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At least 163 records · Page 9Linked to original sources
PubMed2005

An audit of Chlamydia trachomatis screening in colposcopy--Hartlepool experience.

This study aims to detect the prevalence of Chlamydia trachomatis in women attending the colposcopy clinic. The aim of the study is to evaluate whether routine screening for C. trachomatis should be continued as part of the colposcopy examination. All new patients attending the colposcopy clinic were screened for C. trachomatis during the period January 2000--December 2002. Results indicate a chlamydia infection rate of 3.4%. We suggest that routine screening for C. trachomatis needs to be carried out within the colposcopy clinic.

Adolescent↗
PubMed1994

Diagnostic accuracy of cytology and colposcopy in cervical squamous intraepithelial lesions.

OBJECTIVE: To evaluate the diagnostic accuracy of cytology and colposcopy in women with an abnormal cervical smear using histology as the 'gold standard'. DESIGN: Survey of consecutively referred women with abnormal smear. SETTING: The out-patient colposcopical clinic of Herning Hospital, Denmark. PATIENTS: 813 women with a median age of 29.0 years (range 15-71 years) with their first abnormal smear. RESULTS: For detecting cervical high-grade lesions (HGL) the sensitivity of cytology was 41% (36-47%), of colposcopy 67% (62-72%) and in combination 75% (70-80%), so at least 25% of HGL were underestimated. Colposcopy underestimated more CIN-2 than CIN-3 lesions and more small lesions and lesions in smaller transformation zones. Cytology underestimated more CIN-2 lesions but equal numbers of small and large lesions and transformation zones. CONCLUSIONS: Colposcopy was a better tool for diagnosing HGL than cytology, but even in combination too many HGL were missed. All women with abnormal cytology should therefore have colposcopical and histological investigation and prospective studies of the natural history of cervical squamous lesions should include histological evidence.

Adolescent↗
PubMed1995

Computerized colposcopy and conservative management of cervical intraepithelial neoplasia in pregnancy.

BACKGROUND: Computerized colposcopy is the noninvasive digital processing of colposcopic images acquired using a charge-coupled device camera. The purpose of this study was to evaluate the clinical applications of computerized colposcopy, and to record the colposcopic changes associated with progression or regression of cervical intraepithelial neoplasia in pregnancy. METHODS: Forty-one pregnant patients, with abnormal Papanicolaou smears and a fully visualized squamo-columnar junction, were serially monitored throughout their pregnancies using computerized colposcopy. All patients had baseline computer-assisted measurements of their cervical lesions and a repeat measurement at monthly intervals and at 3-months postpartum. RESULTS: During the period of gestation, 17.1% of lesions increased in size, 21.9% remained unchanged, 41.5% decreased in size and 19.5% disappeared completely. In patients with an increase in lesion size, a colposcopically directed punch biopsy was performed which revealed CIN III but no microinvasion. Cervical biopsy during pregnancy was unnecessary in 82.9% of cases. CONCLUSION: The ability to sequentially monitor and quantify colposcopically visualized lesions, using computerized colposcopy, provides a noninvasive objective mode to evaluate progression, stability, or regression of CIN lesions during pregnancy.

Adult↗
PubMedDate not supplied

Do all grade I lesions on colposcopy need to be biopsied?

The present study intends to correlate grade I atypical transformation zone (ATZ) on colposcopy with cytology & histology in 51 patients by retrospective data analysis. Indications of colposcopy were inflammatory smears with unhealthy cervix (37/51). Atypical squamous cells of unknown etiology (2/51) & squamous intraepithelial lesions on cytology (12/51). All the patients exhibited grade I lesions on colposcopy & underwent directed biopsy. On histology chronic cervicitis was the commonest finding 70.6% (36/51) & CIN was found in 19.6% (10/51), out of which CIN II-III occurred only in 3.92% (2/51). Overcall rate of colposcopy for grade I lesions was 80.39%. Age, parity, the postcoital or contact bleeding did not correlate with the histological positivity of the lesions. Grade I ATZ with inflammatory smears revealed CIN II-III only in 2.7% (1/37) while with low grade SIL cytology there was no moderate or severe dysplasia. However Grade I lesions in association with high grade SIL exhibited CIN II-III lesions in 16.6% (1/6). Therefore grade I lesions in presence of inflammatory or low grade SIL smears can be observed & biopsied only if the changes persist. However association of high grade SIL with grade I ATZ calls for immediate biopsy.

