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PubMed1982

Assessment of failures of cryosurgical treatment in cervical intraepithelial neoplasia.

The overall recurrence rate in 166 patients treated with cryosurgery is 10.8%. Recurrent cervical intraepithelial neoplasia is much more common in patients with severe dysplasia. Failures are commonly due to one of four factors. First, cryosurgery is to be used only after adequate colposcopic assessment and a negative endocervical curettage. Cryosurgery is a safe, effective treatment in selected patients, but consideration of surgical management should be given in the older patient who has completed childbearing, particularly those with severe dysplasia or carcinoma in situ. A full 7-minute freeze with optimum application of the cryoprobe to the full affected surface is essential. Careful follow-up of these patients is mandatory. The majority of failures occur within the first 12 months and probably represent persistent rather than recurrent diseases.

Acute Disease↗
PubMed1981

Retinoids and the prevention of cervical dysplasias.

Women with abnormal cytology were matched with normal control subjects for age, parity, ethnicity, and socioeconomic class and participated in a blind case-control study focused on the role of nutrition in cervical dysplasia. Sucrose gradient ultracentrifugation studies for determination of the presence and concentration of the binding proteins for retinol and retinoic acid were performed on colposcopic biopsy tissue specimens. The nutritional survey revealed statistically significant differences for vitamins A and C and beta carotene. Retinol binding protein was absent or minimally detectable and inversely related to the severity of the dysplasia. It is proposed that a double-blind clinical trial be conducted to evaluate whether retinoids may pharmacologically inhibit, arrest, or reverse cervical dysplasia.

Ascorbic Acid↗
PubMed1978

Treatment of cervical intraepithelial neoplasia with the carbon dioxide laser beam. A preliminary report.

Forty-five patients with histologically proved cervical dysplasia or carcinoma in situ were treated by the carbon dioxide-laser method. The carbon dioxide laser induces cell vaporization by causing intracellular steam combustion stimulated by the emission of a mixture of carbon dioxide, nitrogen, and helium. This method of treatment is easily performed in the outpatient clinic without anesthesia, is inexpensive, and is effective in the treatment of cervical intraepithelial neoplasia. The treatment allows preservation of the transformation zone, thus permitting future colposcopic visualization.

Adult↗
PubMed1976

Diagnostic and therapeutic efficacy of cervical conization.

Cervical conization was perfromed on 756 patients at the University of Kentucky Medical Center from July 1, 1964, to January 1, 1973. Sixty-six patients were pregnant at the time of conization. Eighty-six per cent of patients with cytologic findings of carcinoma in situ had histologic verification of carcinoma in situ or severe dysplasia, and there was absolute correlation between cytology and histology in 75 per cent of patients will occult invasive cancer. Cervical biopsies without colposcopic direction predicted either severe dysplasia or carcinoma in situ in 77 per cent of cases but were accurate in only seven of 24 patients with occult invasive cancer. Carcinoma in situ was present in 30 per cent of hysterectomy specimens following conization but recurred in only seven per cent of patients followed without hysterectomy. Recurrent carcinoma in situ following hysterectomy was more common in patients with residual intraepithelial cancer in the uterus but was independent of the size of the vaginal cuff removed. Major postconization complications requiring hospitalization occurred in 3.4 per cent of nonpregnant patients and in 7.5 per cent of pregnant patients.

Adult↗
PubMed1984

The relationship of dietary and serum vitamin A to the occurrence of cervical intraepithelial neoplasia in sexually active women.

Sexually active women with colposcopically directed, biopsy-proved cervical intraepithelial neoplasia were matched with normal control subjects with regard to age, race, and socioeconomic status, in order to determine if dietary and serum vitamin A (retinol) levels can be considered one of the contributing risk factors for the development of this disease process. An evaluation of women in the group with cervical intraepithelial neoplasia statistically showed lower levels of serum vitamin A (p = 0.1), although, dietary profiles of both groups did not yield a statistically significant difference (p = 0.7). These results suggest that low serum levels of vitamin A may be associated with the development of cervical intraepithelial neoplasia.

