecologists and nongynecologists at the time of colposcopy. METHODS: A retrospective cohort study was performed. Data were collected by review of pathology reports and records of all patients with cervical dysplasia treated with cervical excision by loop electrosurgical excision procedure or cold knife conization at our institution between January 1, 1996, and December 31, 1997. Data were analyzed according to type of provider performing the colposcopy before the cervical excision. RESULTS: Gynecologists obtained a total of 190 biopsy specimens in 127 patients, with a mean number of 1.5 +/- 0.75 per patient and a median of 1. Nongynecologists took a total of 148 biopsy specimens in 44 patients, with a mean of 3.4 +/- 1.14 per patient and a median of 3 (P < .001). These differences persisted irrespective of presenting cytology. Nongynecologists were more likely to do endocervical curettage than gynecologists (95% compared with 82%, respectively, P < .001). Cervical dysplasia was diagnosed equally well, even though fewer biopsies were taken by gynecologists. CONCLUSION: Both groups of providers were equally capable of identifying dysplastic lesions. Despite equivalent diagnostic accuracy, nongynecologists used two to three times more pathology resources. If this pattern of use of resources exists at other clinical sites, patients with cervical dysplasia and payers would be better served by gynecologic rather than nongynecologic care.

Adult↗
PubMed1997

The treatment of cervical intra-epithelial neoplasia: when could we 'see and loop'.

OBJECTIVE: To determine the possible role of the selective 'see and loop' approach with a loop electrosurgical excision procedure (LEEP) for high grade cervical intra-epithelial neoplasia (CIN). DESIGN: Comparison of the colposcopic and histological diagnosis in patients who received LEEP treatment. SUBJECTS: Subjects included 95 patients from May to October 1994. SETTING: Department of Obstetrics and Gynaecology, the Prince of Wales Hospital, the Chinese University of Hong Kong. MAIN OUTCOME MEASURES: Agreement between colposcopic and histological diagnosis and between histological diagnosis by biopsy and by LEEP. Sensitivity and false positive rate of colposcopic diagnosis in different classifications of high grade CIN lesions. Decision analysis on the cost of three proposed strategies based on the study results. RESULTS: The colposcopic diagnosis was correct in 58% of cases with 31% overall and 11% undercall rates. The false positive rate of colposcopic examination was 11.4% in the diagnosis of CIN III or more advanced lesions and 36.8% if CIN II lesions are also classified as high grade. Decision analysis showed a saving of: (i) US$53,000: or (ii) US$73,000 per annum if 'see and loop' was performed on all cases where colposcopic diagnosis is: (i) CIN III or more; or (ii) CIN II or more. If the cost of inappropriate surgery by LEEP is estimated to be more than US$550 per person over-treated (i) becomes the preferred strategy. CONCLUSIONS: Selective 'see and loop' approach for high grade CIN III lesions suspected on colposcopy will not over-treat significantly but will reduce the number of colposcopy appointments, waiting list for colposcopy and subsequent expenses.

Colposcopy↗
PubMed2005

[Contribution of viral typing in cytological anomalies of the cervix].

Management practices for low-grade cervical lesions identified on screening swabs have been modified by research on the HPV. The appropriate approach for low-grade lesions is particularly difficult to determine due to the potential risk of malignant transformation coupled with the cost implications of treating lesions which will heal spontaneously in the majority of patients. The diagnosis of these low-grade lesions can be improved by thin layer swabs which have a greater sensitivity than conventional swabs. The current consensus is that swab results should be expressed according to the Bethesda classification. Routine tests for HPV (Hybrid Capture II) should be reserved for patients with an ASC-US swab. Colposcopy is indicated if the swab is positive for a low-grade lesion followed by cytology if the colposcopy is normal. If there is no evidence of HPV, search for oncogenes can lighten the treatment regimen due to the high specificity of the test. If a low-grade histological lesion (CIN1) is proven, cytocolposcopic surveillance should be proposed, surgical resection being undertaken in colposcopy cannot be performed. Here again search for HPV oncogenes at one year is an interesting alternative if the examination is negative. These practices are applicable in adolescents and HIV- positive patients who are particularly exposed to HPV.