Adolescent↗
PubMed2002

Validity of colposcopy in the diagnosis of early cervical neoplasia--a review.

This study was conducted to quantify by meta-analysis the validity of colposcopy in the diagnosis of early cervical neoplasia in order to assess the justification of its integral role in this regard. Eight longitudinal studies were selected, which compared correlation of colposcopic impression with colposcopically directed biopsy results. The prevalence of disease in the studies ranged from 40 to 89%. Colposcopic accuracy was 89%, which agreed exactly with histology in 61% of cases. The sensitivity and specificity of colposcopy for the threshold normal versus all cervical abnormalities were 87-99% and 26-87% respectively. For the threshold normal and low grade SIL versus high grade SIL, the values were 30-90% and 67-97%. Likelihood ratios increased with disease severity. Colposcopy performed better in differentiation of high grade from low grade disease than in differentiation of low grade disease from normal cervix. Colposcopy is a valid tool for the diagnosis of early cervical neoplasia. Its integral role in the management of early cervical disease is justified.

Biopsy↗
PubMed1992

A comparison of simultaneous cervical cytology, HPV testing, and colposcopy.

This pilot study explores the screening techniques for premalignant and malignant disease of the cervix. Given current knowledge of the etiology and progression of cancer of the cervix, should family physicians screen patients with Papanicolaou (Pap) smears, Human Papillomavirus (HPV) smears, colposcopy, or some combination of these three? In a retrospective audit of 75 patients comparing simultaneous Pap smears and colposcopy, 5 of 8 patients with biopsy-proven cervical intraepithelial neoplasia (CIN) and one with invasive cancer had normal Pap smears. Because of this high false-negative Pap smear rate, a prospective study comparing a simultaneous Pap smear, HPV smear, and colposcopic examination (with biopsy when indicated) was undertaken. Seventy consecutive patients seen by the author for routine pelvic examinations consented to and were enrolled in the study. Seven patients had biopsy-proven CIN lesions; 2 were found by Pap smear, 3 by colposcopy, and 5 by HPV smear. The Pap smear missed 5 lesions, colposcopy missed 4, and the HPV smear missed 2. Further studies are needed to determine the optimal screening method for CIN.

Colposcopy↗
PubMed1992

An evaluation of human papillomavirus testing as part of referral to colposcopy clinics.

OBJECTIVE: To determine the usefulness of human papillomavirus (HPV) testing as a triage method for predicting which women referred to a colposcopy clinic were most likely to have histologically confirmed cervical intraepithelial neoplasia (CIN). METHODS: Papanicolaou tests, ViraPap tests for HPV infection, and colposcopically directed biopsies were performed concurrently on 482 women referred to a student health colposcopy clinic. RESULTS: The results demonstrated that HPV positivity was associated with a greatly increased likelihood of histologic confirmation of CIN, especially among women with concurrent cytologic findings that were negative or showed only atypical squamous cells of undetermined significance. CONCLUSIONS: Testing for HPV appears to have a role in the triage of students now being referred to our colposcopy clinic. A combination of HPV testing and repeated cytologic screening would provide reasonably sensitive screening for cervical neoplasia while limiting the use of colposcopic services, which are currently overburdened. The eventual usefulness of HPV testing will depend on the cost and availability of colposcopy services, the cost of Papanicolaou tests, the cost and accuracy of HPV tests, and the predictive value of HPV detection in the population being screened.

Adult↗
PubMed1992

[The role of colposcopy in the diagnosis of HPV infection].