Adolescent↗
PubMed1987

Cervical endometriosis: facilitated diagnosis by fine needle aspiration cytologic testing.

Regarded as infrequent, endometriosis of the cervix probably occurs more commonly than is generally realized. The lesion's apparent rarity may be ascribed to limited awareness of the clinical appearance, combined with technical difficulty in obtaining suitable biopsy material for confirmation. A consequence of previous cervical trauma, endometriosis of the cervix can be expected to increase in incidence with more widespread use of invasive cervical procedures. Clinical recognition and tissue confirmation thus become essential. This paper refocuses attention on cervical endometriosis by documenting the clinical, colposcopic, and histopathologic findings in 16 cases seen at a single colposcopy clinic over a 6-month period. Diagnosis in these patients was facilitated and improved by fine needle aspiration cytologic testing. This technique, not previously used for documentation of endometriosis in this location, is outlined in detail, together with a full description and illustration of the cytologic features.

Adult↗
PubMed1996

Can cervical cancer be prevented by a see, screen, and treat program? A pilot study.

OBJECTIVE: Our purpose was to determine the feasibility of providing a cervical screening facility to the underprivileged communities through an educational program and a mobile clinic in which cytologic smears could be taken, screened immediately, and, when appropriate, the patients treated on site with minimal delay. STUDY DESIGN: A prospective study was conducted in two parts on 5045 patients living in squatter areas around Cape Town, South Africa. The patients were educated about cervical cancer and its prevention and were offered a free Papanicolaou smear taken in a fully equipped mobile clinic. These were immediately stained and processed. Patients diagnosed cytologically as having high-grade squamous intraepithelial lesions were assessed colposcopically and, when indicated, immediately treated by large loop excision of the transformation zone under local anesthesia. RESULTS: In phase 1, colposcopy was done in the nearest colposcopy clinic, 20 km from the screening site. The defaulter rate was 66%. In phase 2, colposcopy and treatment were offered on site. A total of 97% of patients referred for colposcopy attended the clinic, and all patients requiring treatment have been adequately treated. CONCLUSION: With a rapid turnaround time for the reporting of cytologic results and given a colposcopy and treatment facility available located at the screening site at the time women receive their results, the majority of women will undergo colposcopy and treatment.

Adult↗
PubMed1997

Human papillomavirus deoxyribonucleic acid detection in mildly or moderately dysplastic smears: a possible method for selecting patients for colposcopy.

OBJECTIVE: Current screening protocols for cervical cancer dictate that patients with smears read as mild or moderate dysplasia of the uterine cervix undergo colposcopy, although approximately half these women do not prove to have high-grade squamous intraepithelial lesions. The aim of this study was to determine whether human papillomavirus testing is capable of discriminating between high- and low-grade squamous intraepithelial lesions so as to be useful in reducing the number of colposcopic examinations. STUDY DESIGN: We tested 190 consecutive patients with smears read as mild or moderate dysplasia for the presence of human papillomavirus deoxyribonucleic acid by use of two different polymerase chain reactions with the consensus primer pairs CPI/IIG and MY09/11. Typing was carried out by direct sequence analysis of the CPI/IIG amplimers. The MY09/11 amplimers were detected in enzyme-linked immunosorbent assay format with the SHARP (Solution Hybridization Assay for PCR Products) Signal System with two probe mixtures (A and B) to detect nononcogenic and oncogenic human papillomavirus types. The human papillomavirus test results were compared with the histologic diagnosis, which was regarded as the reference standard. RESULTS: Fifty-six of the 190 patients had high-grade squamous intraepithelial lesions. The sensitivity was 96% for the CPI/IIG test and 95% for the MY09/11 polymerase chain reaction plus SHARP Signal System when probe B only was used. The specificity was 33% for the CPI/IIG test and 40% for the MY09/11 polymerase chain reaction plus SHARP Signal System when probe B was used. CONCLUSION: A negative CPI/IIG or SHARP Signal System probe B test can select, respectively, 44 or 54 of the 134 patients without high-grade squamous intraepithelial lesions. The use of these human papillomavirus tests as a secondary triage in patients with smears that were read as mild or moderate dysplasia could prevent those patients from undergoing unnecessary colposcopy. However, respectively, 2 or 3 of the 56 patients who have high-grade squamous intraepithelial lesions would be missed by human papillomavirus testing.

