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PubMed1992

The management of subclinical wart virus infection of the cervix in a genitourinary clinic.

OBJECTIVE: To assess whether cold coagulation to the cervix eliminates subclinical wart virus infection and to determine the effectiveness of treatment for CIN I and II, using cold coagulation, by genitourinary physicians. DESIGN: Prospective study. SETTING: Department of Genitourinary medicine in a large teaching hospital. PARTICIPANTS: All patients who received cold coagulation to the cervix in a 1 year period, who had not had previous treatment. RESULTS: 261 patients were enrolled into this study; of these, 138 (53%) patients attended for repeat colposcopy and cytology at one year. Cure rates for lesions were 66% for initial wart virus infection, 80% for CIN I and 94% for CIN II and III. Four (5%) cases in whom repeat cytology was normal had CIN which would have been missed if repeat colposcopy had not been performed at one year. CONCLUSIONS: Cold coagulation is inappropriate treatment for subclinical wart virus infection of the cervix but is useful for the management of patients with CIN. Repeat colposcopy following treatment to the cervix is not necessary if cervical cytology is normal.

Cervix Uteri↗
PubMed2005

Detection of cervical cancer and high grade neoplastic lesions by a combination of liquid-based sampling preparation and DNA measurements using automated image cytometry.

OBJECTIVE: To establish if measurements of DNA ploidy could be used to assist cytopathologists and cytotechnologists in population based cervical cancer screening programs in countries where manually reading the slides is impossible due to the lack of sufficient skilled cytotechnologists. The goal of such program is to identify only clinically significant lesions, i.e. those where a clinical intervention to remove the lesion is required immediately. STUDY DESIGN: A total of 9905 women were enrolled in the study. Cervical samples were taken with a cervix brush that was then placed into a fixative solution. The cells were separated from mucus by mechanical and chemical treatment and then deposited onto microscope slides by a cytocentrifuge. Two slides were prepared from each case; one slide was stained by Papanicolaou stain for manual cytology examination, while the other slide was stained by a DNA specific stain. The latter slide was used to determine the relative amount of DNA in the cell nuclei. RESULTS: A total of 876 women were followed by colposcopy examination where biopsies were taken from the visible lesions or from suspicious areas and histopathology diagnosed 459 as normal or benign cases, 325 as CIN1, 36 as CIN2, 25 as CIN3/CIS, and 31 as invasive cancer. Of these 876 cases, manual cytology called 655 normal or ASCUS, 197 as LSIL, 16 cases as HSIL, and 8 as cancer. DNA measurements found 704 cases having no cells with DNA greater than 5c, 98 cases where there were 1 or 2 cells having DNA amount greater than 5c, and 74 cases where there were 3 or more cells having DNA amount greater than 5c. If manual cytology were to be used to refer all cases of HSIL and cancer to colposcopy and biopsy, 23 lesions that had to be removed would have been discovered (2 CIN2, 11 CIN3/CIS, and 10 cancers), for a sensitivity of 25.0+/-5.2% at specificity of 99.9+/-0.1%. If DNA assisted cytology were to be used instead, and all cases having 3 or more cells with DNA amount greater than 5c were to be referred to colposcopy and biopsy, then 50 lesions that had to be removed would have been discovered (10 CIN2, 15 CIN3/CIS and 25 cancers) for the sensitivity of 54.3+/-6.2% at specificity of 96.9+/-0.6%. CONCLUSIONS: The study suggests that screening for high grade cervical neoplastic lesions and cervical cancer by DNA assisted cytology could be implemented with minimal use of skilled cytotechnologists, at least in those countries where it would be difficult to introduce population based screening for cervical cancer due to the lack of availability of such skilled cytotechnologists.

Biopsy↗
PubMed1998

How alarming is post-coital bleeding--a cytologic, colposcopic and histopathologic evaluation.

