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At least 19 recordsLinked to original sources
PubMed1989

[Assessment of human papilloma virus colposcopic findings of the cervix (in the Italian colposcopic classification].

HPV-induced flat condylomatosis is not only much more frequently observed on the hexocervix than the florid type, but it also induces colposcopic changes in the epithelium without completely altering its morphology. HPV-induced changes have now been largely identified and are recognisable in colposcopy. They can therefore be classified in the various patterns that characterise colposcopically the transformation epithelium, with undeniable advantages not only from the point of view of their correct classification but also from that of their prognostic evaluation. This is important because viral modifications ANTZ have a different diagnostic and prognostic significance from those observable in the notice squamous epithelium. A classification proposal of the various findings of flat HPV condylomatosis based on italian colposcopic classification is therefore presented.

Colposcopy↗
PubMed1976

Colposcopic evaluation of patients with abnormal cytologic smears during pregnancy.

One-hundred thirty-two patients with abnormal Papanicolaou smears of the cervix uteri during pregnancy underwent colposcopic evaluation. Seventy-five patients had biopsies during pregnancy, and 34 patients had colposcopic evaluation without performing any biopsy. Postpartum colposcopic evaluation was performed on 95 patients. In 93 patients of this group, the postpartum cytologic and histologic information obtained was the same or less than that obtained in antepartum evaluation. In only 1 case, antepartum colposcopically guided biopsy at 38 weeks' gestation revealed moderate dysplasia, and postpartum cold conization showed carcinoma in situ. In another case, colposcopic evaluation and biopsy during pregnancy showed mild dysplasia while colposcopic biopsy as well as examination of a hysterectomy specimen taken at 16 months after delivery revealed severe dysplasia. No case of invasive carcinoma was missed during pregnancy. The results of this study, in support of previous reports, show that colposcopic evaluation is a simple, safe, and accurate method of investigating abnormal Papanicolaou smears during pregnancy.

Adolescent↗
PubMed1989

Comparison of repeat smear, colposcopy, and colposcopically directed biopsy in the evaluation of the mildly abnormal smear.

Repeat smear, colposcopy, and colposcopically directed biopsy were performed in 161 patients referred to our department because of a Pap smear showing mild dysplasia (CIN 1). Colposcopically directed biopsies revealed the presence of CIN of different grades in 61 cases (37.5%). In 33 (20.4%) the CIN grade found at biopsy was higher than 1. Repeat smear confirmed the presence of CIN 1 in 67 women (47.2%). In this group of patients colposcopically directed biopsies showed a CIN grade greater than 1 in 12 cases (17.9%). The repeat smear was negative in 59 patients (41.5%). In this group, biopsy showed varying grades of neoplasia in 12 cases. Colposcopic examination indicated no dysplasia but the presence of minor cervical abnormalities in 76 women (47.2%): at biopsy a CIN grade higher than 1 was found in 9 cases (11.5%). These data suggest that the mildly atypical smear identifies a group of patients at increased risk of CIN but gives little or no information on the disease severity. Repeat smear and colposcopic examination alone appear inadequate to demonstrate the severity of the cervical lesion. Due to the high proportion of CIN 2 and 3 in patients with a mildly abnormal smear, the systematic biopsy of any colposcopically abnormal area seems essential to proper management of the patient.

Adult↗
PubMed1991

A quality-control program for colposcopic practice.

Quality control is accepted as an integral part of the cytology laboratory's activities. However, provision of similar safeguards for colposcopic practice in assessing patients with abnormal cervical cytology has been an elusive problem. This report describes the quality-control program for colposcopy that is used province-wide in British Columbia for 21 hospital-based clinics staffed by 35 colposcopists. Copies of the results of all colposcopic examinations performed are sent to the Central Cytology Laboratory where the program is coordinated and the data are collated, analyzed, and evaluated. These data are used to set standards against which each colposcopist's performance and activity can be measured. One of the quality-control indicators used is a comparison between the colposcopic impression of the lesion and the corresponding direct biopsy diagnosis. Correlation within one histologic degree occurred in 86% of patients examined; this information was used to set a performance standard of 80% as the quality-control index for this particular indicator. Three colposcopists had scores below this standard. Comparisons were also made between presenting cytology, directed biopsy results, initial colposcopic impression, and final colposcopic evaluation (the clinical working diagnosis). The other major aspect of the quality-control program consists of an analysis of all cases of diagnosed invasive cervical cancer in the province in a given year to determine whether any colposcopically related errors occurred in the investigation and management of these cases. This system helps to identify individuals who may benefit from additional training.