Adolescent↗
PubMed1997

Conservative conization for microinvasive carcinoma of the cervix.

OBJECTIVE: Our purpose was to examine conservative conization as treatment for microinvasive carcinoma of the cervix with depth of invasion < 3 mm. STUDY DESIGN: Twelve patients with microinvasive carcinoma of the cervix underwent cervical conization under colposcopic guidance followed by careful observation. RESULTS: The 12 patients were alive without evidence of disease after a mean follow-up of 6.7 years. Four pregnancies with term deliveries were identified. CONCLUSION: Microinvasive carcinoma with a depth of invasion < 3 mm without confluent invasion or lymph vascular involvement can be treated successfully with conservative conization and provided a good pregnancy outcome.

Adult↗
PubMed1997

Patterns of genital injury in female sexual assault victims.

OBJECTIVE: New colposcopic protocols allow examiners to better document genital trauma in rape victims. We report our findings on the locations and types of genital injury seen in female assault victims versus women engaging in consensual sex. STUDY DESIGN: Physical examinations were performed on 311 rape victims seen by San Luis Obispo County's Suspected Abuse Response Team between 1985 and 1993 and contemporaneously on 75 women after consensual sexual intercourse. RESULTS: Among 213 (68%) victims with genital trauma, 162 (76%) had 3.1 mean sites of injury. Comparatively, 8 (11%) consenting women had just single-site trauma. Two hundred (94%) victims had trauma at one or more of four locations, as follows: posterior fourchette, labia minora, hymen, fossa navicularis. Trauma types varied by site; tears appeared most often on the posterior fourchette and fossa, abrasions appeared on the labia, and ecchymosis was seen on the hymen. CONCLUSION: A localized pattern of genital trauma can frequently be seen in women reporting nonconsensual sexual intercourse; such findings are useful for the clinical forensic examiner.

Adolescent↗
PubMed1998

Is human papillomavirus testing an effective triage method for detection of high-grade (grade 2 or 3) cervical intraepithelial neoplasia?

OBJECTIVE: Our purpose was to assess the usefulness of the polymerase chain reaction assay for detection of human papillomavirus infection for prognostic value in the triage strategies for high-grade (grade 2 or 3) cervical intraepithelial neoplasia in women referred for colposcopy after abnormal Papanicolaou smears. STUDY DESIGN: A total of 1007 women referred to a colposcopic clinic providing care for an indigent population were studied. Four hundred fifty-four women were referred after two Papanicolaou smears reported as atypical squamous cells of undetermined significance or low grade-squamous cervical intraepithelial lesion, and 553 were referred after a single smear reported as high-grade squamous intraepithelial lesion. All women had a cervical smear, colposcopy-directed biopsy, and endocervical curettage performed. A sample for human papillomavirus deoxyribonucleic acid detection by polymerase chain reaction was obtained. RESULTS: High-risk human papillomavirus types were detected in 463 (46%) of 1007 women studied. There was a significant increase of the frequency of high-risk human papillomavirus by the increasing severity of biopsy findings ranging from 32.7% in women without cervical intraepithelial neoplasia on biopsy to 60% in women having grade 2 or 3 on the biopsy specimen. Women having a negative Papanicolaou smear found to have high-risk human papillomavirus deoxyribonucleic acid at the time of colposcopy had a significantly higher rate of grade 2 or 3 cervical intraepithelial neoplasia on the biopsy specimen than did women without high-risk human papillomavirus. There was no such difference observed in women with a cytologic finding of low- or high-grade squamous intraepithelial lesions at the time of colposcopy. The polymerase chain reaction assay appears to be more sensitive than the commercial human papillomavirus profile test. The positive predictive value for grade 2 or 3 cervical intraepithelial neoplasia of both tests was similar (21.7% and 22.8%, respectively). CONCLUSION: The human papillomavirus is associated with high-grade cervical intraepithelial neoplasia, but the screening for human papillomavirus deoxyribonucleic acid does not have prognostic value in women reported as having atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesions on two precolposcopy Papanicolaou smears.