Human papillomavirus (HPV) has been implicated as an important etiologic factor in cervical carcinoma. This study evaluates the efficacy of colposcopy in the detection of cervical lesions with koilocytosis features. Colposcopy, cervical smears and biopsy specimens from 217 women seen in our department between January-December 1991 were examined. The colposcopy examination detected 77.5% of the viral presence the histological diagnosis detected 85% of HPV, but the cytologic smears showed only 52% of infection. The data suggests that colposcopy is a good examination to evidence koilocytosis infection.

Adult↗
PubMed1992

Survey of colposcopy practices by obstetrician/gynecologists.

A statewide survey to characterize the colposcopy patterns of practicing obstetrician/gynecologists was undertaken. There was a 66.1% response rate, with 98.2% of respondents performing colposcopy. Of those performing colposcopy, nearly all perform biopsies, cryosurgery and conizations; 73.4% perform laser vaporization, 66.7% perform laser cone biopsy and 11% perform laser cone biopsies in their offices. The mean number of colposcopies performed by respondents in a six-month period was 55. Twenty percent performed less than one examination per week and an additional 60% performed two to three examinations per week. Further studies to assess the diagnostic accuracy of those performing greater and lesser numbers of examinations are needed.

Arizona↗
PubMed1992

Clinical usefulness of computerized colposcopy: image analysis and conservative management of mild dysplasia.

OBJECTIVES: The purposes of this study were to evaluate the clinical usefulness of computerized colposcopy and image analysis, to investigate the correlation between lesion size and grade of dysplasia, and to examine and record the colposcopic changes associated with progression or regression of cervical dysplasia. METHODS: Sixty-eight patients with a fully visualized squamocolumnar junction and a histopathologic diagnosis of mild dysplasia were serially monitored for a period of 1 year using computerized colposcopy and image analysis. All patients had baseline computer-assisted measurements of their cervical lesions and repeat measurements at 3-month intervals. RESULTS: The mean age of the patients was 31 years, and the mean size of the colposcopically visualized lesions was 58 mm2. During the 12-month observation, 5.9% of the lesions increased in size, 32.4% decreased in size, 13.2% remained unchanged, 20.6% disappeared, and 27.9% completely changed location. In patients with an increase in lesion size (N = 4), a repeat biopsy was performed, revealing a progression to moderate dysplasia. Treatment was withheld from patients whose lesions disappeared (N = 14), decreased in size (N = 22), or remained unchanged (N = 9). Active therapy was unnecessary in 66% of cases and repeat biopsy was avoided in 94.1%. CONCLUSIONS: Computerized colposcopy provides objective information and may be an adjunct to cytology and histopathology in some cases. Computerized colposcopy replaces subjective colposcopic evaluation with objective computer assessment and may hold promise for conservative management of cervical dysplasia.

Adult↗
PubMed2005

[Overuse of colposcopy service in Mexico].

BACKGROUND: Cervicouterine cancer is one of the main public health problems in Mexico. Several problems related to the low effectiveness of the Program of Opportune Detection of Cervicouterine Cancer have been identified, among them: low cover of the disease detection and absence of quality control in the detection, diagnosis and treatment of it. In Mexico the quality control problem in cytology has been taken with success, but the opposite occurs with colposcopy practice. For that reason this service is overused by patients with low risk cancer and is not accessible for the high risk population. OBJECTIVE: To evaluate the association between cervicouterine cancer knowledge and satisfaction with the service regarding the use and intention of adherence to it for the follow-up and treatment, as well as analyze the resources used for this attention. PATIENTS AND METHODS: A transversal study was done from May to December, 2002. It included all the patients who went to the Colposcopy Service in three hospitals. 1,606 patients were interviewed, from them 443 cases were first-time visits and 1,163 were subsequent ones. RESULTS: In a multivariate model we observed that the real utility knowledge of cervicovaginal cytology increases the probability that women come back to the Colposcopy Service (OR 2.0, Cl 95%: 1.57, 2.54). Patients who know their diagnosis when it is dysplasia or cancer are more likely to become attached to their follow-up than those who do not know it. 91% of the users (1,463) had two or more cervicovaginal cytolgies done, and 49% (787) had eight or more. Patients who know the purpose and utility of the biopsy had a 4.4 fold probability of become subsequent than those that do not know such information (Cl 95%: 1.72 to 11.35). CONCLUSIONS: Nowadays colposcopy clinics treat 70% of the patients who are subsequent and that have normal reports of cytology. This shows us an overuse of the service, with the consequent service, monetary and opportunity costs for women. More studies should be done to reformulate the rule that controls the treatment of these patients, and incorporate follow-up guidelines according to the natural history of the disease in Mexican women.

