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PubMed2005

Colposcopic and histopathologic evaluation of women participating in population-based screening for human papillomavirus deoxyribonucleic acid persistence.

OBJECTIVE: Evaluation of colposcopic and histopathological findings in women screened for cervical human papillomavirus deoxyribonucleic acid persistence. STUDY DESIGN: A total of 12 527 women, aged 32 to 38 years old, attending the population-based cervical cancer screening program in Sweden were randomized 1:1 to mock testing or human papillomavirus deoxyribonucleic acid testing by general primer 5+/6+ polymerase chain reaction and subsequent typing. Human papillomavirus deoxyribonucleic acid-positive women with a normal Papanicolaou smear (n=341) and an equal number from the control group were human papillomavirus tested on average 19 months later. One hundred nineteen women with type-specific human papillomavirus persistence and 111 controls were referred to colposcopy, and 84.8% attended. RESULTS: Histopathology from colposcopically directed biopsies confirmed cervical intraepithelial neoplasia grade 2 or 3 in 28 of 100 of the women with human papillomavirus deoxyribonucleic acid persistence and in 2 of 95 among controls. CONCLUSION: Among women with normal Papanicolaou smear attending population-based screening, the positive predictive value of human papillomavirus deoxyribonucleic acid persistence for detection of biopsy-confirmed cervical intraepithelial neoplasia 2 or 3 was 29%.

Adult↗
PubMed2006

Subsequent risk and presentation of cervical intraepithelial neoplasia (CIN) 3 or cancer after a colposcopic diagnosis of CIN 1 or less.

OBJECTIVE: The purpose of this study was to determine the risk and presentation of cervical intraepithelial neoplasia (CIN) 3 or cancer after colposcopic diagnosis of CIN 1 or less. STUDY DESIGN: After colposcopy for an abnormal cytology, women with CIN 1 or less had annual cytology evaluations and high-risk human papillomavirus (HPV) tests (Hybrid Capture II). Colposcopy was repeated if the cytology result was ASC-H, or worse, ASC-US/high-risk HPV test positive, or every 2 years if the cytology was normal/high-risk HPV test positive. Differences in rates of CIN 3 or cancer were compared by log rank Kaplan-Meier survival analysis. RESULTS: With median follow-up periods of 26.3 months, 47 of 2490 women (1.9%) with CIN 1 or less subsequently had CIN 3 or cancer. Subsequent CIN 3 or cancer was more likely if the high-risk HPV test was initially positive (45/1960 women [2.3%]) compared with negative (2/530 women [0.4%]; P = .0002) and if women were older (age > or = 30 years, 28/1021 women [2.7%]; age 20-29 years, 17/1017 women [1.7%]; age < 20 years, 2/452 women [0.4%]; P = .045). When CIN 3 or cancer was diagnosed, 45 of 46 women (97.8%) had positive high-risk HPV test and 42/46 women (91.3%) had an abnormal cervical cytology. The yield of CIN 3 or cancer per colposcopy for women (4/205 women [2.0%]) who had normal cervical cytology/positive high-risk HPV tests was lower than for women (41/541 women [7.6%]) who had abnormal cervical cytology/positive high-risk HPV tests (chi-square test, 8.3; P < .005), and it did not increase with increasing length of follow-up. CONCLUSION: Annual cytology and high-risk HPV tests with colposcopy for high-risk HPV test positive/abnormal cytology and at least every 2 years for high-risk HPV test positive/normal cytology is advised after a colposcopic diagnosis of CIN 1 or less.

Adult↗
PubMed1981

Cytologic, colposcopic, and histologic correlation in young females.

The purpose of the reported study was to correlate the cytologic and colposcopic patterns with the histopathologic diagnosis. This was accomplished in 81 young females who underwent direct colposcopic biopsy because of suspicious appearance of the cervix and abnormal or suspicious cytology. Among them 17 were intrauterine DES-exposed females. The results of our study showed that the white epithelium plus punctuation, punctation alone, white gland openings, mosaism, white epithelium plus mosaism, white epithelium, and atypical vessels were the mot common findings compatible with cervical intraepithelial neoplasia (CIN). Cytology and colposcopy together as diagnostic procedures were the most suitable and successful combination for the diagnosis of CIN in young patients with suspicious appearance of the cervix.