Adolescent↗
PubMed2003

Characteristics of a group of adolescents undergoing loop electrical excision procedure (LEEP).

STUDY OBJECTIVE: To describe the sociodemographic characteristics of a cohort of adolescents undergoing loop electrosurgical excision procedure (LEEP) of the cervix, and to determine if LEEP is a safe and effective procedure for evaluation and treatment of high-grade squamous intraepithelial lesions (HSIL) of the cervix in adolescents. SETTING: Case series of all adolescents who underwent LEEP between 1995 and 1997 at Children's Hospital, Boston, MA. DESIGN: Medical and laboratory records were reviewed to assess baseline characteristics and the following outcomes: (1) LEEP pathology results, (2) postoperative complications, (3) pregnancy outcomes, (4) compliance with follow-up appointments, and (5) recurrence of disease over a 12- to 37-month period. PARTICIPANTS: Thirty-five adolescents underwent LEEP. The mean age of the adolescents at the time of LEEP was 17.9 +/- 1.5 yrs. RESULTS: The mean interval between coitarche and LEEP was 3.69 +/- 2.09 yrs. On preoperative colposcopy, 28 (80%) had HSIL on biopsy, 3 (8.6%) had HSIL on Pap smear with a discordant biopsy demonstrating low-grade squamous intraepithelial lesion (LSIL), 1 (2.9%) had a persistent LSIL, 2 (5.6%) had diffuse LSIL with an unsatisfactory colposcopy, and 1 (2.9%) had a HSIL Pap smear with a normal biopsy. LEEP specimen histopathology results were: HSIL in 19 (54%), LSIL in 10 (29%), SIL difficult to grade in 3 (9%), and no residual disease in 3 (9.0%). Postoperative complications were bleeding in 2 (5.7%), pain in 1 (2.9%), vaginal discharge in 1 (2.9%), cervicitis in 3 (8.6%), and endometritis in 2 (5.7%). Fourteen pregnancies were diagnosed after LEEP; no spontaneous abortions occurred. Mean follow-up period was 21.1 +/- 9.4 months. Compliance with follow-up appointments was 51% in the first 12 months post-LEEP and 26% in the second 12 months post-LEEP. Of the 28 patients followed for 12 months or more, there was one recurrence of HSIL confirmed by colposcopy and biopsy. CONCLUSIONS: Outcome and complications of LEEP in adolescent females are similar to those reported in larger series of adult women. LEEP appears to be a safe and effective procedure for the evaluation and treatment of HSIL of the cervix in adolescents, but additional long-term data are needed.

Adolescent↗
PubMed2003

Detection of cervical intraepithelial neoplasia in women with atypical squamous or glandular cells of undetermined significance cytology: a prospective study.

BACKGROUND: (1) To assess the prevalence of histologically confirmed cervical intraepithelial neoplasia in patients with cervical smears diagnosed as atypical squamous or glandular cells of undetermined significance. (2) To evaluate the role of colposcopy and the presence of human papillomavirus in detecting underlying cervical intraepithelial neoplasia. MATERIALS AND METHODS: In this prospective cohort, 148 women with atypical squamous or glandular cells of undetermined significance were evaluated by colposcopy, histological sampling, and human papillomavirus deoxyribonucleic acid testing. RESULTS: Histological diagnosis of >/= cervical intraepithelial neoplasia II was found in 10/148 women. Women with a histological >/= cervical intraepithelial neoplasia II had a higher prevalence of >/= two abnormal quadrants (90% vs. 38%</= cervical intraepithelial neoplasia I, p = 0.002) and of high/intermediate-risk human papillomavirus (90% vs. 42% </= cervical intraepithelial neoplasia I, p = 0.005). CONCLUSION: Our study shows that premalignant lesions of the cervix were present in 7% of the patients with a cytological diagnosis of atypical squamous or glandular cells of undetermined significance. Colposcopy and human papillomavirus deoxyribonucleic acid testing are both important parameters in detecting >/= cervical intraepithelial neoplasia II.

