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At least 19 recordsLinked to original sources

PubMed1992

[Role of colposcopy in the diagnosis of human papillomavirus infection of the uterine cervix].

Among 6706 women screened by cytology, only 9 (0.13%) showed evidence of human papillomavirus infection (HPVI). In 133 women examined by colposcopy for abnormal cytology or/and suspected lesions on the cervix, 41 (30.8%) showed subclinical papillomavirus infection (SPI) while 17.4% and 5.3% showed HPVI by histopathology and cytology, respectively. The conformation rate between colposcopy and pathology was 69.6%. Sixty-nine specimens out of 133 colposcopy guided biopsies were assayed by HPV-DNA dot hybridization with 6B/11, 16, 18 probes to detect the presence of HPV-DNA in the cervical specimens. Thirty-nine (56.5%) gave a positive result. The colposcopic predictive value of positive result for HPVI was 76.7%. The difference between colposcopy (59%) and pathology (20.5%) is statistically significant (P less than 0.01). These results suggest that colposcopy is superior to cytology and histopathology for the detection of SPI in the cervix. In colposcopy HPV-DNA positive women, aceto-while-epithelium was most common (28.2%). As it is difficult to differentiate SPI from cervical intraepithelial neoplasia especially the Grade I lesion by colposcopy, discrimination criteria are proposed together with the chief colposcopic features of SPI.

Colposcopy↗

PubMed1976

Carcinoma-in-situ of the cerivix treated with colposcopy guided epithelial conization. Report of a 4-7 year follow-up study.

Twenty-five patients with the diagnosis of carcinoma-in-situ (CIS) of the cervix were treated with colposcopy guided epithelial conization. During the follow-up study of 4-7 years' duration, there was no recurrence of CIS in 20 of the 25 patients. Between 6 and 12 months after conization, 3 patients showed recurrence of CIS. Two of these patients were treated with further epithelial conization with no evidence of further recurrence 4 years after the second treatment. The third patient refused to accept further epithelial conization and modified radical hysterectomy was done without any evidence of residual tumour in the hysterectomy specimen. One patient showed stromal invasion in both colposcopically guided biopsy and bone biopsy. Modified radical hysterectomy specimen showed remnants of stromal invasion. One patient with Class IV smear failed to show any atypical transformation zone and cervicitis was proven on colposcopy guided biopsy following treatment with Flagyl. For two of the 25 patients, cytology was Class II and therefore failed to diagnose the pre-malignant condition; but colposcopy showed a grade 3 atypical transformation zone and the presence of CIS was confirmed histologically. Simultaneous use of cytology, colposcopy and colposcopically guided biopsy confirmed the diagnosis of CIS in all cases. The authors recommend colposcopically guided epithelial conization in younger patients, provided the malignant lesion is strictly intra-epithelial, and limited to the ectocervix. Routine follow-up with the aid of cyto-colposcopy remains the key factor in this schedule of therapy.

Adult↗

PubMed1978

Role of endocervical curettage in colposcopy.

A series of 1,850 patients with atypical Papanicolaou smears referred to the Colposcopy Clinic at Cook County Hospital were evaluated. There were 2,000 colposcopic examinations with or without directed biopsy and 495 endocervical curettements. Records of 126 patients who had definitive diagnoses were reviewed. Of 126 patients, 41 had diagnostic conization following colposcopy-directed biopsy and endocervical curettage; 85 had only colposcopy-directed biopsy and endocervical curettage. There were two instances in which an invasive cancer was missed prior to therapy, one in the group of 41 patients (incidence of 2.4 per cent), the other in the group of 85 patients (incidence of 1.1 per cent). Cone biopsy contributed very little to establishing the diagnosis of invasive cancer following colposcopy-directed biopsy and endocervical curettage. Safety measures for endocervical curettage performed during pregnancy are presented. The management of patients evaluated by colposcopy-directed biopsy and endocervical curettement requires careful correlation of histo- and cytopathology.

Biopsy↗

PubMed1992

Colposcopy in a family practice residency. The first 200 cases.