Adolescent↗
PubMed1996

Colposcopic and cytologic findings among adolescents referred to two urban teaching hospitals.

STUDY OBJECTIVE: To determine colposcopic findings among adolescents and to determine compliance with management recommendations. DESIGN: Retrospective review of colposcopy logs and patient charts. SETTING: Two urban resident colposcopy clinics. PARTICIPANTS: Low-income, predominantly minority girls 16 years of age or younger referred for evaluation of abnormal cervical cytology. INTERVENTION: Colposcopy with directed biopsy. MAIN OUTCOME MEASURES: Histologic findings in colposcopic biopsies and compliance with management recommendations. RESULTS: Of 62 adolescents evaluated, 17 (27%) had biopsies showing atypia or koilocytosis and 13 (21%) had dysplasia, with grade 2 cervical intraepithelial neoplasia (CIN 2) in 5 (8%). No biopsy showed CIN 3 or invasive cancer. None of 31 endocervical curettings contained dysplasia. Forty-one adolescents (66%) failed to comply with recommendations for surveillance or treatment. CONCLUSIONS: The prevalence of dysplasia among adolescents referred for colposcopy is substantial, and better strategies are needed to ensure proper follow-up.

Adolescent↗
PubMed1992

Clinical significance of endocervical curettage as part of colposcopic evaluation. A review.

This paper addresses the role of endocervical curettage (ECC) as an adjunct of colposcopic evaluation of patients with abnormal cervical cytology. In a meta-analysis of literature data the contribution of ECC to the diagnostic accuracy of colposcopic examination and in the predictive value with regard to the final histologic diagnosis is discussed. The clinical impact of the application of ECC appears to be limited. Figures suggest a reduction in underdiagnosis of (micro)carcinoma in patients with satisfactory colposcopy and an increase of predictive value in diagnosis of invasive disease in unsatisfactory colposcopy.

Journal Article↗
PubMed1981

[Colposcopic differential diagnosis of portiopapillomatosis (author's transl)].

The guidelines for differential diagnosis of portiopapillomas were established on the basis of 21 cases. The term "papilloma" is exclusively confined to the changes occurring at the surface of the portio. Two colposcopic criteria of the typical portiopapilloma are defined. These are: 1. the specific surface structure and the reactivity to acid reagents, and 2. the specific vascular architectonics and its ability to react to cyclopeptid hormones. Hence, three architectonic types of papillae and 3 basic types of blood vessels are described. Basing on the guidelines it has become colposcopically possible to differentiate between a benign papillomatous growth and an exophytic carcinoma. The atypical papillomas are described in the concluding section of the article. These are characterized by anomalies of the surface and of the vessels. The epithelial layer of these papillomas often shows dysplastic or even carcinomatous proliferation.

Carcinoma↗
PubMed1998

Women's experiences of having a colposcopic examination: self-reported satisfaction with care, perceived needs and consequences.

This study was conducted in seven gynaecological clinics in New South Wales (NSW), Australia. The study aimed to assess the level of satisfaction with care, unmet needs and consequences following the procedure reported by women having a colposcopic examination. Of the 161 eligible women attending colposcopy clinics who were approached to take part, 156 (97%) gave written consent to participate and 138 (86%) completed interviews. Consenting women were telephoned within 1 week of their clinic visit to complete a computer-assisted telephone interview (CATI). The survey addressed a number of issues relating to the care they received during their colposcopic examination: satisfaction with care, satisfaction with the waiting time to have a colposcopy, preferences for provider gender, information and health care needs while waiting for the colposcopy, information and health care needs during the colposcopy, short-term physical consequences and shortterm psychosocial consequences of the procedure. Results indicate that satisfaction with care among women ranged from 69% to 96%. The highest expressed needs while waiting for the colposcopy were for information about risks of cancer (91%), reasons for needing a colposcopy (86%), and the colposcopy procedure (86%). Women reported that outcomes such as anxiety and disinterest in sex had further worsened or not been improved following the colposcopy. The results indicate that interventions to address specific concerns would need to be designed, implemented and evaluated.

Journal Article↗
PubMed2001

A colposcopic approach to an endometriotic nodule in the recto vaginal septum under laparoscopic control.