Adult↗
PubMed2005

A clinical audit of a nurse colposcopist. Colposcopy: cytology: histology correlation.

The role of the nurse colposcopist has been established in some countries for a number of years. At National Women's Health the first New Zealand nurse colposcopist training programme was developed in 2000. A clinical audit was undertaken to assess the diagnostic skills of the nurse colposcopist measuring colposcopy: histology: cytology correlation. A retrospective audit of the colposcopy clinical records was performed during the nurse's training programme between July 2000 and March 2002. An 82% (82/100) histology: cytology: colposcopy correlation was achieved by the nurse in the third phase of her training programme. The results are comparable with other reported studies involving medical and nurse colposcopists. Expertise in colposcopy examination can be incorporated into the broader role of a Nurse Practitioner working in the area of women's health.

Clinical Competence↗
PubMed1991

Experience with colposcopy in a family practice center.

The experience of a family practice center that performed colposcopy for one year was reviewed to provide insight into the appropriateness of this procedure to a family practice clinic. Almost three thousand Papanicolaou smears were performed, which prompted 97 colposcopy clinic appointments involving 68 patients. Dysplastic Pap smears accounted for 1.82% of the total. Atypical Pap smears occurred in 3.91% of the tests, and 16.1% of a sample of these demonstrated dysplasia. Controversy concerning the atypical Pap smear is discussed. The colposcopy service was convenient for the patients and was at least revenue neutral while providing a new professional opportunity for selected family practitioners. A referral base of at least 1,000 Pap smears might justify a colposcopy program, depending on referral strategies.

Ambulatory Care↗
PubMed1990

Assessment of endocervical curettage in colposcopy.

Colposcopy has become an accepted diagnostic procedure in the management of patients with abnormal cervical cytology. To assess the value of the endocervical curettage in colposcopy, a retrospective review of 125 cases who had the procedure done during the 20-month period (January 1986-August 1988) was carried out. The ECC were positive in 3 out of 57 (5.3%) patients with satisfactory examination and 24 out of 68 (35.3%) patients with unsatisfactory examination. In all 27 cases, there was insufficient tissue to make a diagnosis of invasive carcinoma. Of the 125 patients studied seventy-two (29 in the satisfactory group and 43 in the unsatisfactory group) underwent conization and/or hysterectomy. Endocervical curettage did not eliminate the need for cone biopsy in all cases of unsatisfactory colposcopy. The tissue diagnosis on ECC did not increase the diagnostic accuracy derived from the colposcopic directed biopsies in either group. There were 20 cases of invasive carcinoma (13 MIC, 7 invasive) in this study, the ECC were positive in 9. We concluded that the ECC has limited value in colposcopy.

Colposcopy↗
PubMed1989

[Teenage pregnancy and routine colposcopy].

The superiority of colposcopy over cytology is clearly demonstrated by the finding of an atypical transformation zone in 42.7% of routine consecutive colposcopies performed on 206 pregnant teenagers 16 years and younger at Paarl Hospital; in only 1.46% of these girls did cervical cytology show atypia or dysplasia. Complete colposcopy was possible in 97.6% of cases whereas cytology was incomplete in 28.2%, with no endocervical cells shown. The colposcopical findings are very similar to those of a concurrent West German study which links these findings to the human papillomavirus notoriously missed by cytology. Colposcopy should be part of the routine evaluation of every teenage pregnancy as cytological examination alone is not only incomplete but also much less sensitive in detecting abnormal change of the cervix.

