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PubMed1990

Is routine colposcopic assessment necessary following laser ablation of cervical intraepithelial neoplasia?

The colposcopic and cytological findings at follow-up of 1000 women treated by laser ablation for cervical intraepithelial neoplasia or human papillomavirus infection at the Regional Department of Gynaecological Oncology, Gateshead, were reviewed. Colposcopy detected six of 27 patients with residual disease compared with cytology which was abnormal in 26 of the 27 and detected 21 as abnormal on the first visit after laser treatment. In our unit invasive disease after laser treatment was never detected solely on initial colposcopic review.

Adolescent↗
PubMed1995

Does colposcopically directed punch biopsy reduce the incidence of negative LLETZ?

OBJECTIVE: To evaluate the role of punch biopsy in reducing the occurrence of negative histology provided by large loop excision of the transformation zone in the management of cervical intraepithelial neoplasia. DESIGN: Retrospective review of computerised data base and clinic files. SETTING: Colposcopy Clinic, Groote Schuur Hospital, Cape Town, South Africa. SUBJECTS: Two hundred and ninety-eight women considered suitable for the local outpatient management of cervical intraepithelial neoplasia. METHODS: Two groups of patients were identified: group A consisted of women who had cervical intraepithelial neoplasia confirmed colposcopically and who underwent directed punch biopsy; group B consisted of women who had cervical intraepithelial neoplasia confirmed colposcopically and were referred for large loop excision of the transformation zone without confirmatory punch biopsy. RESULTS: In Group A (n = 184) 123 women had cervical intraepithelial neoplasia diagnosed on punch biopsy. Large loop excision of the transformation zone was performed on 116 women and 7 were lost to follow up. The procedure confirmed cervical intraepithelial neoplasia in 95 cases (82%), but there was no cervical intraepithelial neoplasia in 21 cases (18%). Sixty-one women had negative punch biopsies. Of these, 13 underwent large loop excision of the transformation zone, 31 had persistently negative follow up cytology, and 9 had positive cervical smears of which 7 were treated with large loop excision of the transformation zone, and 8 were lost to follow up. Overall, 25% of all negative punch biopsies were falsely negative. In group B 114 were treated with large loop excision of the transformation zone and cervical intraepithelial neoplasia was confirmed in 97 cases (85%); one woman had unsuspected microinvasion (1%) and 16 women (14%) had no cervical intraepithelial neoplasia. Negative histology after large loop excision of the transformation zone was not statistically different in groups A and B. CONCLUSION: Punch biopsy does not reduce the occurrence of negative histology after large loop excision of the transformation zone.

Adult↗
PubMed1981

Colposcopic differential diagnosis of dysplasia, carcinoma in situ and microinvasive carcinoma of the cervix.

Two hundred and twenty-eight patients with cervical neoplasia, detected in routine uterine cancer screening at the Center for Adult Diseases, Osaka, from 1973 through 1977 were selected. The histological diagnosis was as follows: dysplasia, 69; carcinoma in situ, 102; and microinvasive carcinoma, 57. A retrospective study of this material was made with the aid of adequate colposcopic colour photographs, and features likely to be useful in differential diagnosis were determined. Atypical vessels were seen in 24 of 36 patients (67%) with Stage Ia1 lesions, but only in a few of those with Stage 02 lesions. Punctation, mosaic and white epithelium were less evident in stage Ia2 than in Stage 01 and Stage 02. Punctation, mosaic and white epithelium in patients with dysplasia were less formed, and their borders were less distinct than in patients with Stage 0 lesions. These characteristic changes are of value in accurate colposcopic diagnosis.

Carcinoma↗
PubMed2005

Demographic variables routinely collected at colposcopic examination do not predict who will default from conservative management of cervical intraepithelial neoplasia I.