Adolescent↗
PubMed2003

Treatment of women with low-grade squamous intraepithelial lesions on cytologic evidence or biopsy results by board-certified gynecologists.

OBJECTIVE: The Bethesda system combined human papillomavirus effects and mild dysplasia/cervical intraepithelial neoplasia grade 1 into a single category called low-grade squamous intraepithelial lesion. We sought to determine whether the treatment of women with low-grade squamous intraepithelial lesions by board-certified gynecologists was different for human papillomavirus effect versus mild dysplasia/cervical intraepithelial neoplasia grade 1. In addition, we sought to document the prevalence of human papillomavirus testing and counseling regarding sexual partners by this group of providers. STUDY DESIGN: A 2-page survey was mailed in April 1998 to a random sample of 491 fellows of the American College of Obstetrics and Gynecology. The response rate was 50.6%. RESULTS: For a Papanicolaou test with human papillomavirus effects, 52% of the respondents would perform colposcopy. For a Papanicolaou test with mild dysplasia/cervical intraepithelial neoplasia 1, 86% of the respondents would perform colposcopy (P <.0001). For biopsy-proved condyloma, 33% of the respondents would treat the patient. For biopsy-proved mild dysplasia/cervical intraepithelial neoplasia grade 1, significantly more respondents would treat the patient (45%, P =.02). Respondents rarely offered routine human papillomavirus testing and frequently made recommendations regarding partner examination and condom use. CONCLUSION: Board-certified gynecologists commonly treat women with a newly diagnosed low-grade squamous intraepithelial lesion Papanicolaou test with colposcopy and frequently differentiate between human papillomavirus effects and mild dysplasia/cervical intraepithelial neoplasia grade 1 in the treatment.

Adult↗
PubMed1991

Diagnosing human papillomavirus of the female lower genital tract: failure of the Pap smear as a sole screening test.

Of 197 patients referred for colposcopy who underwent repeat Pap smears and colposcopic biopsies (when indicated), histologic evidence of human papillomavirus (HPV) infection involving the endocervix, cervix, or vagina or all three sites was documented in 109 biopsies. Sixty-six (61%) had normal Pap smears at the time of colposcopy. Despite a specificity of 92% for detecting HPV, the Pap smear demonstrated a low sensitivity (39%), with a positive and negative predictive test value of 88% and 50%, respectively. In patients with biopsies revealing HPV infection without associated dysplasia, false negative Pap smears were found most often in women with strictly vaginal HPV (74%) (P less than 0.05), followed by those with coexistent cervical and vaginal HPV (65%), and then by those with solely cervical HPV (51%). We question the use of the Pap smear for the detection of lower genital tract HPV, particularly in patients with only vaginal involvement, especially when the smear is repeated at the time of colposcopy. Benefits and disadvantages of other screening tests for HPV are discussed.

Biopsy↗
PubMed1993

Large loop excision of the transformation zone (LLETZ) as an alternative to both local ablative and cone biopsy treatment: a series of 1000 patients.

One thousand patients, referred to the Oxford Colposcopy Clinic, were treated with either large loop excision of the transformation zone (LLETZ, 891 cases) or LLETZ cone (109 cases). Forty-five LLETZ cones were performed empirically, 64 under microcolposcopic guidance. Over 98% of patients were managed as outpatients under local anaesthesia, and 87% of new patients treated with LLETZ had treatment at their first visit. Ninety percent of patients had at least cervical intraepithelial neoplasia grade one (CIN I) and 73% had CIN II or worse. Seventeen cases of invasive or possibly invasive disease were detected, 6 of them unsuspected. The overall rate of complete excision of CIN or worse was 72%. Follow-up was cytologic with or without colposcopy depending on lesion severity. Ninety-one percent of 967 treated patients were free of dyskaryosis at a mean follow-up of 23 months, with complete excision of CIN or worse at LLETZ a significant predictive factor. No cases of invasive carcinoma have developed following treatment. Major morbidity was uncommon, with 3.8% severe hemorrhage. Stenosis was noted in 3.8% cases, mostly after LLETZ cone. One patient (0.1%) has reduced fertility possibly attributable to LLETZ. Questionnaire assessment revealed a very high degree of acceptability of the treatment to patients. LLETZ and LLETZ cone have proved highly acceptable and effective outpatient diagnostic and treatment alternatives to both local ablation and cone biopsy in the Oxford Colposcopy Clinic.