This retrospective analysis studies post-coital bleeding (PCB) in 110 patients presenting to the colposcopy clinic of the University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India, and covers a 2-year period from March 1994 to February 1996. All the patients were evaluated by cytology and colposcopy. Colposcopy-positive patients underwent a directed biopsy. Age, parity and duration of PCB were correlated with histopathologic findings, i.e. benign changes, viral HPV changes and cervical intra-epithelial neoplasia (CIN) 1, CIN 2 and 3 and invasive cancer for risk assessment. 85.5% of the patients had benign findings, 5.6% viral HPV and CIN 1, 3.6% CIN 2 and 3 and 5.5% invasive cancer. Vascular ectopy was the commonest benign colposcopic finding. Cytology had a sensitivity and specificity of 56% and 90%, respectively. The mean age of patients with invasive cancer was 41.3 years versus 32.9 years in patients with benign pathology, the difference being statistically significant (p < 0.05). Mean parity was 4.2 in patients with invasive cancer against 2.8 in benign cases (NS). There was no correlation between duration of bleeding and pathology.

Adult↗
PubMedDate not supplied

Sensitivity of the Pap test in detecting high grade lesions: what should be the acceptable cytologic threshold for colposcopic referral?

OBJECTIVE: To devise an optimal cytology threshold for colposcopy referral in resource-limited settings. STUDY DESIGN: Four hundred seventy-two symptomatic women 20-60 years old were screened by both cytology and colposcopy. Onsite biopsy was taken if lesions grade 1 or above were detected on colposcopy. Women found to have cervical intraepithelial neoplasia (CIN) 2 and above lesions on histopathology were stratified according to their cytologic diagnosis (atypical squamous cells of undetermined significance [ASCUS]+ threshold, low grade squamous intraepithelial lesion [LSIL]+ threshold, and high grade squamous intraepithelial lesion [HSIL]+ threshold). The comparative sensitivity, specificity and predictive values in each group were calculated, taking biopsy as the gold standard. RESULTS: The sensitivity of LSIL + cytology to detect CIN 2+ lesions was 91.5% (referral load, 30.7%). While the sensitivity of ASCUS+ cytology threshold was almost the same (92.3%), the referral load was much higher (42.2%). With HSIL+ cytology threshold, though the referral load was reduced substantially (21.9%), the sensitivity also decreased, to 81.5%. CONCLUSION: The results indicate that in order to achieve high sensitivity, the LSIL cytology threshold appears to be optimum for colposcopic referrals.

Adult↗
PubMedDate not supplied

What is the least costly strategy to evaluate cervical abnormalities in rural women? Comparing telemedicine, local practitioners, and expert physicians.

OBJECTIVE: This study establishes the least costly strategy for evaluation of rural women in need of colposcopy among 3 alternatives: telemedicine, local practitioners, and referral experts. METHODS: Women in rural Georgia who needed colposcopy were examined by an expert colposcopist on site, by a local practitioner, and by a distant expert colposcopist linked by telemedicine. Independent determinations of biopsy intent were used to model the differing biopsy costs of the 3 methods. Record review determined the average total cost of telemedicine. Reports of average cost in year 2000 dollars from societal perspective include medical costs and pain and suffering due to additional biopsies and curettage, telemedicine costs, and costs of potential diagnostic delay for a 1-year time horizon. RESULTS: From the societal perspective in the baseline case, the average cost per patient evaluated was dollar 270 for patients seen by referral experts. The cost was dollar 38 less (e.g., dollar 232) for patients seen by local practitioners, and dollar 35 more (e.g., dollar 305) for patients seen by telemedicine. From the societal perspective, local practitioners were less costly than referral experts because of lower travel costs for patients, but from the medical perspective, their average cost was dollar 32 higher than referral experts because they performed more biopsies and curettage procedures than experts. Telemedicine assistance would have lowered the number of biopsies performed by local practitioners, but as of year 2000 the costs of this technology could not be justified by the savings. CONCLUSION: From the societal perspective, local practitioners performing colposcopy are the least costly way to evaluate cervical abnormalities in rural patients with substantial time and travel costs.

Colposcopy↗
PubMedDate not supplied

A first survey of organized cervical cancer screening programs in Italy. GISCi working group on organization and evaluation. Gruppo Italiano Screening Citologico.