OBJECTIVE: As a result of the low incidence of progression from low grade epithelial abnormalities to cervical intraepithelial neoplasia (CIN) 3 or cervical cancer, a conservative approach to management is supported, especially in young women. Loss to follow-up is a recognised problem with a conservative approach however, with women defaulting known to experience higher rates of cancer. AIM: To determine if any routinely collected demographic variables could predict which Australian women would subsequently default from care having initially elected to have conservative management of CIN 1 lesions. METHODS: Prospectively collected data was audited on 279 women with a colposcopically directed biopsy diagnosis of CIN 1, confirmed on external review, who were enroled by their own choice into a conservative management program and monitored until a definitive lesion outcome was determined. Women who defaulted from follow-up and were lost to care providers despite follow-up appointments and reminder letters were compared to women who completed follow-up with either lesion resolution or progression requiring treatment, to establish if there were any demographic variables to predict default from care. RESULTS: Fifty-two (18.5%) women subsequently defaulted from follow-up. There were no significant differences in age, parity, proportion of women who were pregnant at diagnosis, smoking status, immunosuppressed or had a 'human papillomavirus (HPV) effect' reported on Pap-smear or colposcopic examination. CONCLUSION: We cannot easily identify a subgroup of women who are more likely to default from follow-up of CIN 1 using routinely collected demographic data. Default from follow-up is a major risk with conservative approaches and further research to reduce default rates are required.

Adult↗
PubMed1995

Colposcopic genital findings in prepubertal girls assessed for sexual abuse.

After the introduction of the colposcope for the examination of children suspected of being sexually abused in Leeds, a study was undertaken to describe the findings in detail. A total of 109 consecutive prepubertal girls, mean age 70.4 months were assessed including colposcopic genital and anal examination, and peer group review of reports and photographs. Fifty nine children had signs consistent with blunt force penetrating trauma (hymenal transection/major notch, scar, or hymenal attenuation). Transections were encountered most commonly at 6 o'clock (directly posterior). In 46 the hymenal orifice was gaping with thigh abduction only and in 47 the hymenal orifice transverse diameter was greater than 4 mm on labial separation. Overall, physical findings were commonly present and in only two cases were no signs recorded. Non-specific and frequent findings included patterns of labial and introital reddening. Supportive hymenal signs including swelling, rounding of edge, thickening, distortion, and loss of symmetry were common. Labial fusion was present in 20. Urethral dilatation with labial separation was noted in 14. Physical findings including normality are consistent with abuse and even minor anogenital signs as well as negative findings should be documented. Colposcopy and photography are valuable tools in peer review, teaching, and case management.

Age Factors↗
PubMed1983

Natural history of cervical epithelial abnormalities in patients with vulval warts. A colposcopic study.

The natural history of intraepithelial abnormalities of the cervix associated with human papillomavirus infection was investigated in a prospective study of 50 women with vulval warts, of whom 28 had colposcopic evidence of a cervical epithelial abnormality and 22 a normal cervix. Of the 28 with a cervical abnormality, 26 were re-examined by colposcopy after three months; the epithelial abnormality had persisted in 23 women. Nineteen women who had initially shown abnormality by colposcopy were re-examined six months after their first attendance; the epithelial abnormality had persisted in 14 women. Of the 22 women who initially had a normal cervix, 19 were re-examined after three months; the cervix remained normal in 18, but an epithelial abnormality had developed in one. Fourteen women who initially had a normal cervix were re-examined six months after their first attendance; the cervix was still normal in 11, but an epithelial abnormality had developed in three. Colposcopically directed biopsy specimens were obtained from 21 women who showed an epithelial abnormality; of these, evidence of wart virus infection was present in four, cervical intraepithelial neoplasia in two, both conditions in 13, and no abnormality in two. It is concluded that lesions of the cervix associated with wart virus infection show little evidence of short term regression.

Adult↗
PubMed1986

Gardnerella vaginalis and mosaic colposcopic pattern of the cervix: casual or causal association?

