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I Nyirjesy

Publications and source records attributed to I Nyirjesy.

14 recordsLinked to original sources
PubMed1998

Potential hazards of following atypical and low-grade cervical cytology without colposcopy.

Objective: To determine the frequency of high-grade cervical intraepithelial neoplasia in patients with atypical and low-grade cervical cytology and to assess the optimal evaluation and follow-up.Methods: Prospective observational study of 367 of 7,651 private patients who had cytologic, virologic, or colposcopic changes suggesting cervical intraepithelial neoplasia or cervical carcinoma. The study was performed to determine the frequency of cervical intraepithelial neoplasia in the various cytologic groups and to assess the effect of testing for human papillomavirus on the sensitivity, specificity, and positive predictive value of these tests.Results: Papanicolaou smears that included all non-negative tests (high- and low-grade squamous intraepithelial lesions and atypical squamous or glandular epithelial cells of undetermined significance) had the maximal sensitivity (89%) for high-grade cervical intraepithelial neoplasia and cancer. The combined cytologic categories of high- and low-grade squamous intraepithelial lesions had a sensitivity of 58%, this was reduced to 24% if only high-grade squamous intraepithelial lesions were considered relevant for additional evaluation. If we had not evaluated the patients with atypical squamous and glandular cells of undetermined significance, we would have missed diagnosing one third of high-grade and one half of low-grade cervical intraepithelial neoplasia. Cervical cytology was false negative in 8% of patients with high-grade and in 14% of those with low-grade cervical intraepithelial neoplasias. High-risk human papillomavirus deoxyribonucleic acid was detected in 40% of women with high-grade and in 24% of those with low-grade grade cervical intraepithelial neoplasias. The positive predictive value of cytology with atypical squamous cells of undetermined significance increased from 5% to 38% for high-grade and from 30 to 85% for high- and low-grade cervical intraepithelial neoplasias in patients with detectable high-risk human papillomavirus deoxyribonucleic acid. Virologic studies produced no significant improvement on these diagnoses in women with high- or low-grade cytology.Conclusions: Because of the poor sensitivity of cytology suggesting high-grade squamous intraepithelial lesions, we recommend that all women with atypical or low-grade cytology be recalled for colposcopy and high-risk human papillomavirus deoxyribonucleic acid testing, if available. Decisions whether to perform a biopsy should be based on the result of colposcopic examination. Performing colposcopy only on those patients who have cytologic high-grade squamous intraepithelial lesions and following those with lower grade cytologic anomalies without colposcopic diagnosis appears inadequate to rule out high-grade cervical intraepithelial neoplasia.

Journal Article↗
PubMed1998

Evaluation of atypical and low-grade cervical cytology in private practice.

OBJECTIVE: To evaluate the adequacy of cytology alone for diagnosis of grade of cervical intraepithelial neoplasia (CIN) and to study performance of cytology, human papillomavirus (HPV) testing, and colposcopy in the evaluation of cytologic findings suggesting low-grade squamous intraepithelial lesions (SIL), or atypical squamous (ASCUS) or atypical glandular (AGCUS) cells of undetermined significance. METHODS: Standard gynecologic and cytologic evaluation and colposcopic inspection as an additional screening approach were performed on women with no prior hysterectomies screened in a private practice between January 1, 1993, and August 1, 1995. Among these 7651 women, 367 had ASCUS, AGCUS, or SIL cytology or clinically or colposcopically visible cervical lesions. Sensitivity, specificity, and relative risk of CIN in the 367 women were compared by colposcopic, cytologic, histologic and virologic diagnoses. RESULTS: The sensitivity of all non-negative Papanicolaou smears for CIN 2-3 and cancer was 92%, combined cytologic categories of high- and low-grade SIL were 59%, and high-grade SIL alone was 22%. Colposcopy was performed in all 367 patients, and positive findings led to biopsies in 48%. Colposcopy of patients with ASCUS increased detection of CIN 2-3 by 32% and CIN 1 by 48%. Cervical cytology was false negative in 8% of patients with CIN 2-3 and in 14% of those with CIN 1. These cases of CIN were detected by screening colposcopic inspection. High-risk HPV DNA was positive in 41% of women with CIN 2-3, and in 25% of those with CIN 1. The positive predictive value of ASCUS cytology increased from 5% to 42% for CIN 2-3 and from 30% to 85% for all grades of CIN in patients carrying high-risk HPV DNA. Virologic studies did not add to an increase in the sensitivity for CIN 2-3 among women in the low- and high-grade SIL cytology groups. CONCLUSION: Because of the limited sensitivity of the high-grade SIL cytologic category for CIN 2-3, we recommend that all women with ASCUS, AGCUS, low- or high-grade SIL cytology be recalled for colposcopy, with biopsy only when indicated by colposcopic findings.

Adolescent↗
PubMed1993

Benign breast disease.

Most women initially consult their gynecologist when they have concerns about breast disorders. Although breast cancer is usually the patient's biggest fear, it is benign breast disease, a common disorder, which often complicates a thorough evaluation and which interferes with the early diagnosis of breast cancer. This article summarizes the current state of knowledge on the cause, diagnosis, and prognosis of selected benign breast disorders. Recent progress includes a promising line of research on the content of cyst fluids, better definition of breast cancer risk, and increasing acceptance of ultrasound techniques to differentiate cystic from solid masses.

Breast Diseases↗
PubMed1992

Management of breast problems in gynecologic office practice using sonography and fine-needle aspiration.

Breast-related problems were studied in 500 consecutive gynecologic patients by clinical assessment and mammography. Sonography and fine-needle aspiration were performed to clarify inconclusive clinical or mammographic findings. Cysts were correctly diagnosed by sonography in 175 of 189 patients (four of 193 with cysts had no ultrasound examination). Fine-needle aspiration provided immediate treatment in 116. Cysts were not aspirated in 75 patients, and two women required a biopsy because of atypical or suspicious cytologic changes. Carcinoma was detected in 23 patients; palpation was correctly positive in 15, sonography in 12 of 17, mammography in 18 of 22, and fine-needle aspiration in five of seven. We believe that sonography and fine-needle aspiration are useful extensions of the physical examination for benign breast disease, providing immediate diagnosis of cysts and facilitating the diagnosis of cancer. Our data, in agreement with the literature, indicate that no single method is completely reliable in diagnosing carcinoma. Therefore, a judicious combination of all available techniques should be used.

Ambulatory Care↗
PubMed1984

Detection of breast carcinoma in a gynecologic practice.

The approach to detecting breast carcinoma in gynecologic practices remains controversial. Fourty-five breast carcinomas were detected in 8757 patients, using a combination of physical examination, mammography, thermography, and fine-needle aspiration. The sensitivity of each modality is as follows: physical examination, 62.2%; mammography, 63.2%; thermography, 75.6%; and fine-needle aspiration biopsy, 93.7%. Review of the current literature reveals a lack of agreement concerning the indications and the recommended frequency of use of each type of examination. Because of inaccuracies in each technique, a multimodal approach is indicated for the earliest detection of breast carcinoma.

Adult↗