In Italy, where no national screening program for cervical cancer exists, organized programs have developed on a local basis. We performed the first survey of existing organized programs by mailing a standard questionnaire to a large network of possibly involved services. For the present survey, a program was defined as organized if personal invitations were sent. We identified 29 already active organized programs and 4 others in a starting phase. The target population of active programs included 2,074,820 women in the age range 25-64 years, corresponding to 13.5% of the Italian female population of the same age. The situation is rapidly evolving since many regional programs are being implemented. Most programs followed Italian and European recommendations as regards the age limits, interval between screening rounds, presence of a fail-safe system for women referred for colposcopy, presence of protocols for diagnostic workup and treatment, and presence of referral centers for such phases. However, many programs did not meet national guidelines as regards the size of laboratories interpreting smears, which were frequently small. Second-level referral centers also frequently had a very small activity. The average (weighted for size of the invited population) compliance to invitation and coverage (proportion of women with at least one test in the last 3 years) was 32.6% and 66.0%, respectively, therefore needing to be improved. Compliance to colposcopy (weighted for number of referred women) was 81.4%. We found a very high variability in the proportion of women referred for colposcopy that could only be partly explained by different referral protocols and could depend on different criteria of smear interpretation: the average (weighted for number of tested women) was 2.01%. A need for improvement in the process of evaluation and for homogenization of criteria of cytology interpretation was identified: work in this regard is on-going.

Adult↗
PubMed2005

Quality and efficacy of a telecolposcopy programme.

We tested the performance of telecolposcopy in the diagnosis of various squamous intraepithelial lesions. There were three groups of physicians: Group 1 consisted of 15 gynaecologists who were not trained in colposcopy; Group 2 consisted of six experienced colposcopists (specialists); Group 3 was a supervising team consisting of three experts (colposcopists with more than 15 years of colposcopy experience). The first group took colpophotographs during gynaecological examinations and used a Web browser to compare them with examples from a database of colposcopy findings. Group 2 made their own diagnoses independently. Then the supervising team examined the findings from all 250 patients and made diagnoses that could be considered the 'gold standard'. The findings were identical for Groups 1 and 2 in 219 cases, i.e. an inter-observer agreement of 88%; Cohen's kappa was 0.81. The findings were identical for Groups 1 and 3 in 208 cases, i.e. an inter-observer agreement of 83%; Cohen's kappa was 0.74. The findings were identical for Groups 2 and 3 in 239 cases, i.e. an inter-observer agreement of 96%; Cohen's kappa was 0.93. There was high inter-observer agreement between all participants. However, there were also significant differences in some cases. In the cases of suspected invasive carcinoma, the results showed a significant difference (chi2=4.8, P< 0.005) because gynaecologists from Group 1 were not sure of their diagnosis and they wanted to obtain a second opinion by referring the decision to a higher level.

Colposcopy↗
PubMed2000

[Comparison between reference oncologic colpocytology and severity of intraepithelial cervical lesions].

OBJECTIVE: The study was designed to compare the Pap smear results, performed on the public health service, with: the results of Pap smear collected on the reference service; the colposcopy and punch biopsy results. METHODS: The total of 213 women assisted at the women's hospital from January 1989 to April 1991, and followed until July 1998 were selected. Ninety were referred because a Pap smears suggestive of Human Papillomavirus (HPV) induced lesion or cervical intraepithelial neoplasia (CIN) grade 1, and 123, CIN 2 or 3. RESULTS: Among the 90 women referred because of HPV/CIN 1.49% presented CIN 2 or 3 in the Pap smears performed at this service. At the colposcopy, 16/90 women did not present suspicious lesions, and in 10 women, the squamous columnar junction was not observed. At biopsy, 42 (46%) presented CIN 2 or 3. Out of the 123 women referred with Pap smear of CIN 2 or 3.54% presented CIN 2 or 3 at this service. At the colposcopy, 24 women did not present suspicious lesions and the squamous columnar junction was not observed in 12. About biopsy, 61 (49%) presented CIN 2 or 3. CONCLUSIONS: The expectant conduct in cases of Pap smear with HPV/CIN 1, should follow a criterion, involving qualified professionals to collect the Pap smear, and should provide people awareness as to control follow-up.