We made a retrospective study of the flora found in the vaginal smears of sexually active women who presented with a mosaic colposcopic pattern of the uterine cervix in an attempt to study some of its epidemiologic factors. Of the 195 cervicovaginal cytologies of patients with mosaic, 61 revealed an abnormal flora (31.2%) while of the 9,856 patients without mosaic, only 2,234 cytologies had an abnormal flora (22.7%) demonstrating a statistically significant higher frequency (p less than 0.0001) of an abnormal flora in women with a mosaic pattern on the cervix. A statistically significant association (p less than 0.02) was encountered between the presence of Gardnerella vaginalis and the mosaic colposcopic pattern, and surprisingly a statistically greater frequency (p less than 0.05) of biopsied dysplasias in the same group. At the moment we can interpret these observations as nothing more than interesting initial findings.

Adult↗
PubMedDate not supplied

Genital human papillomavirus infections: correlation of cytological, colposcopic and histological features with viral types in women and their male partners.

To determine the incidence of anogenital papillomavirus infections and to assess the value of available diagnostic methods, we compared the cytological, colposcopic and histological features of anogenital papillomavirus-related lesions with their associated human papillomavirus types (HPV) in 300 women and in their male partners. HPV-type deoxyribonucleic acid was detected by blot hybridization in 398 out of 624 subclinical and clinically defined anogenital lesions. Whatever the site of the lesion, condylomas and low-grade intraepithelial neoplasia (IEN) were found in 84% of lesions associated with HPV 6-11, compared with 32% of lesions containing HPV 16-18 (P < 0.001). Among the HPV 16-18 associated lesions, high-grade cervical, vaginal, vulvar and anal intraepithelial neoplasias represented 45% (P < 0.001) of the lesions. In 65% of 23 cases of squamous anogenital cancer, HPV 16-18 and mixed types were present (P < 0.001). In 54% (161/300) of cases, the lesions were multicentric (161/300). On cytological examination, 27% of the samples gave false negative results. In cervical lesions, there was a good correlation between virological and colposcopic findings, but this was not true for extracervical mucous epithelia in the vagina or on the vulva. With peniscopy in the male partners 220 out of 410 had penile condylomatous lesions and more than half of the 350 male specimens examined by molecular hybridization contained HPV DNA. A correlation was found between the virus types in penile lesions or in cells of the distal urethra and in the cervical lesions of the sexual partner.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2005

Evaluation of a digital store-and-forward colposcopic system--a pilot study to assess usability for telemedicine.

We evaluated the diagnostic reliability of cervical examination using digital colposcopy compared with conventional binocular colposcopy. A total of 315 patients were examined and diagnosed by a colposcopist on-site. During the colposcopic examination, digital camera images were stored on a PC (median five pictures per patient). A second physician, experienced in colposcopy, re-evaluated the initial diagnostic findings using the stored digital images. The primary and secondary findings in each patient were categorized according to the Rome classification system. There was agreement between the primary and secondary examiners in 69% of cases (kappa=0.60). There was no systematic bias in terms of under- or over-rating. The proportion of non-assessable colposcopic examinations was 9%. Digital colposcopy was reliable and provided advantages in terms of a better follow-up examination and internal quality control of the diagnosis. The pilot study suggests that telecolposcopy may provide better training and further education for physicians and students, and may also improve the diagnostic possibilities in gynaecology.

Adult↗
PubMed1990

Carcinoma of the cervix in a pregnant woman with negative Pap smears and colposcopic examination.

A case is reported of squamous cell carcinoma of the cervix developing in a pregnant woman while manifesting five consecutive false-negative Pap smears and colposcopic appearance suggestive of dysplasia. Pap smears and colposcopic examinations are helpful in diagnosing dysplastic and early cancerous lesions of the uterine cervix. We describe a case where both Pap smears and colposcopy failed to diagnose an early occult invasive lesion in the cervix of a pregnant woman who manifested only CINIII by colposcopy, while the Pap smear was falsely negative on five consecutive occasions.

Adult↗
PubMed1989

Male partners of women with genital human papillomavirus infection. An assessment of colposcopic abnormalities by histological examination and human papillomavirus hybridization.