The surgical treatment of endometriotic nodules in the recto vaginal septum is aimed at removing the deeply infiltrating fibro muscular and abnormal glandular tissue, in order to relieve pelvic pain. The laparoscopic approach to the recto vaginal septum is difficult and potentially dangerous. We describe a new mode of access using a combination of laparoscopy and colposcopy. A 20-year-old woman presented with dyspareunia and dyschezia. Vaginal examination revealed a tender nodule, measuring 1.5 &#50 2 cm, in the posterior vagina wall. The endometriotic deposit was positioned at the top of the recto vaginal septum, extending into the posterior vaginal fornix. An air-contrast barium enema and vaginogran (lateral view) excluded a lesion that had penetrated the full thickness of the rectal wall. We carried out colposcopic CO 2 laser ablation of the nodule under laparoscopic control. 'Chocolate fluid' spilled from the lesion and the entire nodule was vaporised until normal tissue was reached. The patient was reviewed 3 and 6 months following the operation, and her symptoms had resolved. The colposcope allows an approach into an area of the pelvis that is usually difficult to access.

Journal Article↗
PubMed1992

Predictive value of human papillomavirus DNA detection by filter hybridization and polymerase chain reaction in women with negative results of colposcopic examination.

This study focused on women who had an abnormal Papanicolaou smear and a subsequent colposcopic examination negative for a cervical squamous intraepithelial lesion. Cervical swabs obtained during the initial colposcopic examination were analyzed for human papillomavirus (HPV) DNA, and these results were correlated with the follow-up examinations. Human papillomavirus DNA was detected by dot-blot hybridization in 31 of 109 (28%) cases. The rate of subsequent biopsy-proved squamous intraepithelial lesion was 17 of 31 (55%) for the HPV-positive group compared with 9 of 78 (11%) for the HPV-negative group. The HPV-DNA detection rate by polymerase chain reaction was 46 of 109 (42%), with a rate of subsequent squamous intraepithelial lesion of 18 of 46 (39%) for the HPV-positive group, compared with 8 of 63 (13%) for the HPV-negative group. Most women had no evidence of squamous intraepithelial lesions on follow-up if the concurrent Papanicolaou smear was normal, even when HPV DNA was detected, suggesting that HPV detection per se does not necessarily correlate with subsequent squamous intraepithelial lesion.

Cervix Uteri↗
PubMed1990

Colposcopic survey of Papanicolaou test-negative cases with hyperkeratosis or parakeratosis.

A colposcopic survey was performed in 269 consecutive women with negative cytology showing hyperkeratosis or parakeratosis. A colposcopy-guided biopsy specimen of cervical abnormalities was taken in 88 cases, and human papillomavirus infection (HPV) was detected histologically in 25 cases. No cervical intraepithelial neoplasia (CIN) was detected. The detection rate of HPV was not significantly different from that observed in a consecutive series of 1073 Papanicolaou test-negative subjects self-referred for colposcopy. Colposcopic screening of subjects showing hyperkeratosis or parakeratosis with otherwise negative smears is not recommended because it does not allow detection of cytologically false-negative CIN.

Adult↗
PubMed1988

Colposcopic manifestations of cervical and vaginal infections.

We analyzed the associations of colposcopic features with cervical and vaginal pathogens and with clinical diagnoses in randomly selected women attending a clinic for sexually transmitted diseases. Logistic regression models were used to adjust for coinfections. Significant associations (P less than 0.01) were found for endocervical mucopus with C. trachomatis, N. gonorrhoeae, and herpes simplex virus (HSV); ulcers/necrotic areas with HSV; "strawberry cervix" with T. vaginalis; increased surface vascularity with HSV; hypertropic cervicitis with C. trachomatis; and immature metaplasia with C. trachomatis and cytomegalovirus. Koilocytosis on cervical cytology was significantly associated with an atypical transformation zone on colposcopy, as well as with satellite lesions. The presence of leukoplakia and ectocervical asperities were also associated with koilocytosis. Awareness of these associations is important for colposcopists to identify patients who need specific microbiologic studies. Although colposcopy is generally used to evaluate patients selected because of abnormal cytology, our study suggests that colposcopic examination could be a useful adjunct to cytology in screening for a variety of cervical and vaginal infections.