Adolescent↗
PubMedDate not supplied

[Screening and follow-up for cervical cancer prevention in rural Mexico using visual inspection].

OBJECTIVE: To compare the standard cervical cancer screening procedure--the Papanicolaou test or Pap smear--with detection through visual inspection using acetic acid (VIA), and visual inspection with acetic acid assisted by Aviscope (VIAM). MATERIAL AND METHODS: The study was conducted between October 1998 and December 2000, in two Mixteca regions in Oaxaca, Mexico. A field trial design was used to randomize the two regions to either of the two inspection methods. In one region 2,240 women received VIA; in the other, 2,542 women received VIAM. Women positive to visual inspection and a subsample of women with negative results were referred for colposcopy and, if necessary, cervical biopsy. Statistical data analysis consisted of descriptive statistics and comparison of groups using chi-squared tests. Diagnostic values were obtained for VIA and VIAM, using as gold standards colposcopy and biopsy. RESULTS: VIAM identified a higher proportion of women with a cervical abnormality (16.3%) than VIA (3.4%), as well as normal women (58.5% vs. 53.8%).VIA identified a higher proportion of women with benign changes (41.2%) than VIAM (19.6%).VIAM had a greater sensitivity (p>0.05) but lower specificity (p<0.05) than VIA, using as gold standards colposcopy and biopsy. CONCLUSIONS: The two study groups were comparable for age, parity and cytological results; however, visual inspection results were different between the groups: VIAM identified more lesions confirmed by biopsy. The diagnostic utility of VIAM and VIA was lower than expected. Training of clinical personnel in visual inspection is critical to improve the effectiveness of these screening methods.

Acetic Acid↗
PubMed1987

Conservative management of the abnormal smear during pregnancy. A long-term follow-up.

One hundred and thirty-two pregnant women who had a smear suggestive of cervical intra-epithelial neoplasia (CIN) II or more during the 10th to 12th gestational week, were followed with repeated smears and colposcopy every month and, when indicated, a colposcopically guided biopsy. Post-partum follow-up included cytology, colposcopy, portio biopsies and endocervical curettage. Seventy-nine women with normal findings post partum were checked once a year in a long-term study. A close correlation (71% of CINIII) was found between cytological and histological diagnoses in cases of persistent (three or more) abnormal smears. However, in women with regression of the cytological diagnosis, high frequencies of histologically verified CIN were found. Thus, 37.5% (18/48) of normal or CINI smears were histologically still CINIII. Histologically verified CIN during pregnancy, on the other hand, showed a post partum progression of two degrees or more of CIN in only two cases. Cytology seemed to be inappropriate post partum, with 23.3% smears which were normal or suggestive of CINI, when histology showed CINIII. In a long-term follow-up, 24% of women with a normal post partum follow-up for at least one year had a subsequent recurrence of CIN. It is concluded that follow-up of abnormal smears during pregnancy with repeated smears is not a reliable method. Post-partum follow-up should include at least colposcopy and a biopsy when indicated by the colposcopical examination. Women with a normal post partum follow-up constitute a high risk group for future recurrence of CIN and should be carefully followed for at least 5 years.

Adult↗
PubMed1997

Increasing women's knowledge and satisfaction with cervical cancer screening.

In a randomized clinical trial, the efficacy of three interventions, designed to increase patient knowledge of cancer screening and satisfaction with preventive health care, were evaluated: verbal information; graphically supported information; information provided using video colposcopy; no standardized information (control condition). A sample of 147 healthy women were randomly assigned to the intervention group (IG) or the control group (CG). Pre- and post-test measures were obtained using a semi-structured interview, the State-Trait Anxiety Inventory and the Patient Satisfaction Tool. At pre-test, women had a low level of knowledge which increased significantly at post-test. The knowledge scores were slightly higher in women who received information supported by graphic or video colposcopy than in women who received standardized information without teaching aids. Compared to the CG, women in the IGs scored significantly higher on questions related to cervical cancer prevention. The level of satisfaction was significantly higher in women receiving video-supported information and graphic-supported information compared to women receiving information without teaching aids. The results indicated that visual teaching aids were effective: video colposcopy in increasing patient satisfaction with preventive health care; and graphic representation in improving knowledge regarding cancer screening. The combination of both should routinely accompany cervical cancer screening.