Men whose female sexual partners showed histological evidence of human papillomavirus infection were examined. Human papillomavirus DNA was identified in 29 of 35 biopsy samples of colposcopically-identified penile lesions. Human papillomavirus strains that were related to human papillomavirus genotypes 6/11 were observed most commonly (seven of eight patients) in the partners of patients with warty atypia or condylomata, while human papillomavirus strains that were related to human papillomavirus genotypes 16/18 were most-commonly (eight of 15 patients) observed in tissue from the partners of patients with cervical intraepithelial neoplasia. Measurement of human papillomavirus DNA in lesions by the filter in-situ hybridization technique more-frequently indicated human papillomavirus infection (29 of 35 lesions) than did conventional histopathological assessment (21 of 35 lesions) in this "high-risk" group. We conclude that colposcopically-identifiable lesions in male sexual partners are likely to contain human papillomavirus DNA, even if is no definite histological evidence of human papillomavirus infection is present, and that such lesions frequently contain strains of human papillomavirus that have been associated with the development of anogenital carcinoma.

Colposcopy↗
PubMed1976

Colposcopic evaluation of cervical intraepithelial neoplasia.

Colposcopic examination and directed biopsies were performed on 70 patients with abnormal cerivcal cytology. The correlation of the histology of the directed biopsies with the colposcopic appearance was 80%; it was 86% with the original Papanicolaou smear. In no case was the histology of a subsequent cone biopsy or hysterectomy specimen more advanced than that of the directed biopsy. Conization was avoided in 52 of the 70 patients and could have been avoided in seven others.

Adult↗
PubMed1992

Loop electrosurgical excision procedure of the transformation zone and colposcopically directed punch biopsy in the diagnosis of cervical lesions.

OBJECTIVE: To estimate the disagreement between the histologic reports at colposcopically directed punch biopsy of the cervix and subsequent loop excision of the transformation zone, and to assess the indications for loop excision in current practice. METHODS: The histologic diagnoses from loop electrosurgical excision procedures and concurrent colposcopically directed punch biopsies were compared in 337 consecutive women undergoing loop excision in a 5-year period. RESULTS: Disagreement between punch biopsy and loop excision was recorded in 190 cases (56.4%). The undercall and overcall rates for punch biopsy were 14 and 42.4%, respectively. Undercall at punch biopsy occurred in 24 of 46 cases of cervical intraepithelial neoplasia (CIN) III and in one microinvasive cancer diagnosed at loop excision, and disagreement was within one grade of CIN in 16 cases. CONCLUSIONS: Loop electrosurgical excision allows further and more accurate histologic examination of the transformation zone and should be the standard assessment procedure in all cases of CIN II detected at punch biopsy and whenever cytology or colposcopy suggests the risk of punch biopsy undercall. Immediate treatment by local destruction should not be performed, to avoid underestimation of the severity of the lesion.

Biopsy↗
PubMed2004

Correlation of colposcopic anogenital findings and overall assessment of child sexual abuse: prospective study.

OBJECTIVE: To examine the relationship between colposcopic anogenital findings and overall assessment of sexual abuse. DESIGN: Prospective study. SETTING: Regional hospital, Hong Kong. PATIENTS: Seventy-seven children (mean age, 6.5 years; range, 6 months-16 years) referred consecutively for sexual abuse evaluation between July 1999 and June 2002 were included. MAIN OUTCOME MEASURES: Colposcopic anogenital findings (categorised as normal, non-specific, concerning for abuse, or clearly abnormal) were correlated with the overall assessment of likelihood of abuse (classified as no evidence of abuse, possible abuse, probable abuse, or definite abuse). The sensitivity and specificity of clearly abnormal findings in detecting definite abuse were computed, and the diagnostic impact of colposcopy findings were expressed as likelihood ratios. RESULTS: Anogenital findings were normal in 45% of patients, non-specific in 29%, concerning for abuse in 13%, and clearly abnormal in 13%. Seven of the 16 confirmed cases of sexual abuse had normal or non-specific findings. Overall assessment showed that 46% of all patients had no evidence of abuse, 20% had cases of possible abuse, 13% had cases of probable abuse, and 21% had cases of definite abuse. The sensitivity and specificity of abnormal anogenital findings in detecting definite abuse were 56.3% and 98.4%, respectively. Colposcopy showed a fair correlation with the overall assessment of abuse (weighted kappa, 0.245). The diagnostic impact of normal, non-specific, concerning, and clearly abnormal findings in terms of likelihood ratios were 0.23, 1.12, 0.00, and 34.30, respectively. CONCLUSIONS: Anogenital findings are often normal or non-specific in sexual abuse. In general, colposcopy examination findings do not directly reflect the final diagnosis. A category-4 finding on colposcopy is very helpful in confirming definite abuse, whereas other findings do not rule out the diagnosis.

