[Good rules for cervical cytologic sampling].

P R Broso; C Garrone

Home/Archive/PubMed

PubMed · 9463179

[Good rules for cervical cytologic sampling].

P R Broso·C Garrone

View original source ↗Export metadata ↓

Abstract

There are still many little problems concerning methods about cervical cytology sampling. Are there some risks of teaching Papanicolaou smear technique? In which day of the cycle is it better to do sampling? How long in advance is it better to avoid sexual relations, and do not use any vaginal douching? Is it better to remove in advance cervical mucus? When should the sampling be done if the colposcopy is made in the same time? How should you behave if the cervix is not exposed? How many slides have to be spreaded? Which is better, the fixation with alcohol or aerosol? Where should the sampling be repeated? Is the patient anamnesis reliable? What should it mean the presence of some parasites and some foreign bodies manifested on the slide? Different answers have been given to reply to these questions and to some others. Smear's collecting is a simple method, but it needs an exact manual skill and an adherence to some precise rules. A relevant part of the final result depends how sampling has be done. Improvements must be done in every link of chain events.

Explore related subjects

Colposcopy Female Humans Methods Papanicolaou Test Time Factors Vaginal Smears English Abstract Journal Article Review

Keep this discovery

Explore connections, maps & timelines

BibTeX RIS

P R Broso, C Garrone. 1997. [Good rules for cervical cytologic sampling].. https://pubmed.ncbi.nlm.nih.gov/9463179/

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

KEEP EXPLORING

Related citations

PubMed2002

Cost-effectiveness of alternative triage strategies for atypical squamous cells of undetermined significance.

CONTEXT: Every year approximately 2 million US women are diagnosed as having a cervical cytological result of atypical squamous cells of undetermined significance (ASC-US). OBJECTIVE: To determine the most efficient and cost-effective management strategy for women in the United States diagnosed as having ASC-US. DESIGN AND SETTING: Cost-effectiveness analysis of data from clinical trials, prospective studies, and other published literature. A computer-based model was used to compare 4 management strategies for a cytological result of ASC-US: immediate colposcopy; human papillomavirus (HPV) triage, which includes colposcopy if high-risk HPV types are detected; repeat cytology, which includes follow-up cytology at 6 and 12 months and referral for colposcopy if a repeat abnormal result occurs; and reclassifying ASC-US as normal in which a cytological result of ASC-US is ignored. Reflex HPV DNA testing uses either residual liquid-based cytological specimens or samples co-collected at the time of the initial screening for conventional cytology. Another method, referred to as the 2-visit HPV DNA triage, requires a woman with an ASC-US result to return within 1 month to provide another speciman sample. MAIN OUTCOME MEASURES: Years of life saved (YLS), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. RESULTS: The least costly strategy for biennial screening was to reclassify ASC-US as normal, resulting in a reduction in total cancer incidence of 75% for conventional cytology and 84% for liquid-based cytology compared with no screening. The next least costly strategy was HPV DNA testing resulting in a reduction in total cancer incidence of 86% for conventional cytology and 90% for liquid-based cytology, followed by immediate colposcopy with a reduction of 87% and 91%, respectively. Compared with reflex HPV DNA testing, a strategy of repeat cervical cytology or delayed HPV testing costs more but is less effective. When all strategies were compared simultaneously, varying frequency and type of cytological test, biennial (vs every 3 years) liquid-based cytology with reflex HPV testing had a cost of $174 200 per YLS. In a similar comparison, liquid-based cytology with reflex HPV testing conducted every 3 years (vs every 5 years) had a cost of $59 600 per YLS and was more effective and less costly than a strategy of conventional cytology incorporating repeat cytology or immediate colposcopy conducted biennially. CONCLUSION: Reflex HPV DNA testing provides the same or greater life expectancy benefits and is more cost-effective than other management strategies for women diagnosed as having ASC-US.

Colposcopy↗

PubMed2002

Can cervicography be improved? An evaluation with arbitrated cervicography interpretations.

OBJECTIVE: The purpose of this study was to estimate the optimal performance of cervicography. We compared an arbitrated cervigram classification with an arbitrated referent diagnosis of cervical neoplasia. STUDY DESIGN: From an initial group of 8460 women, a stratified sample of cervigrams from 3645 women and histologic information from 414 women underwent arbitration. Interobserver agreement was assessed for cervicography and the referent diagnosis. Sensitivity, specificity, and predictive values were estimated for initial and arbitrated cervicography results, compared with the initial and arbitrated referent diagnoses. RESULTS: For the detection of arbitrated high-grade lesions or cancer, arbitrated cervicography yielded an overall sensitivity of 63.9% and a specificity of 93.7%. Significantly higher sensitivity was associated with younger age and age-related visual characteristics. CONCLUSION: Optimization of the cervigram classification improved performance over a single interpretation in this population but suggested the limits of static visual screening.

Colposcopy↗

PubMed2002

Teaching residents humanistic skills in a colposcopy clinic.

OBJECTIVE: The aim of this project is to add formal training and evaluation of humanistic skills for residents in a colposcopy clinic. Medical education of residents in office procedures has generally focused on proficiency in a particular technical skill and acquisition of clinical knowledge regarding management options. The literature supports assessing pattern recognition with visual images and observing a specific number of procedures to achieve proficiency. Little attention has been given to training residents to demonstrate sensitivity during procedures. However, we believe this is a key element, as the procedure involves anxious patients who are fearful of cancer and fearful of pain in their most private body parts. Further, women who have painful or unpleasant colposcopy procedures are less likely to follow up for further evaluation of treatment and may be at higher risk to develop cervical cancer. DESCRIPTION: Colposcopy training for gynecology residents, family medicine residents, medical students, and emergency room sexual assault nurses is provided at a colposcopy clinic that performs more than 400 procedures per year. The majority of women are referred for colposcopy from outside clinics, and more than one third are non-English-speaking. We have added to our traditional didactics and case instruction curriculum a session dedicated to training residents in humanistic skills related to performing colposcopy. Topics of discussion include (1) how to ask sensitive questions regarding risk factors for cervical dysplasia, (2) how to explain the procedure and obtain consent, especially with non-English-speaking women, (3) how to educate patients about human papilloma virus (HPV) and prevention of cervical cancer, (4) how to speak to the patient and the attending physician during the procedure to reduce rather than increase anxiety, (5) how to provide comfort measures during colposcopy (e.g., using a warm speculum, using local anesthesia, hiding instruments from patient view), and (6) how to review findings during and after procedures. The discussion includes errors that previous residents have made and approaches that create effective, culturally sensitive role models. The training session participants are given feedback regarding statements or actions that may make patients anxious or less comfortable during and following clinical procedures. Residents are evaluated at the end of each rotation by faculty who rate their technical skills, visual pattern recognition, knowledge on the subject, and humanistic qualities. DISCUSSION: The training session participants have responded favorably to feedback about observed interactions with patients during procedures. Indications are that this training may improve the quality of care given by providers during colposcopy and other sensitive procedures. To document the curriculum's effect on patient satisfaction and care, we plan to pilot the use of a patient survey regarding physicians' humanistic qualities.

Colposcopy↗