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At least 19 recordsLinked to original sources
PubMed2002

[A comparative study of digital colposcope and optical colposcope in the diagnosis of early lesions of uterine cervix].

OBJECTIVE: To evaluate the clinical value of domestically manufactured digital colposcope system (SLC-2000) in the detection of early cervical lesions. METHODS: During a follow-up study of patients in Xiangyuan county, Shanxi, a high risk area for cervical cancer, a digital colposcope and an optical colposcope were randomly used for diagnosis, with pathology as the gold standard. RESULTS: In 163 cervical biopsy specimens, 103 were diagnosed as chronic inflammation by histologic examination. Among 60 specimens which gave abnormal pathology, there were papilloma 1, cervical intra-epithelial neoplasia (CIN) I 37, CIN II 18 and CIN III 4. In 33 endocervical curettage specimens, 3 were pathologically positive. Comparing the digital and optical colposcope in diagnosing the positive lesions of > or = CIN I, the sensitivity of the former and latter were 83.3% and 95.0%, the difference without being statistically significant (P = 0.075). The specificity, positive predictive value, and accuracy of these two instruments were 61.2%, 21.4%, 55.6% and 41.3%, 69.3% 48.5%, with significant difference (P = 0.000, P = 0.035, and P = 0.000). In diagnosing > or = CIN II cervical lesions, these three results of the two instruments did not show any significant difference either. The negative predictive value of the digital and optical colposcope were 86.3% and 88.0%, also showing no significant difference (P = 0.075). CONCLUSION: The specificity, positive predictive value, and accuracy of the digital colposcope in diagnosing cervical lesions > or = CIN I are all superior to those of the traditional optical colposcope, even though the sensitivity of the latter is higher. There is no difference between the two instruments in diagnosing lesions > or = CIN II. Not only is domestic digital colposcope (SLC-2000) effective, but feasible and practical in the diagnosis, research and follow-up of cervical lesions.

Colposcopes↗
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↗
PubMed1998

Colposcopic appearance of cervical intraepithelial neoplasia is age dependent.

OBJECTIVE: We investigated to determine whether colposcopic, histologic, and virologic parameters of cervical intraepithelial neoplasia are influenced by a patient's age. STUDY DESIGN: A cohort of 967 women with a mean age of 37.1 years underwent screening for detection of cervical intraepithelial neoplasia by colposcopy, cytologic examination, and testing for high-risk human papillomaviruses with the Hybrid Capture System (Digene, Silver Springs, Md) and a general primer and type-specific primer polymerase chain reaction system. Cervicography was used for documentation and reproducible evaluation of the colposcopic appearance of the cervix. In 86% of patients with trivial colposcopic changes of doubtful significance (100/116) and 89% of patients with colposcopic changes consistent with cervical intraepithelial neoplasia (89/99), punch biopsy specimens were taken for histologic evaluation. RESULTS: In patients with trivial colposcopic changes of doubtful significance, histologically confirmed cervical intraepithelial neoplasia was almost as frequent (32%, 37/116) as in patients with colposcopic changes consistent with cervical intraepithelial neoplasia (43%, 43/99, difference not significant). The ratio between colposcopic evidence of cervical intraepithelial neoplasia and trivial colposcopic changes was 1.9 in patients <35 years old with cervical intraepithelial neoplasia, versus 0.5 in patients >/=35 years old with cervical intra-epithelial neoplasia (P =.005). Patients with trivial colposcopic changes of doubtful significance were older (median age 36 years) than were patients with colposcopic changes consistent with cervical intraepithelial neoplasia (median age 29 years, P =. 008). In patients with cervical intraepithelial neoplasia who had no or trivial colposcopic changes, the thickness of neoplastic epithelium was smaller (P =.008) and the number of cellular layers was lower (P =.01) than in patients with cervical intraepithelial neoplasia who had colposcopic changes consistent with cervical intraepithelial neoplasia. In patients <35 years old the rate of positive results for a high-risk human papillomavirus (P <.005) and the viral load (difference not significant) were higher than in women >/=35 years old. The rate of positive results for high-risk human papillomaviruses differed independently of age among patients with normal colposcopic findings, patients with trivial colposcopic changes of doubtful significance, and patients with colposcopic changes consistent with cervical intraepithelial neoplasia (P <.005). CONCLUSIONS: In women >/=35 years old cervical lesions associated with intraepithelial neoplasia are thinner and thus less colposcopically conspicuous than those in women <35 years old. Patients >/=35 years old with acetowhite cervical lesions consistent with trivial changes of doubtful significance should therefore undergo punch biopsy for histologic evaluation.

Adolescent↗
PubMed1993

Colposcopic accuracy in a residency training program: defining competency and proficiency.