BACKGROUND: The incidence of abnormal Papanicolaou smears has increased dramatically in the last decade. Many family physicians now find it necessary to perform colposcopies themselves to provide optimal care for their patients. There is little literature that evaluates the performance of this procedure by family physicians. METHODS: The findings of the first 200 colposcopies performed in a community hospital-based family practice residency program are reported. Descriptive data were prospectively gathered between August 1987 and December 1989. RESULTS: The median age of the patients was 25 years, the median number of sexual partners was three, and the median age at the time of first sexual intercourse was 17 years. The majority had colposcopy performed because of a class III Papanicolaou smear (108 [54%]). Twenty-five (12.5%) were pregnant at the time of colposcopy; for this reason a biopsy was not performed on 19 of the patients. An average of three distinct cervical lesions were seen in each patient. The most frequent histologic finding was some degree of dysplasia (116 of 181 biopsied [64%]). Twenty-two cases of severe dysplasia (carcinoma in situ) were found. However, no cases of invasive carcinoma were found. CONCLUSIONS: High-quality colposcopy and effective treatment with appropriate referral can be done at the primary care level for most patients. Many patients failed to return for follow-up evaluation after treatment, indicating the need for better tracking of patients.

Adolescent↗

PubMed1976

Colposcopy screening for cervical cancer in a family planning program.

A brief history is presented of colposcopy in the United States and at Louisiana State University. Incorporation of colposcopy screening as a part of the cervical cancer screening program in the Louisiana Family Planning Program is discussed, and the reasons for the need of "in house" colposcopy service are outlined. Data of the Louisiana Family Planning Program Colposcopy Service for the three-year period 1972 through 1974 are presented. Analysis of these data reveals that cytology when used without colposcopy fails to reveal the presence of major cervical pathology in 30.2% of patients. It is concluded that colposcopic screening must be a part of all family planning and cervical cancer detection programs.

Colposcopy↗

PubMed1976

Colposcopy.

The main clinical value of colposcopy in modern gynecology is in the clinical diagnosis of patients with abnormal cytology. In colposcopically directed biopsies it is possible for an experienced colposcopist to sample with a high degree of accuracy the most advanced histopathologic changes. This significantly decreases the frequency of diagnostic conization. Colposcopy can efficiently select patients for outpatient treatment of cervical intraepithelial neoplasia, since it precisely defines the size and localization of epithelial changes. A new application of colposcopy is in the evaluation of young girls who have been exposed to stilbestrol in utero. In these patients colposcopy can improve the diagnosis of changes in cervical-vaginal epithelium.

Adenocarcinoma↗

PubMed1992

A comparison of simultaneous cervical cytology, HPV testing, and colposcopy.

This pilot study explores the screening techniques for premalignant and malignant disease of the cervix. Given current knowledge of the etiology and progression of cancer of the cervix, should family physicians screen patients with Papanicolaou (Pap) smears, Human Papillomavirus (HPV) smears, colposcopy, or some combination of these three? In a retrospective audit of 75 patients comparing simultaneous Pap smears and colposcopy, 5 of 8 patients with biopsy-proven cervical intraepithelial neoplasia (CIN) and one with invasive cancer had normal Pap smears. Because of this high false-negative Pap smear rate, a prospective study comparing a simultaneous Pap smear, HPV smear, and colposcopic examination (with biopsy when indicated) was undertaken. Seventy consecutive patients seen by the author for routine pelvic examinations consented to and were enrolled in the study. Seven patients had biopsy-proven CIN lesions; 2 were found by Pap smear, 3 by colposcopy, and 5 by HPV smear. The Pap smear missed 5 lesions, colposcopy missed 4, and the HPV smear missed 2. Further studies are needed to determine the optimal screening method for CIN.

Colposcopy↗

PubMed1992

An evaluation of human papillomavirus testing as part of referral to colposcopy clinics.

OBJECTIVE: To determine the usefulness of human papillomavirus (HPV) testing as a triage method for predicting which women referred to a colposcopy clinic were most likely to have histologically confirmed cervical intraepithelial neoplasia (CIN). METHODS: Papanicolaou tests, ViraPap tests for HPV infection, and colposcopically directed biopsies were performed concurrently on 482 women referred to a student health colposcopy clinic. RESULTS: The results demonstrated that HPV positivity was associated with a greatly increased likelihood of histologic confirmation of CIN, especially among women with concurrent cytologic findings that were negative or showed only atypical squamous cells of undetermined significance. CONCLUSIONS: Testing for HPV appears to have a role in the triage of students now being referred to our colposcopy clinic. A combination of HPV testing and repeated cytologic screening would provide reasonably sensitive screening for cervical neoplasia while limiting the use of colposcopic services, which are currently overburdened. The eventual usefulness of HPV testing will depend on the cost and availability of colposcopy services, the cost of Papanicolaou tests, the cost and accuracy of HPV tests, and the predictive value of HPV detection in the population being screened.