Adolescent↗
PubMed1978

Colposcopic evaluation of DES-exposed progeny at two large medical centers: the squamous neoplasia problem.

Two hundred eight patients with confirmed or suspected diethylstilbestrol exposure were examined colposcopically at two separate medical centers. Cervicovaginal ridges were present in 90 (43.3%) and ectopy was found in 188 (90.4%) of the patients. Evidence of vaginal adenosis was present in 122 (58.6%) of the cases. Seventy-four percent of the patients had abnormal colposcopic findings: 15.4% having columnar epithelium on the surface of the vagina and 66% having abnormal transformation zones (white epithelium, punctation, mosaic). Twenty patients (9.6%) were initially identified histologically as having squamous dysplasia. Subsequent review of the histologic material in these cases could document only two cases of significant squamous dysplasia, both severe, the remainder having immature, atypical metaplasia or possibly very mild dysplasia. This finding emphasizes the problems encountered in histologically differentiating squamous neoplasia from the peculiar metaplasia found in these patients, thereby making it difficult to establish whether these patients are at increased risk for the development of squamous neoplasia.

Adolescent↗
PubMed2002

Evaluation of colposcopically directed cervical biopsies yielding a histologic diagnosis of CIN 1,2.

OBJECTIVE: To determine the prognostic value of the diagnostic category CIN 1,2. MATERIALS AND METHODS: Computerized pathology records of patients with CIN 1,2 at colposcopically directed biopsy followed by treatment with excision were examined, and we compared the diagnostic biopsy with the final tissue diagnosis. Two pathologists who were blinded to the final diagnosis reviewed the original biopsies independently. The ability of the referee pathologist to predict CIN 2 or 3 lesions and interobserver consistency are described. RESULTS: Sixty-nine cases of biopsies with CIN 1,2 were reviewed. Nineteen of these patients were lost to follow-up. Of the 46 cases with either an excisional biopsy or hysterectomy, 12 cases (26.1%) demonstrated CIN 2 or greater. Pathologist A and B correctly predicted the high-grade lesions in 66.7% and 58.3% of cases reviewed. Pathologist A and B agreed with each other in 33 of the 46 cases (71.1%). CONCLUSIONS: 1) CIN 1,2 on a colposcopic biopsy is associated with a high-grade lesion in 26.1% of the cases. 2) Experienced gynecologic pathologists can identify these high-grade lesions on review in only two thirds of the cases. 3) CIN 1,2 is a useful diagnostic category to prevent undertreatment.

Journal Article↗
PubMed2003

Colposcopically obtained images of vulvar, vaginal, and cervical epithelium for assessment of safety of intravaginal agents among normal adolescent females: comparison with in vivo exam and interobserver agreement.

OBJECTIVES: This study was designed to assess identification of epithelial abnormalities of both in vivo examination as compared with colposcopically obtained images and interobserver assessment of the same images of the lower genital tract in healthy women. MATERIALS AND METHODS: Ninety women between the ages of 14 and 21 years were recruited for a phase II trial of a vaginal Lactobacillus crispatus capsule. All women underwent a baseline and 1-week colposcopic examination. Multiple genital tract areas were evaluated for abnormalities and photographed. The original examiner and two experienced colposcopists reevaluated all images masked to previous interpretations. Agreement was evaluated using kappa statistics. RESULTS: The representative kappa statistics for direct observation vs photographic interpretation for the vulva, vagina, and cervix are: 37%, -2%, and -4%, respectively. The kappa statistics comparing the three observers ranged from 1% to 39%. CONCLUSIONS.: There is poor agreement between in vivo exams and photographic interpretation, and interobserver assessments of lower genital tract photographs.

Journal Article↗
PubMed2004

Interobserver variability of colposcopic interpretations and consistency with final histologic results.