Adolescent↗
PubMedDate not supplied

Efforts to improve the follow-up of patients with abnormal Papanicolaou test results.

BACKGROUND: We describe and evaluate efforts to improve the follow-up care of patients with abnormal Papanicolaou test results at an academic family practice center at Shadyside Hospital in Pittsburgh. METHODS: From 1994 to 1996, 1796 patients received Papanicolaou testing; 147 (8 percent) of the smears had abnormal findings--16 percent had atypia, 83 percent had dysplasia, and 1 percent had carcinoma in situ. Patients received follow-up care based on a formalized protocol using educational input, logistic aids, and automated prompting. RESULTS: Overall follow-up success rates and colposcopy completion rates increased dramatically. Whereas 36 percent of patients with abnormal findings on Papanicolaou smears had been overdue for follow-up in 1990, only 13 percent were overdue in 1996 after our interventions. Patients assigned to Papanicolaou testing for follow-up of abnormal findings failed to receive a test in 9 of 45 (20 percent) cases, but those assigned to colposcopy follow-up failed to receive a test in only 10 of 102 (10 percent) of cases. Appointment failure rates at colposcopy clinic dropped from 56 percent in 1993 to 12 percent in 1996. Colposcopic biopsy was far superior to Papanicolaou test for detecting precursors of cervical cancer at follow-up. CONCLUSIONS: Educational programs, formalized approaches to care, transportation assistance, and reminder systems are not only practical but also can dramatically improve the outcome of cervical cancer screening programs.

Adolescent↗
PubMed1998

Screening for cervical cancer: a review of women's attitudes, knowledge, and behaviour.

The United Kingdom (UK) cervical screening programme has been successful in securing participation of a high proportion of targeted women, and has seen a fall in mortality rates of those suffering from cervical cancer. There remains, however, a significant proportion of unscreened women and, of women in whom an abnormality is detected, many will not attend for colposcopy. The present work reviews the psychological consequences of receiving an abnormal cervical smear result and of secondary screening and treatment, and examines reasons for women's non-participation in the screening programme. Psychological theories of screening behavior are used to elucidate women's reactions and to suggest methods of increasing participation, of improving the quality of the service, and of reducing women's anxiety. A literature search identified studies that examine factors influencing women's participation in the screening programme, their psychological reaction to the receipt of an abnormal cervical smear result, and experiences of colposcopy. Reasons for non-participation include administrative failures, unavailability of a female screener, inconvenient clinic times, lack of awareness of the test's indications and benefits, considering oneself not to be at risk of developing cervical cancer, and fear of embarrassment, pain, or the detection of cancer. The receipt of an abnormal result and referral for colposcopy cause high levels of distress owing to limited understanding of the meaning of the smear test; many women believe the test aims to detect existing cervical cancer. The quality of the cervical screening service can be enhanced by the provision of additional information, by improved quality of communication, and by consideration of women's health beliefs. This may result in increased participation in, and satisfaction with, the service.

Adult↗
PubMed1999

[Contemporary model for treatment of erythroplakia].

In literature worldwide is still commonly used the term erosion to describe red areas within cervix around the external orifice. In such cases with negative cytology result, for cervical cancer prevention, the electrocoagulation or electro-conisation or other destructive operations are routinely used. Without colposcopy verification such management is inappropriate. The physician treats but does not know what he treats. It may be both common ectopy or regeneration zone so physiologic cervical states but it may be also CIN or even early cervical cancer, however cytologically negative. The first group of lesions is effectively diagnosed with colposcopy without additional diagnostic procedures and the CIN lesions are diagnosed in high percentage of accuracy. Not all of these lesions should be treated. In the group of colposcopically and cytologically unsuspected lesions just very extensive lesions with active mucous glands should be treated. Such lesions cause recurrent cervical inflammation. All other erythroplakia type lesions demand no treatment. The presence of ectopy around the external cervical orifice is just profitable for diagnosis of epithelial changes and cervical physiologic processes observation. All cases of abnormal colposcopy or cytology results, suspected of CIN should be treated as prevention of cervical cancer. In lower CIN grades electroresection (LEEP) is recommended, while in higher grades the cervical conisation is the appropriate mode of treatment.

