PubMed Health⌕ Search
Home/Archive/PubMed

PubMed · 12523612

Intracervical sonographic-pathologic correlation: preliminary results.

Theodore J Dubinsky·Susan D Reed·Verena Grieco·Michael L Richardson
View original source ↗Export metadata ↓

Abstract

OBJECTIVE: To determine whether current-generation endoluminal ultrasonic transducer technology could visualize dysplastic and malignant cervical lesions. METHODS: Inclusion criteria for patients enlisted in the study were abnormal Papanicolaou test results, an abnormality seen at colposcopy, and consent for a cone biopsy. In addition, we included 4 women who were undergoing hysterectomy but had no evidence of cervical abnormalities at the time of surgery, for a total of 28 women. We used a 20-MHz annular array intravascular transducer. We correlated all sonographic and pathologic results with regard to being normal or abnormal using the Pearson product moment correlation coefficient, and we evaluated interobserver variation by having 5 blinded sonologists interpret each examination and calculating kappa statistics. RESULTS: We performed intracervical sonography on 24 women with abnormal Papanicolaou test results and on 4 women without abnormalities. Nineteen of the 24 women with proven disease had abnormal sonographic images. Five women with pathologically proven cervical intraepithelial neoplasia I had normal sonographic images. Lesions ranged in size from 0.3 to 7 mm. Two carcinomas (5 and 7 mm diameter), multiple nabothian cysts, cervicitis, and 2 giant cell foreign body reactions were visible on sonography. The correlation coefficient for abnormal sonographic and pathologic findings was 0.87 (P < .005). We obtained a kappa value of 0.75 for interobserver variation. CONCLUSIONS: Intracervical sonography was able to visualize dysplastic lesions and carcinomas as hypoechoic defects with surrounding echogenic areas of glandular cervical mucosa. Lesions were shown with sufficient resolution and interobserver variation to suggest that the technique may be clinically applicable, particularly for planning surgical therapy. However, design of a transducer that can be easily sterilized between examinations, similar to current endovaginal probes, would be necessary to make intracervical sonography a clinically feasible examination.

Explore related subjects

ColposcopyFemaleHumansImage Processing, Computer-AssistedObserver VariationPapanicolaou TestTransducersUltrasonographyUterine Cervical NeoplasmsVaginal SmearsUterine Cervical DysplasiaJournal Article

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

Theodore J Dubinsky, Susan D Reed, Verena Grieco, Michael L Richardson. 2003. Intracervical sonographic-pathologic correlation: preliminary results.. https://doi.org/10.7863/jum.2003.22.1.61

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

PubMed2007

Which questionnaire? A psychometric evaluation of three patient-based outcome measures used to assess surgery for stress urinary incontinence.

AIMS: The aim of the study was to further validate three patient-based outcome measures (PBOM) used to assess the outcome of surgery for stress urinary incontinence and to compare their psychometric properties with a view to determining the most appropriate measure for clinical use. METHODS: The work was embedded within a randomized controlled trial of laparoscopic and open colposuspension. The trial recruited 291 women from six centers. The three instruments compared were Bristol Female Lower Urinary Tract Symptom Questionnaire (BFLUTS), Kings Health Questionnaire (KHQ), and the Symptom Severity Index and Symptom Impact Index (SSI/SII). The International Consultation on Incontinence (ICI) ABC grading system of psychometric propertie's reliability, validity, and responsiveness was used to evaluate the instruments. RESULTS: From the analysis of the psychometric properties of the three instruments, the SSI/SII appeared to have the best psychometric profile; Grade A, BFLUTS was of grade A, and KHQ was of grade B. SSI/SII had a good degree of internal consistency (Cronbach's alpha 0.74-0.78). BFLUTS and KHQ both had domains in which the internal consistency was <0.7. The SSI domain of the SSI/SII was the only domain to correlate to the 1-hr pad test. All domains of the SSI/SII were able to distinguish those cured from not cured and it was most responsive to change. Unlike the KHQ, the SSI/SII had no significant ceiling or floor effects. CONCLUSIONS: This study has demonstrated that when instruments are used in different populations their psychometric properties may change. All three instruments analyzed had limitations when used as an outcome measure for surgery for stress urinary incontinence.

Colposcopy↗
PubMed2006

Cervical cytology of atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion (ASC-H): characteristics and histologic outcomes.

BACKGROUND: The 2001 Bethesda System category of atypical squamous cells (ASC) denotes changes suggestive, but inconclusive for, a squamous intraepithelial lesion (SIL). ASC is subcategorized as: 1) "undetermined significance (ASC-US)," when changes suggest low-grade or indeterminate-grade SIL and 2) "cannot exclude high-grade squamous intraepithelial lesion (ASC-H)," when a cancer precursor is suspected. METHODS: To better define the characteristics of ASC-H, the authors analyzed and compared human papillomavirus (HPV) testing data and outcomes after 2 years for participants in the Atypical Squamous Cells of Undetermined Significance Low-Grade SIL Triage Study (ALTS), a randomized trial of 5060 women. RESULTS: Among women with thin-layer cytology findings of ASC-H, 84% tested positive for HPV, 50% (95% confidence interval [95% CI], 41%-60%) were diagnosed with cervical intraepithelial neoplasia (CIN) type 2+, and 30% (95% CI, 22-39%) were diagnosed with CIN3+. Positive HPV tests and diagnoses of CIN2+ and CIN3+ were found to be more common among women with ASCH compared with those with ASC-US, but the highest frequencies were found to be associated with high-grade SIL. For women age < 35 years with ASC-H, HPV detection exceeded 85%, whereas only 4 of 10 women (40%) age >/=35 years tested positive for HPV (P = 0.009). CONCLUSIONS: A finding of ASC-H seems to confer a substantially higher risk for CIN2+ and CIN3+ than ASC-US. Immediate colposcopy may be the appropriate management for young women with ASC-H, but the utility of HPV testing for managing older women with ASC-H requires additional study.

Colposcopy↗
PubMed2006

The up-to-date evidence on colposcopy practice and treatment of cervical intraepithelial neoplasia: the Cochrane colposcopy & cervical cytopathology collaborative group (C5 group) approach.

This overview presents the up-to-date evidence on colposcopy practice and other diagnostic modalities such as HPV DNA test and cytology for cervical intraepithelial neoplasia (CIN). Current evidence supports the use of colposcopy for the detection of intraepithelial lesions as a second line tool. CIN treatment involves either excisional or destructive techniques, usually performed under local anesthesia. Although a debate exists about the most efficient approach, the currently available evidence reveals no differences in efficacy among the available conservative methods of treatment. New evidence supports treatment by destructive rather than excisional techniques, at least for low grade lesions in women wishing future childbearing, as they appear to have no apparent pregnancy-related morbidity. Treatment failures rates might increase in cases of involved excision margins, older age or glandular involvement. There is no worldwide consensus on the optimal follow-up policy, interventions or frequency in surveillance after treatment. HPV DNA test combined with either colposcopy or cytology is a promising combination for the early detection of treatment failures due to residual disease. Existing guidelines should probably be updated incorporating the new information emerged from recently published work.

Colposcopy↗