OBJECTIVE: To evaluate the interobserver reliability of colposcopy and the prediction of final histologic results. MATERIALS AND METHODS: Visibility of the squamocolumnar junction, presence and grading of atypical transformation zone (ATZ), and presence and grading of cervical intraepithelial neoplasia (CIN) were assessed by nine expert colposcopists in 100 cervigrams. Pairwise kappa, group kappa, and class-specific kappa values were computed. Frequency and degree of interobserver disagreement on CIN and ATZ grading and correlation with histologic results were studied. RESULTS: The median pairwise kappa and the group kappa values were excellent for ATZ detection, acceptable for the squamocolumnar junction, and poor for the other variables; the presence of ATZ had a sensitivity for CIN of 90.2% and a specificity of 48.6%; the colposcopic impression of high-grade CIN had a sensitivity of 54.4% and a specificity of 88%. CONCLUSIONS: Some colposcopic predictions are reproducible between observers, predictive of the histologic results, and can be integrated in the algorithm for the management of patients with abnormal Pap smear results.

Journal Article↗
PubMed1991

The cytological prediction of cervical intraepithelial neoplasia in colposcopically directed biopsies.

The tissue sections and preceding cervical smears of 1262 women who had colposcopic cervical biopsies were reviewed and the reports correlated. Close correlation between the cytological and histological findings, to within one histological grade of cervical intraepithelial neoplasia (CIN), was noted in 86% of cases. However, the biopsy was negative, or contained evidence of wart virus infection only, in 24% of cases where dyskaryotic cells had been observed in the cervical smear. Of particular concern was the fact that negative histological findings were recorded in 13% of cases where the smear contained cells showing a moderate dyskaryosis and in 1.26% of cases where the smear showed severe dyskaryosis. This suggests that colposcopically directed biopsies do not always reflect the underlying pathological changes in the cervix. Management of these cases is discussed. In 45 women with a normal cervical smear prior to biopsy, histology revealed seven cases of CIN 3 and one case of invasive squamous carcinoma. This indicates that referral for colposcopy is advisable whenever there is clinical suspicion of cancer, even if the cervical smear report is normal.

Biopsy↗
PubMed2006

Colposcopic management of high-grade referral smears: a retrospective audit supporting 'see and treat'?

OBJECTIVE: The National Health Service Cervical Screening Programme monitors the quality of colposcopy services through the annual KC65 returns. The 2002 returns demonstrated that Standard 7c, which specifies a biopsy rate > or = 90% at first colposcopy visit for high-grade referrals, was not met in the assessed 3-month period. This was investigated along with the other standards. METHODS: Retrospective colposcopy records were accessed for the 597 new referrals, excluding 10 pregnant patients, seen at the colposcopy clinic at the Royal Victoria Infirmary between 1 July 2001 and 31 December 2002, following an abnormal high-grade smear. Cytology and histopathology computer records were checked for confirmation. The results were assessed against the colposcopy standards applicable at that time and the revised standards (2004). RESULTS: Biopsies were taken from 94.47% (Standard > or = 90%) of women at index colposcopy visit including wire loop excision biopsies from 66.16% (87.97% of high-grade colposcopic appearances). Cervical intraepithelial neoplasia (CIN) on histology was found in 91.79% in the study group (Standard > or = 85%) and in 96.71% of index visit biopsies (Standard > or = 90%), meeting the applicable colposcopy standards. The revised 2004 standards specify a biopsy in > or = 95% of high-grade referrals and excision biopsies in 95% if colposcopic appearances are also high-grade, if colposcopy is low grade but the smear is severely dyskaryotic, or when the lesion extends into the canal. The positive predictive value of high-grade cytology for this entire group was 75.54% with CIN present in 90.95%. CONCLUSION: From this study it appears that high-grade cytology in this centre reliably indicates high-grade CIN. Therefore, in women referred for colposcopy following a high-grade smear, excision biopsies should be performed in a higher proportion at the first visit to comply with the revised standards.

Biopsy↗
PubMed1980

The accuracy of colposcopically directed biopsy in patients with suspected intraepithelial neoplasia of the cervix.

We compared the histological diagnoses of premalignant/malignant lesions of the cervix obtained by examining colposcopically directed biopsy material from 201 outpatients with those obtained by examining tissues from a subsequent, more extensive operative procedure. In all, 98 per cent of operative diagnoses were never more than one degree in advance of diagnoses made by colposcopic biopsy. In all seven patients with invasive or microinvasive squamous carcinoma, the lesion was suspect at colposcopy and confirmed by directed biopsy.

Adolescent↗