BACKGROUND: The determination of proficiency in procedural skills has evoked keen interest, but meaningful guidelines are limited by the absence of pertinent clinical data. Colposcopic accuracy is defined as the clinical correlation between a colposcopic impression and a histologic report. The colposcopic accuracy of physicians in a university-based family practice residency colposcopy program was evaluated. METHODS: Demographic information, clinical findings, and laboratory results of patients evaluated by colposcopy were prospectively recorded. Colposcopic accuracy was calculated based on the agreement of the colposcopic impression with the histologic interpretation within one histologic grade. RESULTS: Colposcopic examinations were performed on 282 patients. Histologic evidence of premalignant cervical disease was identified in 115 patients as follows: mild dysplasia, 72; moderate dysplasia, 24; and severe dysplasia, 19. The colposcopic impression agreed within one histologic grade in 188 of 205 patients for a colposcopic accuracy rate of 91.7% (95% CI = 87.1% to 95.1%). CONCLUSIONS: Given an acceptable latitude of clinical correlation between the colposcopic impression and histologic interpretation, the colposcopic accuracy of family physicians compared favorably with that reported by other colposcopists. The more common colposcopic errors were overestimation of low-grade disease and underestimation of high-grade disease. Colposcopic accuracy at an essential minimal proficiency level of 80% should form the basis for assessing specialized perceptual ability and therefore determining colposcopic competency.

Adolescent↗
PubMed2000

Self-reported desire to improve colposcopic impressions.

BACKGROUND: Women who participate in cervical cancer screening programs must have access to high quality colposcopy services when their cytology test are abnormal. The purpose of this project is to evaluate colposcopic services currently available in New Hampshire and whether colposcopy providers are willing to network to maintain and improve their colposcopic pattern recognition skills in order to improve their colposcopic correlations. METHODS: A survey was mailed to 1314 providers throughout New Hampshire. The survey ascertained the extent of current colposcopic services in New Hampshire through practitioner and practice demographics, the cervical procedures performed, the self-reported colposcopy skill level, and the self-reported quality of past colposcopic education. It also measured interest in networking with others to improve their colposcopic pattern recognition skills. RESULTS: The survey response rate was 62%. 145 of the 810 respondents (18%) are currently performing colposcopies, indicating a statewide potential colposcopy accommodation rate of 3.5 to 7 women per month per colposcopist. 57% of the physician assistants, 59% of the family physicians, 75% of the gynecologists and 100% of the nurse practitioners were interested in enhancing their colposcopic pattern recognition skills by networking through quarterly meetings. CONCLUSIONS: The crude accommodation rate for colposcopy appears sufficient for the women of New Hampshire although the geographic distribution of the colposcopists is unknown. A majority of the colposcopists were interested in networking to improve their colposcopic pattern recognition skills, which could improve patient care.

Clinical Competence↗
PubMedDate not supplied

Is colposcopic biopsy overused among women with a cytological diagnosis of atypical squamous cells of undetermined significance (ASCUS)?

BACKGROUND: The diagnosis of atypical squamous cells of undetermined significance (ASCUS) during cervical screening indicates cellular abnormality but is not sufficient for a definitive diagnosis of a squamous intraepithelial lesion (SIL). Before the 2001 consensus guidelines for the management of women with cervical cytological abnormalities are introduced, follow-up management of ASCUS women by colposcopic biopsy is done at patient and physician discretion. METHODS: In this study, we examined variables associated with the method of follow-up (colposcopic biopsy, repeat Pap smear) in a sample of 651 women(ages 18-82 years) who were diagnosed with ASCUS and were then referred for either a colposcopic biopsy or a repeat Pap smear at their next follow-up appointment. RESULTS: In a multivariate logistic regression analysis (outcome variable = follow-up by colposcopic biopsy or by repeat Pap smear), we found that the odds of follow-up by colposcopic biopsy were 8-fold (OR 8.5, 95% CI 4.4-16.3) higher for high-income (>47,117 US dollars vs. <24,767 US dollars) women, 2-fold higher (OR 2.8, 95% CI 1.5-5.1 ) for women with private insurance (relative to Medicaid), and 3-fold higher (OR 3.1, 95% CI 1.3-7.4) for middle-aged women (ages 36-45 vs. > 55 y). CONCLUSIONS: In stratified analyses, we found that high income was positively associated with odds of colposcopic biopsy in all strata of health coverage and that among those in the highest income category, private insurance remained an indicator of colposcopic biopsy use. Our findings raise the possibility that among women with ASCUS, there is an overuse of colposcopic biopsy by high-income and privately insured women who are likely to be at low risk of cervical malignancies.