Biopsy↗
PubMed1998

Low risk of perinatal transmission of human papillomavirus: results from a prospective cohort study.

OBJECTIVE: Our purpose was to evaluate the risk of perinatal transmission of human papillomavirus. STUDY DESIGN: Pregnant women were evaluated at <20 weeks' and between 34 and 36 weeks' gestation for genital human papillomavirus by clinical and colposcopic examination and by polymerase chain reaction. Their 151 infants were evaluated at birth, 6 weeks, and 6, 12, 18, 24, and 36 months of age for detection of human papillomavirus deoxyribonucleic acid by polymerase chain reaction on samples from the mouth, external genitalia, and anus. Polymerase chain reaction was performed with human papillomavirus L1 consensus primers and hybridization to human papillomavirus types 6, 11, 16, 18, 31, 33, 35, 39, and 45 and to a generic probe. RESULTS: During pregnancy 112 (74%) of 151 women had historic, clinical, or deoxyribonucleic acid evidence of genital human papillomavirus infection. At 479 infant visits, human papillomavirus deoxyribonucleic acid was detected from only five (1.5%) of the 335 genital, four (1.2%) of the 324 anal, and none of the 372 oral or nasopharyngeal specimens. A positively reacting specimen was obtained from three (4%) of 80 infants born to women with human papillomavirus deoxyribonucleic acid detected at 34 weeks' gestation and from five (8%) of 63 born to women without human papillomavirus deoxyribonucleic acid (p = 0.47). All positive results in the infants were positive only with the generic probe and were preceded or followed by negatively reacting specimens. No clinical manifestations of human papillomavirus infection were detected in any infant. CONCLUSIONS: The isolated detection of unclassified human papillomavirus types from infants at only single visits may represent low-level genital or nongenital human papillomavirus or may represent contamination. Although perinatal transmission of human papillomavirus is not ruled out by these data, the upper 95% confidence interval for detection of perinatal transmission from women with any evidence of genital human papillomavirus was only 2.8%.

Adolescent↗
PubMed1999

Spontaneous resolution rate of grade 1 cervical intraepithelial neoplasia in a private practice population.

OBJECTIVE: The purpose of this study was to assess the rate of spontaneous resolution of grade 1 cervical intraepithelial neoplasia in a private practice patient population. STUDY DESIGN: One hundred consecutive women with biopsy-proven grade 1 cervical intraepithelial neoplasia were offered expectant management in the form of repeat Papanicolaou smears every 3 months up to 1 year or treatment. Women with inadequate colposcopic examination, positive endocervical sampling, or discordant Papanicolaou smears were excluded. RESULTS: Eighty-nine (89%) women agreed to undergo expectant management. Of these, 67 (75.3%) experienced spontaneous resolution of lesions on the basis of 2 subsequent and consecutive normal smears corroborated by colposcopy. The median time to resolution was 9 months (n = 38). Seventeen (19.9%) women were treated at 1 year for persistent atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesions by loop electrosurgical conization. Of these, 1 (1.1%) had a more advanced lesion (grade 2 cervical intraepithelial neoplasia). Four (4.5%) had progression before 1 year and were treated. Only 1 (1.1%) patient was lost to follow-up. CONCLUSION: Expectant management of grade 1 cervical intraepithelial neoplasia is safe and cost-effective in a reliable patient population.