Adolescent↗
PubMed1985

[Studies on a cell sampling method in mass screening for uterine cervical cancer--comparison of data obtained with a cotton tipped applicator, wooden spatula and cotton tipped applicator plus colposcopy].

In mass screening tests for uterine cancer carried out Shimane Prefecture, we used three different scraping methods. This summary is a report of a comparison of the findings with each method. Results are as follows: From 1973-1982, 214, 798 Japanese women were examined in mass screening tests. Among the 42, 443 examined using a cotton tipped applicator, there were 15 (0.035%) with mild dysplasia, 8 (0.019%) with severe dysplasia, 6 (0.014%) with carcinoma in situ and 8 (0.019%) with invasive carcinoma. In 38,106 women examined using the spatula, 25 (0.066%) had a mild dysplasia, 10 (0.026%) a severe dysplasia, 18 (0.047%) a carcinoma in situ and 26 (0.068%) an invasive carcinoma. In 134,249 examined using a cotton tipped applicator plus colposcopy, 283 (0.211%) had a mild dysplasia 108 (0.080%) a severe dysplasia, 57 (0.042%) a carcinoma in situ and 78 (0.058%) an invasive carcinoma. Thus, the use of a cotton tipped applicator plus colposcopy leads to higher rates of detection of mild and severe dysplasia. In the group with a negative Papanicolaou smear and for whom the cotton tipped applicator plus colposcopy was used, there were 214 with a mild dysplasia, 65 with a severe dysplasia, 11 with a carcinoma in situ and 7 with an invasive carcinoma. The combination of cotton tipped applicator and colposcopy proved to be the most effective for mass screenings for uterine cancer, as the detection rates for severe dysplasia and carcinoma in situ were higher and there were fewer incidences of false negative results.

Carcinoma in Situ↗
PubMed1979

[The role of colposcopy in the diagnosis and treatment of dysplasias and intra-epithelial carcinomas of the uterine cervix (author's transl)].

Colposcopy plays an essential role in the diagnosis and treatment of dysplasias of the uterine cervix. It may be used to assess the lesions recognising dysplasia, observing the degree of severity and indicating regions from which biopsies should be taken. It accurately defines the limits of the lesions by indicating the site of the squamo-columnar junction, on the ectocervix or in the cervical canal. In association with Schiller's test, it defines the peripheral limits of the lesions on the cervix or vagina and leads to the discovery of purely vaginal lesions. On the basis of such an assessment, it is possible to discuss appropriate method for reaching a histological diagnosis, perform selective biopsies or obtain surgical specimen, and the best form of treatment. Only colposcopy offers the possibility of determining the indications for local treatment and observing patients after treatment. Colposcopy must be accompanied by precise technique in the histological examination of biopsies and operative specimens. Colposcopy is not a routine method of examination. In order to be effective and reliable, it must be selective and performed by a specialised colposcopist.

Biopsy↗
PubMed1994

Colposcopy in a private family practice: a one year experience.

OBJECTIVE: To describe results achieved by family physicians performing colposcopy in our private practice. METHODS: A chart review was performed one year after initiating colposcopy services. RESULTS: Forty-five patients underwent 47 colposcopic exams, most often for mild dysplasia or persistent atypia on Papanicolaou smears. Of the 21 patients with persisting atypia on smear, 16 (76.2%) showed dysplasia on biopsy. Twenty-five patients (55.6%) underwent cryotherapy, which successfully eradicated the abnormality in 16 of the 20 (80%) for whom follow-up is complete. Ten patients (22.2%) were referred to gynecologists for further evaluation and/or treatment. Six patients (13.3%) had not received the recommended follow-up after either colposcopy or cryotherapy. CONCLUSIONS: Family physicians in private practice performing colposcopy and cryotherapy can provide complete care for 75% of patients with abnormal Papanicolaou smears. Patients with squamous atypia on smear may have dysplasia on biopsy more often than previously reported. A recall system and regular chart audits are recommended to improve follow-up.

Adolescent↗