Adolescent↗
PubMed2001

The colposcopic impression. Is it influenced by the colposcopist's knowledge of the findings on the referral Papanicolaou smear?

OBJECTIVE: To determine whether the colposcopic impression is influenced by the colposcopist's knowledge of the referral Papanicolaou smear. STUDY DESIGN: Using a community hospital database, the accuracy of the colposcopic impression (accuracy = proportion of women with histology greater than cervical intraepithelial neoplasia [CIN] 2 that have colposcopic impressions of greater than CIN 2) when referral smears were atypical squamous cells of uncertain significance (ASCUS), atypical glandular cells of uncertain significance (AGUS) or low grade squamous intraepithelial lesion (LSIL) was compared to that when smears showed high grade squamous intraepithelial lesion (HSIL) or cancer. The analysis was repeated with a screening study database in which colposcopic impression was assigned without knowledge of the Papanicolaou smear. Univariate and logistic regression analysis of the second database determined the relative importance of size and grade of lesion and Papanicolaou result to the accuracy of the colposcopic impression. RESULTS: In the community database, colposcopic accuracy was 60/510 (12%) when smears were ASCUS, AGUS or LSIL and 77/132 (58%) when smears were HSIL or cancer (P < .001); in the second database, it was 2/19 (11%) when smears subsequently were reported as negative, ASCUS, AGUS or LSIL and 33/65 (54%) when smears were HSIL or cancer (P < .005). An accurate colposcopic impression was seen in 5/39 (13%) women with one-quadrant lesions, 8/18 (44%) with two-quadrant lesions and 23/27 (85%) with three- or four-quadrant lesions (P < .005). None of 19 women with smears reported as negative, ASCUS, AGUS or LSIL had lesions involving three or four quadrants of the cervix, while 27/65 (42%) women with smears reported as HSIL or cancer had such lesions (P < .005). With logistic regression, the more quadrants of the cervix involved, the more accurate the colposcopic impression. Once controlled for lesion size, there was no improvement when worst histologic grade or Papanicolaou smear result was considered. CONCLUSION: Through lesions greater than CIN 2 were more often overlooked when referral smears were negative, ASCUS, AGUS or LSIL than when they were HSIL or cancer, the real reason that the lesions were not detected by colposcopy was that they were small.

Clinical Competence↗
PubMed2004

Colposcopic proficiency-disease spectrum in a single family practice colposcopists' clinic.

PURPOSE: We sought to assess colposcopic proficiency in a family practice teaching clinic. METHODS: Subjects were a prospective cohort of women age 13 to 68 who were colposcopy clinic attendees from 1991 to 2002. Data recorded on each subject included demographic variables, sexual history, history of sexually transmitted diseases, reason for referral to colposcopy, Pap smear results, colposcopic impression, colposcopic biopsy results, and diagnoses. The Kappa statistic was used to measure agreement between clinical colposcopic assessment and biopsy results. RESULTS: Eight hundred twenty-six patients were enrolled. Compared to biopsy, colposcopic impression overall correctly predicted normal cervical biopsy in 55.8% (95% CI: 45.8%, 65.8%) of cases, and predicted abnormal biopsy 84.9% (95% CI: 81.6%, 88.1%) of the time. Colposcopic impression of low-grade squamous intraepithelial lesion (LSIL) correctly predicted LSIL on biopsy in 64.6% of cases, and correctly predicted the absence of LSIL 74.2% of the time. Colposcopic impression of high-grade squamous intraepithelial lesion (HSIL) correctly predicted biopsy results of HSIL in 70.05% of cases (Kappa = 0.544, P<.0001). There was a 12.7% error rate in discriminating normal from LSIL (Kappa -.258, with P<.0001). CONCLUSION: Family physicians perform colposcopy with good correlation between colposcopic impression and subsequent histology.

Adolescent↗
PubMed1984

Use of colposcopically directed, four-quadrant cervical biopsy by the colposcopy trainee.

Colposcopically directed cervical biopsies performed by experienced colposcopists have greatly reduced the need for conization of the cervix to evaluate patients with cervical intraepithelial neoplasia (CIN). Because of the subjectivity of the colposcopic technique and variable time required to become skilled, continued reliance on cervical conization is often recommended to validate colposcopic findings for novice colposcopists . We assessed the colposcopic skill of residents in training in obstetrics and gynecology who had received 9-12 months of instruction in colposcopic techniques. Biopsies of each quadrant of the ectocervix were done after the resident recorded his or her colposcopic diagnosis. In 26% of the patients there was overestimation or underestimation of the histologic findings by more than one grade in the cervical quadrant suspected on colposcopy to contain the most advanced CIN lesion. In 30% of patients the histologically most advanced CIN lesion was not identified by the colposcopist . In 11% of patients with histologic findings of CIN both cytology and colposcopy were negative. Only 69% of the histologically confirmed lesions were diagnosed colposcopically by the resident colposcopists . The four-quadrant, colposcopically directed biospy technique is recommended as an effective training method for the beginning colposcopist .