Adult↗
PubMed1999

Effects of multiple applications of benzalkonium chloride and nonoxynol 9 on the vaginal epithelium in the pigtailed macaque (Macaca nemestrina).

OBJECTIVE: Safe and effective vaginally applied microbicides could help to control the continuing spread of sexually transmitted diseases. STUDY DESIGN: This study used nonhuman primates to test the effects of multiple applications of nonoxynol 9, benzalkonium chloride, or a combination on vaginal flora and lower reproductive tract tissues. Fourteen monkeys (Macaca nemestrina) received daily vaginal applications of nonoxynol 9, benzalkonium chloride, or both for 3 to 4 days. Vaginal microflora and colposcopic observations were made at baseline and during and after completion of treatments. Cervical biopsy specimens were collected from a subset of animals. RESULTS: Cervical erythema and vaginal erythema were observed in all 3 treatment groups. Cervical papillae and epithelial disruption were present in both the nonoxynol 9 and the nonoxynol 9 plus benzalkonium chloride groups. Vaginal epithelial disruption was noted in both the benzalkonium chloride and the nonoxynol 9 plus benzalkonium chloride groups. Cervical biopsy specimens from each group revealed acute inflammatory infiltrates with occasional plasma cells and lymphoid follicles. Detection of most microorganisms, including viridans streptococci, decreased in the benzalkonium chloride and the nonoxynol 9 plus benzalkonium chloride groups. Detection of Lactobacillus species decreased in the benzalkonium chloride group. All microflora levels recovered after several days without microbicide use. CONCLUSIONS: Although nonoxynol 9 is currently the only microbicide approved for use as a spermicide in the United States, its repeated use may be detrimental to the epithelial tissues of the female reproductive tract. Benzalkonium chloride, currently approved for use in other countries, not only may damage epithelial tissues but also appears to reduce the population of potentially protective Lactobacillus species in the vagina.

Animals↗
PubMed1999

Short fragment polymerase chain reaction reverse hybridization line probe assay to detect and genotype a broad spectrum of human papillomavirus types. Clinical evaluation and follow-up.

The purpose of this study was to detect and genotype 16 different human papilloma virus (HPV) types simultaneously using a short fragment polymerase chain reaction (SPF) hybridization line probe assay (LiPA). 152 women who were referred to the gynecologist because of abnormal cervical smear underwent colposcopic examination and repeat cervical smear. In addition, the cervical scrapes were analyzed for the presence of HPV by a novel general HPV polymerase chain reaction assay followed by a single reaction genotyping assay allowing for a simultaneous detection and identification of 16 different HPV types. HPV DNA was detected in 38% of normal follow-up cervical scrapes, 51% of scrapes with atypical squamous cells of undetermined significance, 78% of scrapes with mild dysplasia (low grade squamous intraepithelial lesions), 86% of scrapes with moderate dysplasia (high grade squamous intraepithelial lesions), and in 88% of scrapes with severe dysplasia and carcinoma in situ. One case of invasive squamous cell carcinoma was positive for HPV 16. Overall, a single HPV type was detected in 56% of HPV positive scrapes, with HPV 16 being the most common and accounting for 45% of all single infections. Forty-four percent of the positive scrapes contained multiple HPV types, of which double infections prevailed. Follow-up results proved the reproducibility and reliability of SPF HPV LiPA. In conclusion, we have used and evaluated the SPF-HPV-LiPA system for the detection and genotyping of HPV infections. The combined detection-typing method proved to be sensitive, specific, simple, and fast, making mass screening of cervical scrapes accessible for routine practice and facilitating individual patient management.