Adolescent↗
PubMed1995

Every woman with an abnormal cervical smear should be referred for treatment: debate.

No dispute exists regarding the optimal management of women with moderate or severe dyskaryosis (high grade SIL). These women should have a colposcopic assessment and biopsy. Women with borderline nuclear abnormalities should have a repeat smear and undergo colposcopy only if the abnormality persists. Low-grade abnormalities (low-grade SIL) are common, and their management is relevant. We suggest that these women be referred for an immediate colposcopic assessment for the following reasons: a. a policy of cytologic surveillance allows an opportunity for default, and these women are at an increased risk of invasive cancer. b. a significant proportion of these women will have underlying CIN grade III that should be treated. c. a minority of these women revert to cytologic normality without a recurrent dyskaryotic smear and, therefore, eventually will be referred to colposcopy. d. a policy of immediate referral to colposcopy may be financially less expensive and avoid unnecessary anxiety to the woman during the period of undergoing repeated smears.

Clinical Protocols↗
PubMed1998

Positive predictive rate of colposcopic examination of the cervix uteri: an overview of literature.

Study of literature revealed that the positive predictive rate of the colposcopic impression is better as the cervical lesion is more severe. When directed biopsies are taken, the positive predictive rate of colposcopy increases considerably. For microinvasive disease, the positive predictive rate is quite poor, probably because of the absence of characteristic features. Large loop biopsies diagnosed all cases of microinvasive disease missed by directed biopsies, but this technique has the disadvantage of considerable "overtreatment" when integrated in the management of all patients with abnormal cytology. The restrictions of colposcopy are the invisibility of the squamocolumnar junction and observer variability in the assessment of the impression. The levels of agreement among experienced colposcopists are in the same range as those in cytological and histopathological diagnosis. It is concluded that colposcopy is an indispensable tool in the management of premalignant cervical disease, as long as the restrictions of the technique are kept in mind by the colposcopist.

Adolescent↗
PubMed2005

A prospective evaluation of "see and treat" in women with HSIL Pap smear results: is this an appropriate strategy?

OBJECTIVE: The evaluation of abnormal cervical cytologic results is time consuming and costly. Most patients with high-grade squamous intraepithelial lesion (HSIL)-cervical intraepithelial neoplasia 3 (CIN 3) Pap smear results require an excisional procedure for diagnostic or therapeutic reasons. "See and treat" is a surgical procedure that involves a loop electrosurgical excisional procedure (LEEP) simultaneously to diagnose and to treat premalignant cervical disease in one visit. This procedure eliminates a second visit that typically is required for treatment. Data is lacking on the incidence of CIN 2 and CIN 3 in patients with an HSIL (CIN 2) Pap smear result. The objective of this study was to determine the incidence of CIN 2 and CIN 3 in patients with an HSIL (CIN 2) Pap smear using a see-and-treat protocol. METHODS: Women referred from local health departments to our university-based colposcopy clinic for evaluation of an HSIL (CIN 2) Pap smear result were evaluated for inclusion in a see and treat protocol. All eligible patients underwent colposcopy to rule out an obvious cervical carcinoma followed by an immediate LEEP to remove the transformation zone. A colposcopic impression was made using the Reid colposcopic index. Pathologic specimens were analyzed for the presence of CIN and the incidence of CIN 2 and CIN 3 was determined. RESULTS: To date, 51 patients have been enrolled in the study. Exclusion criteria included age less than 19 years, pregnancy, or medical contraindications. The mean age of the patients was 26 years (range, 19-45 years). Forty-seven percent were white, 47% were black, and 6% were Hispanic. Of the 51 patients who underwent LEEP, 43 of 51 (85%) had satisfactory colposcopy and no patient had a lesion suspicious for cervical carcinoma. The average Reid colposcopic index was 3.5. Of the 51 LEEP specimens, 4 of 51 had no evidence of CIN (8%), 4 of 51 (8%) had CIN 1, 18 of 51 (35%) had CIN 2, and 25 of 51 (49%) had CIN 3. Eighty-four percent of patients had either CIN 2 or CIN 3, resulting in an overtreatment rate (CIN 1 or less) of 16%. CONCLUSIONS: The use of a see and treat protocol for patients with HSIL (CIN 2) Pap smear results may be an acceptable treatment option because of a high incidence of CIN 2 and CIN 3.