Biopsy↗
PubMed1991

Colposcopes: a critical review.

A multidimensional professional team consisting of a practicing colposcopist, a mechanical engineer, and a medical photographer independently critically evaluated the features of selected colposcopes. Qualitative observations and quantitative measurements were performed on 13 colposcopes representing eight manufacturers and distributors. Optical characteristics, ocular system operation, mobility and stability, relative ease of use, component characteristics, space for instrumentation, and visual illumination, uniformity, and color were comparatively assessed. The specific colposcope information provided may benefit practicing physicians or novice colposcopists who are contemplating purchasing a colposcope. The presented framework of critical feature evaluation may also facilitate the informed selection of other colposcopes not included in this selective, critical, comprehensive review.

Colposcopes↗
PubMed1991

Colposcopic analysis of genital human papillomavirus infections during an 8-year prospective follow-up.

A long-term prospective follow-up program has been conducted for genital human papillomavirus (HPV) infections in 532 women in Kuopio since 1981. By regular examinations (at 6-month intervals) using colposcopy, cytology and/or punch biopsy, 426 of these women have been followed up for the minimum of 48 months (mean 71 +/- 19 months). These 426 women were included in the present report. The colposcopic data of all women at the first and the latest visits were recorded from the colpophotographs, analysed and correlated with cytology, histology, HPV DNA detection and clinical behavior (i.e. prognosis) of the disease. Colposcopic abnormalities were found in 313 (73.5%) women at the first visit and in 138 (32.4%) patients at the latest visit. HPV infections were diagnosed in 368 (86.4%) women at the first visit and in 75 (17.9%) at the latest visit on light microscopy (i.e. biopsy and/or PAP smear). CIN was found in 54.7% of the women at the first visit. HPV DNA was detected by in situ hybridization in 38.2% of the biopsies assayed. Colposcopical multicentric lesions were found in one third of the women upon examination of the entire lower genital tract. The majority of the lesions were situated within the transformation zone. HPV infection and CIN were most frequently encountered in women with multiple lesions. Progression to CIN III was most frequent in large lesions (28.6%). No colposcopic pattern was able to distinguish HPV infections from CIN lesions, or predict the progression of the former. The results implicate that: (1) colposcopy is an essential method to disclose abnormalities due to CIN and HPV infections, but histological changes cannot be predicted on a single colposcopy; (2) HPV infection is a multicentric disease, making the careful examination of the entire lower genital tract mandatory on every colposcopy; and (3) the HPV progressors cannot be predicted on the basis of the colposcopic patterns.

Adult↗
PubMed1991

Histological differences between colposcopic-directed biopsy and loop excision of the transformation zone (LETZ): a cause for concern.

Colposcopic examination and biopsy were performed on 100 patients with abnormal cervical cytology. All were suitable for ablative therapy but were treated by loop excision of the transformation zone (LETZ) as outpatients. Histological comparison between the colposcopic biopsies and LETZ samples showed poor agreement with only 43% of cases illustrating identical degrees of dysplasia. The dysplasia was underestimated by colposcopic biopsy in 16% of cases and overestimated in 41% of cases, when compared to the LETZ specimen. Microinvasive carcinoma was diagnosed in 3 cases on the LETZ histology, having been missed by the preceding colposcopy and colposcopic biopsy. The disparity between histological findings is of great concern and would not have been detected if the patients were treated by ablative therapy. It is the authors' view that LETZ should replace ablative therapy in the treatment of localized cervical dysplasia and that it may avoid the need for pretreatment colposcopic biopsy. LETZ limits the possibility of inadequate treatment and also provides a method of audit for the colposcopist.

Adolescent↗
PubMed1985

Genital warts and cervical cancer. VII. An improved colposcopic index for differentiating benign papillomaviral infections from high-grade cervical intraepithelial neoplasia.