Colposcopy↗
PubMed2000

Cervical intraepithelial neoplasia in pregnancy.

OBJECTIVE: To determine the progression/regression rate of cervical intraepithelial neoplasia in pregnancy and to describe the number of patients requiring treatment for cervical neoplasia during or following the pregnancy. METHODS: A retrospective analysis of 305 pregnant women with abnormal cervical cytology was performed. The colposcopic, cytologic and histologic findings of repeated examinations during pregnancy and of the subsequent examination eight weeks postpartum were registered and compared. All smears were obtained by cotton bud and Cytobrush. Colposcopy was performed using standard techniques and cervical biopsies were taken in case of colposcopic abnormalities. Endocervical curettage was omitted during pregnancy. At postpartum evaluation colposcopy, directed biopsies and endocervical curettage were performed in all cases. RESULTS: One hundred and two patients (33%) were followed only by cytology and colposcopy. The remaining 203 patients (67%) had one to four colposcopically directed biopsies during the pregnancy. Comparing the initial histology in pregnancy to the postpartum histologic evaluation 25% showed spontaneous regression while 75% of the women exhibited progression (28%) or persistence (47%) in the severity of cervical neoplasia. Two patients were treated by cervical conization in early pregnancy and 143 women (53%) were treated within the first year after the pregnancy. In the postpartum period microinvasive carcinoma was diagnosed in two patients, but no women advanced to more serious stages of cervical cancer. CONCLUSIONS: The high persistence rate of cervical intraepithelial neoplasia in pregnancy leads us to recommend a liberal use of colposcopically directed biopsies during pregnancy and to ensure a high follow-up rate in the postpartum period.

Adult↗
PubMed2000

Comparison of self-collected vaginal, vulvar and urine samples with physician-collected cervical samples for human papillomavirus testing to detect high-grade squamous intraepithelial lesions.

BACKGROUND: Certain types of human papillomavirus (HPV) in cervical samples are strongly associated with squamous intraepithelial lesions (SIL) and invasive cervical carcinoma. We determined and compared the test characteristics of testing for HPV with samples obtained by patients and with samples obtained by their physicians. METHODS: In a consecutive series of women referred to a colposcopy clinic at a teaching hospital because of abnormalities on cervical cytologic screening, 200 agreed to collect vulvar, vaginal and urine samples for HPV testing. The physician then collected cervical samples for HPV testing, and colposcopy, with biopsy as indicated, was performed. Presence of HPV was evaluated using the hybrid capture II assay (Digene Corp., Silver Spring, Md.) with a probe cocktail for 13 carcinogenic types. Cervical specimens were also tested for HPV by polymerase chain reaction and hybridization with type-specific probes. Cervical smears for cytologic examination were obtained from all women. RESULTS: High-grade lesions (high-grade squamous intraepithelial lesions [HSIL], equivalent to cervical intraepithelial neoplasia [CIN] grade 2 or 3, and adenocarcinoma) were found in 58 (29.0%) of the 200 women. Carcinogenic types of HPV were detected in the self-collected vaginal samples of 50 (86.2%) of these 58 women, in the self-collected vulvar samples of 36 (62.1%) and in the self-collected urine samples of 26 (44.8%). Carcinogenic types of HPV were detected in the cervical samples collected by physicians for 57 (98.3%) of these 58 women. The remaining 142 women (71.0%) had normal findings or low-grade squamous intraepithelial lesions (LSIL, CIN grade 1). Test results were negative or noncarcinogenic types of HPV were detected in the self-collected vaginal samples of 76 (53.5%) of these 142 women, in the self-collected vulvar samples of 89 (62.7%) and in the self-collected urine samples of 99 (69.7%). The sensitivity for self-collected samples ranged from 44.8% to 86.2%, and the specificity from 53.5% to 69.7%. For the samples collected by physicians, the sensitivity was 98.3% and the specificity 52.1%. The self-sampling methods were generally acceptable to the women: 98.4% of respondents (126/128) deemed urine sampling acceptable, 92.9% (118/127) found vulvar sampling acceptable, and 88.2% (112/127) found vaginal sampling acceptable. INTERPRETATION: Self-collection of samples for HPV testing was acceptable to women attending a colposcopy clinic for investigation of suspected cervical lesions and shows sufficient sensitivity to warrant further evaluation as a screening test for cervical cancer prevention programs.