Female↗
PubMed2000

[Conization with positive margins: what strategy should be adopted?].

OBJECTIVE: To define recommended treatment in cases of positive margins on cone biopsy specimens. PATIENTS AND METHODS: This single-center retrospective study concerned 220 conizations performed between January 1996 and June 1998. The results of 70 conizations (31.8%) with positive margins were analysed. There were 32 cold knife conizations (mean age: 43 years) and 38 conizations by the loop electrosurgical excision procedure (mean age: 33 years). RESULTS: Mean depth of conization was 15.94 mm for cold knife conization and 10.08 mm for loop electrosurgical conization. Fifteen patients were excluded (5 with invasive cancer and 10 were lost to follow-up). This study included 55 patients with a mean 12-month follow-up. Six underwent hysterectomy for mini-invasion on the specimen or advanced age. Eleven underwent a second conization (followed by hysterectomy in 2 cases). The other 38 patients were submitted to simple surveillance with cervico-vaginal cytology and colposcopic examination. The rate of residual lesions (cervical intra-epithelial neoplasia: CIN 3) after conization with positive margin was 14.5% (n = 8). CONCLUSION: Residual persistent dysplasia is not present in all patients after conization with positive margins. Cytology and colposcopy allow detection of dysplasia, indicating the need for a second conization. In women with no desire for further pregnancy, systematic repeat surgery must be recommended.

Adult↗
PubMed1996

Vulvoperineal reconstruction after excision of anogenital multifocal intraepithelial neoplasia ("MIN").

Over the past 7 years, 12 women have been treated utilising a radical surgical approach for extensive vulval involvement as a component of multifocal intraepithelial neoplasia (MIN) of the female genital tract. The patients were analysed with respect to the anatomical site of involvement, age, presenting complaints and their duration, colposcopic examination, histopathology and surgical treatment. Gynaecologists, general surgeons and plastic surgeons were involved in the surgical treatment which was an initial colostomy followed by a definitive vulvoperineal resection and simultaneous vulval reconstruction using meshed split skin grafts or a combination of skin grafts and local flaps. 17 vulvoperineal reconstructions were done for 12 patients. Three had an incomplete histopathological clearance at the initial operation. Apart from these three patients, one had recurrence of symptoms alone, without any evidence of MIN, which was possibly due to human papilloma virus infection. One patient developed malignant squamous invasion 4 years later, which was cured with surgical excision and reconstruction. Colostomy closure was done after achieving local control of the disease. This staged approach does achieve the objectives of eliminating disease and alleviating symptoms. It preserves function and attempts to reconstruct normal anatomy without compromising the principles of surgical oncology and results in a high patient satisfaction.

Adult↗
PubMed2000

Effects of oral contraceptive pill use on vaginal flora and vaginal epithelium.

The objective of this study was to examine the effect of oral contraceptive (OC) use on vaginal discharge, epithelium, and flora. Thirty women who planned to use OC for contraception were evaluated before and 2 months after the start of OC use. At both visits, genital symptoms and exposures were assessed by questionnaire; vaginal signs were assessed by speculum examination and colposcopy; vaginal microflora was evaluated by quantitative culture; and a vaginal biopsy was obtained for histopathologic evaluation. Variables were compared between the initial visit and after 2 months of OC use. It was found that OC use did not change the gross, colposcopic, or histologic appearance of the vaginal epithelium or characteristics of vaginal or cervical discharge. Vaginal flora essentially remained unchanged after 2 months of OC use, except that a small decrease occurred in the number of subjects with > or =10(5) colony forming units/mL of H(2)O(2) producing Lactobacillus from 16 at baseline to 9 (p = 0.04) and in the total number of subjects with Ureaplasma urealyticum from 17 at baseline to 10 of 29 (p = 0.04). The results indicate minimal effect of OC use on the vaginal epithelium and vaginal and cervical discharge, and a small effect on vaginal flora.

Adolescent↗