Adult↗
PubMed2005

Telomerase activity as a potential diagnostic marker for triage of abnormal Pap smears.

OBJECTIVES: To determine whether there is an association between high levels of telomerase and premalignant cervical disease and to provide a preliminary analysis of telomerase activity as a potential triage strategy. MATERIALS AND METHODS: Premenopausal women were invited to participate in the study during routine gynecologic visits as well as visits where colposcopy was performed. Samples were taken from the cervix using a broom device and placed in cold phosphate-buffered saline. A total of 92 samples were evaluated. Cells were counted and lysed, and a semiquantitative measure of telomerase activity was determined using a commercially available telomerase enzyme-linked immunosorbent assay kit. The presence of human papillomavirus (HPV) types 16 and 18 was assessed by polymerase chain reaction analysis. One-way analysis of variance was used to test for the association of telomerase activity with cytology, HPV type 16 or 18 status, and colposcopy and/or biopsy findings. RESULTS: When telomerase levels were analyzed according to Pap smear results, there were no differences among four groups of cytology findings (normal, atypical squamous cells of undetermined significance, low-grade squamous intraepithelial lesion, and high-grade squamous intraepithelial lesion). When colposcopy and/or biopsy results were considered, significantly higher levels of telomerase were detected in cervical intraepithelial neoplasia (CIN) 2,3 samples than in normal Pap smear samples and CIN 1 samples (p = .035). There was no significant difference in telomerase levels between samples that tested positive for HPV type 16 or 18 and those that did not (p = .111). CONCLUSIONS: Telomerase levels were significantly higher in cytologic samples from women with biopsy-proven CIN 2,3 than in samples from women with normal cytology results or CIN 1. These results warrant larger studies to determine whether telomerase activity may be a useful triage tool for abnormal cytologic findings.

Adolescent↗
PubMed2006

Home Study Course: summer 2006.

OBJECTIVE: The Home Study Course is intended for the practicing colposcopist or practitioner who is seeking to develop or enhance his or her colposcopic skills. The goal of the course is to present colposcopic cases that are unusual or instructive in terms of appearance, presentation, or management, or that demonstrate new and important knowledge in the area of colposcopy or pathology. Participants may benefit from reading and studying the material or from testing their knowledge by answering the questions. ACCME ACCREDITATION: The American Society for Colposcopy and Cervical Pathology (ASCCP) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The American Society for Colposcopy and Cervical Pathology designates this educational activity for a maximum of 1 AMA PRA Categorys I Creditt. Physicians should only claim credit commensurate with the extent of their participation in the activity. ASCCP also designates their educational activity for 1 Category 1 credit hour of the ASCCP's Program for Continuing Professional Development. Credit is available for those who choose to apply. The Home Study Course is planned and produced in accordance with the ACCME's Essential Areas and Elements. DISCLOSURES: The clinical history and images in the Home Study Course may represent an actual case, but not always. To improve educational quality, some gross, cytological, or histological images may come from photographic libraries. Good teaching cases are often difficult to obtain, and we encourage our readers to submit cases with high-quality images to the Home Study Course editor or executive editor to consider for publication. Lastly, faculty must disclose any significant financial interest or relationship with proprietary entities that may have a direct relationship to the subject matter. For this course, the authors had no such relationship to report.

Adult↗