A new colposcopic sign (sharpness of peripheral margins) was graded into three objective categories representing subclinical papillomaviral infection, lower grade dysplasia, and grade 3 cervical intraepithelial neoplasia. Colposcopic features were prospectively recorded in 72 women and then correlated with histologic findings. Histologic diagnoses were evenly spread within the disease spectrum: 18 patients had subclinical papillomaviral infection without associated dysplasia; 15 had grade 1, 16 had grade 2, and 23 had grade 3 cervical intraepithelial neoplasia with or without koilocytotic atypia. Differences in the pattern of the peripheral margin were discriminatory throughout the entire diagnostic range. Predictive accuracy of this new colposcopic sign (79%) compared favorably with that of color (72%), vascular atypia (81%), and iodine staining (72%). Each criterion was independent of the other three. Hence, combining these four individual signs into a colposcopic index was 97% correct in forecasting approximate histologic findings. Because formulation of the colposcopic index is based on critical analysis rather than pattern recall, the use of this method will greatly simplify the otherwise arduous task of learning colposcopy.

Carcinoma in Situ↗
PubMed1990

Use of the colposcope in childhood sexual abuse examinations.

The addition of the colposcope to the armamentarium of the medical investigator of childhood sexual abuse has many advantages. The ability to accurately record anatomic findings has implications for the medical community, the judicial system, the accused, the victim, and the family. Through the use of the photographs produced by this instrument, examiners can inspect physical findings without the time constraints imposed by the short attention span of the young child. If necessary, colleagues can be consulted and interpretations discussed. The availability of these photographs to the courts has reduced the need to re-examine the child for another opinion. The colposcopic photograph has also proved to be an excellent teaching and research tool. As an aid to teaching, the photographs and slides produced by this instrument help the instructor demonstrate anatomic findings while allowing the student time to ask questions. As a research tool, this instrument has opened up a myriad of possibilities for medical examiners. It has facilitated the collection of clinical data, it has allowed the standardization of examination techniques, and with the help of computers it has made possible the sophisticated analysis of the information collected. The colposcope has limitations. Aside from its cost, it is a difficult instrument to use in the examination of the young child. The time required for an examination can increase substantially as the examiner attempts to maneuver the scope into a proper position. During this procedure, the maintenance of the child in a suitable state of relaxation, while avoiding further emotional trauma, can be a challenge. The reality that the photograph is two dimensional and represents only the findings at that moment will always be a limiting factor in its use as a means of assessing a child's anatomy. Even the multimethod approach employed to offset this problem may compound the situation by further increasing the length of the examination. Most of these and other dilemmas encountered in the use of the colposcope can be solved by additional experience with this instrument. Despite the improvements brought about by the introduction of the colposcope, more advanced technology may be needed to help solve some of the problems currently plaguing medical examiners. The use of video tape could provide a solution to the documentation of the changes that occur in the soft tissues as the child moves or becomes more or less relaxed. The potential of the computer appears unlimited, and its application to the problem of the interpretation of findings could make a significant contribution to the field.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1976

Colposcopic evaluation of patients with abnormal cervical cytology.

Because of suspicious or abnormal smears, 620 patients were referred to the Colposcopy Clinic of the British Columbia Cancer Institute between 1st March 1973 and 31st December 1974; it was possible to make a colposcopic examination in 549 of these patients (88.5 per cent). The colposcopic impression was within one histological grade of a colposcopically-directed biopsy in 476 patients (86 per cent). There were 221 patients who had a cone biopsy after a colposcopically-directed biopsy and in 192 of these (87 per cent) the two biopsies were within one histological grade of each other; but there were two patients with occult invasive carcinoma in a cone biopsy and only carcinoma in situ in a directed biopsy. In the same group of 221 patients the colposcopic evaluation and final diagnosis (the most advanced histological lesion seen in biopsy) agreed in all but seven patients.

Adult↗
PubMed1975

[Therapeutic results of colposcopically controled collection of cervix tissue in atypical smears of women up to the age of 35 years].