Adenocarcinoma↗
PubMedDate not supplied

Incidence and evaluation of an AGUS Papanicolaou smear in primary care.

BACKGROUND: The category atypical glandular cells of undetermined significance (AGUS) occurs in about 0.5% of Papanicolaou smears. Although recent case series report a great many dysplastic, cancerous, and precancerous lesions of the cervix and endometrium associated with AGUS, little attention has been focused on this issue in primary care literature. METHODS: We report a case series of 52 women with AGUS Papanicolaou smears in a family health center during 2 years (1997 to 1998), along with colposcopy and biopsy results and 18 months of follow-up findings. These results were compared with findings of recent reports. RESULTS: The incidence of AGUS was 0.5%, 52 of 10,564 Papanicolaou smears. Colposcopy was performed in 45. Biopsy (n = 46) showed 2 adenocarcinomas of the endometrium, and 6 high-grade dysplastic lesions, including 1 squamous cell carcinoma in situ. Nineteen women had cervical intraepithelial neoplasia stage I-changes of human papillomavirus effect, and 4 had endocervical polyps. Three women were lost to follow-up. The frequency of dysplastic and cancerous lesions in our population (17.4%) is consistent with series findings from cytology and obstetrics and gynecology literature, reporting that 19.5% of women with AGUS have either cancer--adenocarcinoma of the endometrium, squamous cell carcinoma, or extrauterine (8%)--or high-grade lesions--cervical intraepithelial neoplasia II-III, carcinoma in situ, or cervical adenocarcinoma in situ, (11.5%). CONCLUSIONS: A relatively large percentage of women with AGUS on Papanicolaou smears have cancerous and dysplastic squamous and glandular lesions of the exocervix, endocervix, and endometrium. Clinical practice guidelines recommend patients with AGUS should be evaluated with colposcopy and endocervical curettage. Consensus supports endometrial sampling in women 35 years and older and in those with a laboratory report of AGUS, favors neoplasia or suggests an endometrial source.

Adolescent↗
PubMed2001

Predictors of follow-up of atypical and ASCUS papanicolaou tests in a high-risk population.

OBJECTIVE: Our goals were to assess adherence to the National Cancer Institute clinical practice guideline for the management of atypical squamous cells of uncertain significance (ASCUS) Papanicolaou (Pap) test results in a community at high risk of cervical cancer. We also hoped to identify predictors of adherence to the guideline. STUDY DESIGN: We used an historical cohort and collected data by chart abstraction. POPULATION: Our study included women receiving care in 7 urban community health centers who had an initial ASCUS or atypical Pap test result in 1996. We excluded women with a history of cervical dysplasia or human immunodeficiency virus infection, yielding a final sample of 387 women. OUTCOMES: measured The outcome measured was the level of adherence to the guideline, defined as falling within 1 of 3 mutually exclusive categories (complete, moderate, or low). RESULTS: Care providers recommended colposcopy after an initial atypical Pap test result in 12% of cases and repeat cytology in 67%. Failure to document a plan for management was found in 19% of cases. Complete adherence was achieved for 27% of subjects, moderate adherence for 28%, and low adherence for 45%. The factors associated with complete versus moderate or low adherence included site of care, description of the abnormality (ASCUS vs atypia), availability of on-site colposcopy, and discussing the plan at a visit. CONCLUSIONS: Adherence with the National Cancer Institute clinical practice guideline in this setting was disappointing and varied substantially by site. Factors amenable to change that may improve follow-up include good communication of results with patients and providing colposcopy at the site of primary care.

Cohort Studies↗