Adult↗

PubMed1992

[The role of colposcopy in the diagnosis of HPV infection].

Human papillomavirus (HPV) has been implicated as an important etiologic factor in cervical carcinoma. This study evaluates the efficacy of colposcopy in the detection of cervical lesions with koilocytosis features. Colposcopy, cervical smears and biopsy specimens from 217 women seen in our department between January-December 1991 were examined. The colposcopy examination detected 77.5% of the viral presence the histological diagnosis detected 85% of HPV, but the cytologic smears showed only 52% of infection. The data suggests that colposcopy is a good examination to evidence koilocytosis infection.

Adult↗

PubMed1979

[The role of colposcopy in the diagnosis and treatment of dysplasias and intra-epithelial carcinomas of the uterine cervix (author's transl)].

Colposcopy plays an essential role in the diagnosis and treatment of dysplasias of the uterine cervix. It may be used to assess the lesions recognising dysplasia, observing the degree of severity and indicating regions from which biopsies should be taken. It accurately defines the limits of the lesions by indicating the site of the squamo-columnar junction, on the ectocervix or in the cervical canal. In association with Schiller's test, it defines the peripheral limits of the lesions on the cervix or vagina and leads to the discovery of purely vaginal lesions. On the basis of such an assessment, it is possible to discuss appropriate method for reaching a histological diagnosis, perform selective biopsies or obtain surgical specimen, and the best form of treatment. Only colposcopy offers the possibility of determining the indications for local treatment and observing patients after treatment. Colposcopy must be accompanied by precise technique in the histological examination of biopsies and operative specimens. Colposcopy is not a routine method of examination. In order to be effective and reliable, it must be selective and performed by a specialised colposcopist.

Biopsy↗

PubMed1976

[The development of colposcopy (author's transl)].

In 1925, in this Journal, Hans Hinselmannn gave the reslults of his experience with the method of colposcopy he devised for the early recognition of cancer of the uterine cervix. In 50 years it has proved to be an indispensable procedure in experienced hands, by which the prestages and early stages of the most frequent genital cancer in women, carcinoma of the cervix, can be detected while still of microscopic dimensions (microcarcinoma). Papanicolaou's vaginal cytology used in combination with colposcopy increases diagnostic accuracy to more than 95%. Cytology, as a preliminary orienting laboratory procedure, and colposcopy as a clinical investigation method togethe - if the two individual methods are used in their proper places - offer optimal diagnostic prospects. The opportunities of mastering colposcopy and its use in the cancer prophylaxis program are pointed out.

Adult↗

PubMed1977

False positive cervical cytology: an important reason for colposcopy.

Over an 18 month period, 352 patients with a report of abnormal cervical cytology ranging from mild dysplasia to invasive carcinoma were evaluated with colposcopy and, if indicated, directed biopsies. From the group, there were 26 women in which a lesion consistent with the cytologic diagnosis was not found in each of these cases, an error in the interpretation of the Papanicolaou smear, resulting in a false positive report, was suspected. The cytology was reviewed and the results were compared to the original reports. Twelve cases were reinterpreted as negative for cervical neoplasia. A similar review of the histology failed to reveal a previously missed lesion. Cervical conization in four patients and repeat cytology and colposcopy in 22 patients confirmed the false positive interpretations of the original cervical cytology. The importance of colposcopy as a means of recognizing false positive cytology and avoiding an unnecessary cervical conization is emphasized.

Cervix Uteri↗

PubMed1979

Evaluation of abnormal cervical cytology during pregnancy with colposcopy.

During a 6 1/2 year study period the authors used colposcopy to evaluate 174 pregnant patients with abnormal cervical cytology. The technique of colposcopy proved safe, accurate, and effective in determining the presence or absence of cervical cancer in the present patient's cervix. Colposcopy is mandatory for the evaluation of abnormal cervical cytology during pregancy.

Adult↗

PubMed1977

Colposcopy in the management of early cervical neoplasia.

An outline of the capacity of colposcopy in detection of early neoplastic changes at the ectocervix and the cervical os is given. Figures are presented of results reached by combined use of colposcopy and cytology in 6,536 women (divided into age groups of over and under 30 years) including histological findings. The results emphasize the need to use colposcopy as an additional method in cervical cancer detection.

Adult↗

PubMed1992

Assessment of the accuracy of cytology in women referred for colposcopy and biopsy: the results of a 1 year audit.