The case series consists of 106 women consecutively collected during 1968 to 1973 from those with a vaginal smear belonging to Papanicolou's groups III and attending the gynaecological department in Umeå. Probably the series is a fair random sample of the population (congruent to 150,000 people) of the area served by the clinic. The extension of the colposcopically delimited atypical transformation zone (with its upper bordèrline against normal cervical villi) in most cases being small, the surgical procedure--a small cone congruet to ring biopsy--was accordingly insignificant. In 9 cases only a large conization was performed. As only a small part of the cervical tissue was usually removed it is probable that the enzymatic and mechanical properties of the cervix as well as its capacity as a sperm reservoir could be preserved. The median of the observation time is 26 months, range 3 months to 5 years. At the follow up the colposcopic and histological picture has so far shown no sign of atypia in 91 subjects. The same applies cytologically to the patients subjected to a large conization. Two women have moved away from the district. A relapse occurred in 4 patients, who after a large conization have remained cytologically negative. Throughout the investigation the term a typia has been used to characterize the cytological, colposcopic and histological changes, the degree and extension of this atypia being taken into considertion. Thus the abstruse nomenclature in common use is avoided. Cytological atypia is cellular in character, while histologically it includes the degree of structural derangement of the epithelial architecture as well. Colposcopically the angioarchitecture and the capillary distance seem to be the most important features. The correlation between the colposcopic and the cytological and histological findings is high when the degree of atypia is marked. It is inferred, therefore, that the descriptive term atypia should replace the superfluos bulk of terms in the fields in question.

Colposcopy↗
PubMedDate not supplied

Improving the sensitivity of cervical cytologic screening. A comparison of duplicate smears and colposcopic examination of patients with cytologic inflammatory epithelial changes.

During a ten-month period, 264 cervical cytologic specimens were submitted in duplicate to two separate cytology laboratories. An attempt was made to perform colposcopy on all 45 patients reported as having an abnormality by either laboratory. All but one patient with a cytologic diagnosis of cervical intraepithelial neoplasia (CIN) underwent colposcopy, as did 68% of the patients with a diagnosis of nondysplastic atypia (inflammatory epithelial changes [IEC]). Five cases of histologically verified CIN were found by colposcopic study of patients with a cytologic diagnosis of CIN; two additional cases were found by colposcopic study of patients with a cytologic diagnosis of IEC. On the assumption that patients not colposcoped were not systematically different from the others with IEC, the screening sensitivities for both laboratories and for cytology followed by colposcopy of IEC cases were estimated. A statistically significant improvement in screening sensitivity was achieved by colposcopic examination of patients with IEC. This conclusion was tempered by a Bayesian analysis that suggested that some of the apparent improved sensitivity could be due to falsely positive biopsy reports. Despite potential benefits, it is premature to recommend universal colposcopic examination of patients with cytologic reports of inflammatory epithelial changes.

Cervix Uteri↗
PubMed1979

Evaluation of colposcopic accuracy without endocervical curettage.

A study was undertaken to evaluate the accuracy of colposcopic examination when performed without the use of endocervical curettage. It included 763 cases of suspected cervical-vaginal pathology. An additional evaluation of colposcopic accuracy was made for special-case categories of 1) stromal invasion, 2) pregnancy, 3) menopause, and 4) diethylstilbestrol (DES) exposure. Colposcopic accuracy was determined by cytologic and histologic material obtained either at the initial colposcopic evaluation or during follow-up surgery. With the literature as a standard for accuracy, it was concluded that the omission of endocervical curettage from the colposcopic examination did not reduce accuracy. In addition, the diagnostic conization rate was lower than in most reported series. Finally, the rate of missed invasive lesions was not increased by the omission of endocervical curettage.

Adolescent↗
PubMed1977

Colposcopic evaluation of patients with abnormal cervical cytology.

A total of 1580 new patients underwent colposcopic evalution in the Dysplasia Clinic at Nassau County Medical Center. Of these patients, 186 had abnormal Papanicolaou smears associated with pregnancy, 150 were referred because of in utero exposure to diethylstilbestrol, and 1244 were referred because of abnormal cervical cytologic smear or suspicious cervical or vaginal lesion. Further analysis of this latter group revealed that 1184 (95%) patients had satisfactory colposcopic evaluation, and directed biopsy showed the following: 10 cases of invasive cervical carcinoma, 9 of carcinoma in situ with microinvasion, 118 of cervical carcinoma in situ, 110 of severe dysplasia, and 424 cases of mild to moderate cervical dysplasia. All of these patients subsequently were treated accordingly. Evaluation of final histologic specimen revealed a very high correlation with colposcopically guided biopsies. In 54 patients, where colposcopic evaluation was unsatisfactory, diagnostic cold knife conization was performed. Final histologic diagnosis disclosed a more advanced lesion in 30 patients (or 56%) of this group. The result of this study shows that satisfactory colposcopic evaluation is a highly accurate method of evaluation of abnormal cervical and vaginal cytologic smear.