Adolescent↗
PubMed1991

Colposcopic features of papillomaviral infection and premalignancy in the female lower genital tract.

Colposcopy plays an important role in the investigation and direct management of papillomavirus infection of the female lower genital tract. The colposcopic appearance of subclinical papillomavirus disorders resembles intraepithelial neoplasia, and the matter is further confused in that subclinical lesions are often accompanied by intraepithelial neoplasia into which they grade with indefinite borderlines. High accuracy in prediction of histologic diagnosis in the spectrum that ranges from subclinical papillomavirus infection to major grades of intraepithelial neoplasia may be achieved by a system of grading of colposcopic appearances.

Cervix Uteri↗
PubMed1991

Colposcopic evaluation of human immunodeficiency virus-seropositive women.

To determine the effect of human immunodeficiency virus (HIV) infection on cervical histology, 32 known HIV-seropositive women underwent cervical colposcopic evaluation. All had cervical cytology, colposcopically directed biopsy, and T-cell studies performed. Thirteen of 32 patients (41%) had cervical intraepithelial neoplasia (CIN). Another 14 of 32 patients (44%) had histologic evidence of cervicitis. Abnormal cytology, noted in only three women, suggested CIN in one and inflammatory atypia in two. All (five of five) patients with a clinical diagnosis of AIDS had CIN, compared with 30% (eight of 27) of non-AIDS HIV-positive patients (P less than .05). Patients diagnosed with CIN had significantly lower CD4 cell counts (221/mm3 versus 408/mm3; P less than .06) and CD4:CD8 ratios (0.33 versus 0.62; P less than .02) than those without CIN. Patients with cervicitis had greater T-cell immunosuppression than did those with normal histology. In addition, patients with AIDS were more likely to have higher-grade lesions than were non-AIDS HIV-seropositive patients. Seven of 12 CIN specimens available for analysis by polymerase chain reaction using consensus sequence primers detected human papillomavirus (HPV) DNA, including three patients with three or more HPV types. Our data suggest that abnormal cervical pathology is common among HIV-positive women and that cytologic screening is not predictive of CIN in this population. In addition, the presence and severity of cervical dysplasia correlates with quantitative T-cell function. We strongly recommend that cervical colposcopy be part of the routine management of HIV-seropositive women.

Adult↗
PubMed2005

Colposcopic directed biopsy in the management of abnormal pap smear at Phramongkutklao Hospital.

OBJECTIVE: To evaluate agreement in pathologic diagnosis of tissue obtained by colposcopic directed biopsy (CDB) and conization or total abdominal hysterectomy (TAH) in the diagnosis of cervical intraepithelial neoplasia (CIN). MATERIAL AND METHOD: Medical records of women with abnormal cervical cytology referred for colposcopic examination from January 1, 1999 to December 31, 2003 were reviewed. Agreement in diagnosis of CIN in tissue obtained by CDB and tissue obtained by conization or TAH is defined as not more than one level of CIN disparity. RESULTS: Agreement between pathologic diagnosis of tissue from CDB and tissue from conization or TAH is 67.1% with a 95% confidence interval of 57-77%. Six cases of invasive cancer were not diagnosed from CDB but subsequently diagnosed from conization. CONCLUSION: Agreement between pathologic diagnosis of tissue obtained from CDB and tissue from conization or TAH in the present study was too low to accept CDB as a diagnostic modality for CIN in selected cases. Conization should be performed in these cases after diagnosis of CIN is made by CDB.

Adult↗