The results of weekly colposcopy review meetings have been audited for 1 year and cases where there was a discrepancy between the referral cervical smear and the initial colposcopy biopsy have been analysed. New referrals (n = 476) for colposcopy were studied. In the final outcome 80% of 326 women referred for moderate or severe dyskaryosis were found to have cervical intraepithelial neoplasia (CIN) grade II or III or invasive carcinoma. Three women found to have invasive carcinoma had been referred for severely dyskaryotic smears. Twenty women were referred for smears with cell changes suggesting glandular neoplasia: five were found to have adenocarcinoma in situ, whereas eight had CIN and seven had negative biopsies. The results justify the referral policy and demonstrate the need for further investigation when initial colposcopic biopsies are negative.

Adenocarcinoma↗

PubMed1992

Colposcopy in family practice: pilot studies of pain prophylaxis and patient volume.

In a family practice office with volume representative of an average one-person practice, the implementation of colposcopy services was studied. During six months, 257 patients received Papanicolaou (PAP) smears. These patients represented 16.2% of the total 1,585 female patient visits for ages greater than 16. Of the 257 cytology specimens, 10.1% (26) revealed dysplasia or evidence of Human Papilloma Virus (HPV), indicating the need for colposcopic examination. Pathology reports of all biopsied cases confirmed the presence of dysplasia or HPV. These results suggest that the average family physician might reasonably anticipate about 100 colposcopy sessions per year, assuming each patient receives a diagnostic and a therapeutic colposcopic evaluation. In the course of colposcopy services in a family practice, 46 patients underwent 67 colposcopic examinations with cervical biopsy and/or cryotherapy in the office. Some patients received nonsteroidal anti-inflammatory medication 30-60 minutes before the procedure, with selection according to physician preference. All patients rated the pain experienced during the procedure on a 10-point visual-analog scale. Pain scores were significantly lower in those who received medication. Overall, patients tolerated the procedure well and there were no reported complications. Because of the possibility of such factors as the placebo effect influencing these results, a randomized, placebo-controlled, double-blind study will be needed to verify the findings.

Adolescent↗

PubMed1992

Colposcopy findings of CIN and cancer-like lesions of the cervix in pregnancy.

In the course of routine colposcopy evaluation of the cervix in all the cases examined and treated in our clinic we pay attention to the cervical lesions accompanying pregnancy, which are macroscopically and/or colposcopically, and even frequently histologically suspected of CIN and/or cancer. These lesions include findings connected with HPV-infection, i.e. fully developed papillomas, subclinical forms of this infection, as well as the decidual ectopy of the cervix. Fully developed papillomas estimated not only macroscopically and colposcopically, but sometimes also histologically yield falsely positive pictures of cancer, and the decidual transformations on the cervix can be misinterpreted as non-epithelial malignant changes. The incidence rate of cervical papillomas is about 1% in non-selected material; one half of these cases occurs in pregnancy. Decidual ectopy was diagnosed in our material in 6.2% of pregnant women, chiefly between 21 and 30 years of age, and only in single cases in non-pregnant women. On the basis of our routine colposcopy examinations of the cervix in pregnancy conducted for over 30 years, the authors present the colposcopy-clinical signs of these CIN and carcinoma-like changes of the cervix in pregnancy. These observations are colpophotographically documented and allow us to differentiate between these changes and pre- and neoplastic lesions of the cervix in pregnancy.

Carcinoma in Situ↗

PubMed1992

Correlation of colposcopy and histology in cervical biopsies positive for CIN and/or HPV infection.

The purpose of our study was the investigation of colposcopic findings in 108 patients with histologically proved CIN and/or HPV infection in colposcopically directed cervical punch biopsies. The chi square test with Yates' correction was used for the statistical analysis. In 82 cases there were histological changes suggestive of HPV infection, 91 cases showed CIN while in 65 cases CIN was superimposed on HPV infection. The sensitivity of colposcopy was 89% for the detection of CIN and 61% for HPV. In 45% of CIN cases colposcopy underdiagnosed the CIN level, especially in more severe lesions (level II or higher, P < 0.001). We have also observed that the HPV-related colposcopic findings significantly increased the probability of underdiagnosing CIN (P < 0.05). Our results suggest that biopsy is always necessary in order to establish the diagnosis and determine the severity of CIN, especially if the colposcopist suspects HPV infection. We have also shown that many cases of HPV infection are not detected by colposcopy, because they are masked by the coexisting CIN.

Colposcopy↗