Adolescent↗
PubMed1989

Child sexual abuse--genital tract findings in prepubertal girls. II. Comparison of colposcopic and unaided examinations.

In recent years the inspection of the vulva of sexually abused girls by magnification with a colposcope has become increasingly popular. However, data concerning the usefulness of colposcopy in such evaluations are lacking. In a prospective study, 130 prepubertal girls (mean age 5.5 years) who were identified by child protective agencies to be victims of sexual abuse were evaluated both by an unaided examination and by colposcopy. If the colposcopic findings differed from those of the unaided inspection, the macroscopic examination was repeated to determine whether the abnormality could have been detected without magnification. Altogether, 92 of the 130 girls were found to have abnormal findings. In the majority of girls with abnormalities (96%), the abnormalities were observed during the unaided examination. Of the four patients in whom the findings were detected initially by the colposcopic examination, these findings were observed during the repeat unaided examination. The findings were observed by colposcopic examination alone in only one patient. We conclude that unaided examination is adequate for the evaluation of most victims of sexual abuse.

Child↗
PubMed1987

Colposcopic correlates of cervical papillomavirus infection.

We compared the colposcopic and histologic features of 39 papillomavirus-related cervical lesions with their associated human papillomavirus type. Two thirds of the lesions contained human papillomavirus type 16-related deoxyribonucleic acid, and 69% of them were classified as cervical intraepithelial neoplasia I or II, in contrast to 92% of lesions containing human papillomavirus 6/11 deoxyribonucleic acid. On histologic examination, low-grade cervical intraepithelial neoplastic lesions tended to be sharply demarcated and have an uneven or granular surface contour. In contrast, high-grade lesions often had diffuse borders and were usually smooth in appearance. Both low- and high-grade lesions displayed variable degrees of whiteness, thickness, and papillomatous configurations. Patterns of coarse punctuation were more common in higher grade cervical intraepithelial neoplastic lesions and in those containing human papillomavirus 16. Predictably, the colposcopic features of lesions containing human papillomavirus 6/11 deoxyribonucleic acid sequences compared closely with those of low-grade cervical intraepithelial neoplasia. In contrast, human papillomavirus 16-associated cervical intraepithelial neoplasia exhibited a greater spectrum of colposcopic patterns, including those associated with condyloma and low- and high-grade cervical intraepithelial neoplastic lesions. We conclude that, although a portion of low- and high-grade cervical intraepithelial neoplastic lesions can be distinguished colposcopically, a significant number of lesions containing features of low-grade cervical intraepithelial neoplasia or condyloma contain human papillomavirus 16 deoxyribonucleic acid and cannot be distinguished from presumably innocuous human papillomavirus infections.

Adult↗
PubMed1989

Cervical intraepithelial neoplasia in lymphoma patients: a cytological and colposcopic study.

Twenty-seven patients with Hodgkin's (n = 19) and non-Hodgkin's (n = 8) lymphomas underwent cytological and colposcopic screening of the uterine cervix. Colposcopically directed cervical punch biopsies were taken from all patients in whom a colposcopic abnormality was detected. Lymphoma patients were compared with 79 controls with normal cervical cytology and no known haematological abnormality. Colposcopically directed punch biopsies were taken from the cervical transformation zone of all controls. Significantly more lymphoma patients (19%) than controls (3%) had CIN II or III (P less than 0.01) and cervical human papillomavirus infection, as judged by the presence of koilocytes (52% of lymphoma patients; 27% of controls; P less than 0.02). All six lymphoma patients with CIN had Hodgkin's disease (HD), and five had received combination chemotherapy. Half of the cases of CIN in lymphoma patients and all the cases of CIN in control patients were not detected by cervical cytology. This study suggests that female patients with HD are at increased risk of CIN, and that cervical cytology alone may be an inadequate form of screening for these patients.

Adult↗