Adolescent↗
PubMed2006

Colposcopic accuracy of obstetrics and gynecology residents.

OBJECTIVE: The objective of our study was to determine the accuracy of gynecology residents' colposcopic impressions. METHODS: A retrospective review of colposcopic examinations was performed. Colposcopic impressions were compared to cervical biopsy and the results stratified by level of residency training. kappa Statistics were calculated to determine the strength of correlation between impression and biopsy results. RESULTS: Agreement within one-step between cervical histology and the colposcopic impression was found in 351 (77%) of the subjects. Histology impression agreement occurred in 92% of the nurse practitioner procedures, 77% of the second year resident (R2) cases, 75% of R3 colposcopies and 73% of the R4 procedures. The association between cervical biopsy and impression was highly significant (P<0.0001). However, the strength of the correlation was only slight (kappa=0.197). The kappa value was highest for the nurse practitioners (0.376, fair correlation) and lowest for the R3 residents (0.110, slight correlation). The positive predictive value for the association of any colposcopically detected abnormality with any histologic abnormality was 64.1%. The overall PPV was highest for the nurse practitioners (79.3%) and lowest for the R2 residents (58.7%). CONCLUSIONS: While the colposcopic impressions of gynecology residents were accurate, there was little difference in the accuracy of colposcopic assessment based upon the level of resident training.

Adolescent↗
PubMed2005

Interobserver agreement for colposcopy quality control using digitized colposcopic images during the ALTS trial.

OBJECTIVE: To estimate interobserver agreement among colposcopy quality control reviewers viewing digitized cervical images during the Atypical Squamous Cells of Undetermined Significance/Low-Grade Squamous Intraepithelial Lesion Triage Study (ALTS). MATERIALS AND METHODS: Three colposcopy quality control reviewers independently examined modem-transferred digitized colposcopic images from subjects examined at four clinical centers. Reviewers indicated colposcopic impression, Reid colposcopic index scores, lesion size, and the technical quality of the image. Rates of agreement were evaluated using the kappa statistic and McNemar and Bowker tests of symmetry. RESULTS: Regarding colposcopic impressions, the average weighted kappa for pairs of initial reviewers was 0.36 (95% confidence interval, 0.33-0.39). kappa scores with respect to Reid colposcopic index, cervical image quality, and lesion size ranged from 0.23 to 0.28, 0.18 to 0.27, and 0.33 to 0.42, respectively. CONCLUSIONS: Fair rates of agreement and poor to fair kappa scores among ALTS colposcopy quality control reviewers were noted for colposcopic impression, Reid colposcopic index scores, image quality, and lesion size. Great latitude exists in the interpretation of digitized cervical images. Poor image quality partially may explain these suboptimal results.

Cervix Uteri↗
PubMed2006

[The accuracy of diagnosing cervical intraepithelial neoplasia with colposcopically directed biopsy].

OBJECTIVE: To evaluate the accuracy of colposcopically directed biopsy in the diagnosis of cervical intraepithelial neoplasia (CIN). METHODS: The clinical data of 153 patients with CIN diagnosed by colposcopically directed biopsy and treated with cervical loop electrosurgical procedure (LEEP) shortly after were retrospectively studied. The consistency of pathological examination between colposcopically directed biopsy and LEEP was evaluated. The factors of missed diagnosis of cervical invasive carcinoma were analyzed. RESULTS: The diagnosis of 106 out of the 153 patients by colposcopically directed biopsy was consistent with that by LEEP as confirmed by pathologic diagnosis with a consistence rate of 69.3%, however, the diagnoses of 47 of the 153 patients by colposcopically directed biopsy were not consistent with those by LEEP, with an inconsistent rate of 30.7%, including 22 cases of overdiagnosis (14.4%, 22/153) and 25 cases of underdiagnosis (16.3%, 25/153). Eighteen patients were confirmed as with cervical invasive carcinoma by LEEP/hysterectomy at last with a missed diagnosis rate of 11.8%. The missed diagnosis rate of invasive carcinoma by colposcopically directed biopsy was significantly higher in the patients with cytologic diagnosis of with > or = HSIL than in the patients cytologically diagnosed as with < HSIL (chi(2) = 8.208, P < 0.05). CONCLUSION: The accuracy of diagnosing CIN with colposcopically directed biopsy is still unsatisfying. Attention should be paid on the patients with cytological diagnosis of > or = HSIL so as to avoid missed diagnosis of cervical carcinoma.

Adult↗
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↗