Colposcopic Assessment Research Articles

Risk of High-Grade Cervical Dysplasia in Older Patients With a Positive Human Papilloma Virus Cervical Screening Test

Introduction The Australian National Cervical Screening Program has mandated management algorithms that are uniform across all age groups, but evidence is emerging that perhaps the risk of high-grade squamous intraepithelial lesion (HSIL) may decrease in the postmenopausal period. Objective The aim of the study is to identify if patients ≥50 years of age referred to a tertiary colposcopy service have a different risk of HSIL or greater (+). Materials and Methods This is a retrospective cohort study of 3239 referrals to a hospital colposcopy clinic with a positive human papillomavirus (HPV) cervical screening test between December 2017 and May 2023. Patients were included if they were aged 25–74 years, had a cervix, and completed an outpatient colposcopic assessment. Medical records were analyzed to determine the incidence of HSIL+ for each age group and compared them using χ2 and multivariable regression. Results The overall incidence of invasive carcinoma was 0.93% and HSIL/adenocarcinoma-in-situ was 20.38%. Patients ≥50 years of age were less likely to have HSIL or greater diagnosed than those <30 (p < .0001) or those 30–49 (p < .0001), even after considering referral HPV subtype and reflex cytology (OR = 0.45, 95% CI = 0.34–0.59). The risk of invasive carcinoma in those aged ≥50 was no different than those aged 30–49 (p = .982). Conclusions We observed a lower incidence of HSIL or greater with increasing age even after considering referral HPV subtype and reflex cytology. As further data emerges regarding the risk of high-grade disease in those ≥50 years of age, refinement of the risk-based screening algorithm to account for advanced age may be required.

The role of colposcopy in HPV vaccination era.

Colposcopy has traditionally played a crucial role in the assessment and management of abnormal cervical cytology and human papillomavirus (HPV) -related lesions. However, with the reduction in high-risk (HR) HPV types due to vaccination, the role of colposcopy in the HPV vaccination era is being questioned. The aim of this narrative review was to highlight the latest evidence from the world of HPV vaccination and the future role of colposcopy in the HPV vaccination era. PubMed, MEDLINE, Scopus, Web of Science were searched for relevant articles up to June 2024. HPV vaccination may influence colposcopic practice by reducing HR-HPV vaccine type, colposcopy referrals, colposcopic positive predictive value for CIN 2+, and by changing referral patterns, colposcopic performance, and procedures. The relative incidence of HPV-negative adenocarcinoma and its precursors may be increasing, presenting a new challenge that may increase the difficulty of colposcopic assessment. The role of colposcopy in the management of cervical abnormalities will vary according to vaccination status, vaccine type and timing of vaccination. As this evolves, colposcopy will need to adapt to provide optimal care tailored to individual risk profiles and to maintain the key role in cervical cancer prevention that it has acquired over the past decades. There will certainly be a need to improve the quality and performance of colposcopy by reducing inter- and intra-observer variability in colposcopic practice, including more objective patient selection, greater knowledge, expertise and skill, with the aim of achieving reproducible, sensitive and less biased assessment of cervical appearance.

Artificial Intelligence and Colposcopy: Automatic Identification of Vaginal Squamous Cell Carcinoma Precursors

Background/Objectives: While human papillomavirus (HPV) is well known for its role in cervical cancer, it also affects vaginal cancers. Although colposcopy offers a comprehensive examination of the female genital tract, its diagnostic accuracy remains suboptimal. Integrating artificial intelligence (AI) could enhance the cost-effectiveness of colposcopy, but no AI models specifically differentiate low-grade (LSILs) and high-grade (HSILs) squamous intraepithelial lesions in the vagina. This study aims to develop and validate an AI model for the differentiation of HPV-associated dysplastic lesions in this region. Methods: A convolutional neural network (CNN) model was developed to differentiate HSILs from LSILs in vaginoscopy (during colposcopy) still images. The AI model was developed on a dataset of 57,250 frames (90% training/validation [including a 5-fold cross-validation] and 10% testing) obtained from 71 procedures. The model was evaluated based on its sensitivity, specificity, accuracy and area under the receiver operating curve (AUROC). Results: For HSIL/LSIL differentiation in the vagina, during the training/validation phase, the CNN demonstrated a mean sensitivity, specificity and accuracy of 98.7% (IC95% 96.7–100.0%), 99.1% (IC95% 98.1–100.0%), and 98.9% (IC95% 97.9–99.8%), respectively. The mean AUROC was 0.990 ± 0.004. During testing phase, the sensitivity was 99.6% and 99.7% for both specificity and accuracy. Conclusions: This is the first globally developed AI model capable of HSIL/LSIL differentiation in the vaginal region, demonstrating high and robust performance metrics. Its effective application paves the way for AI-powered colposcopic assessment across the entire female genital tract, offering a significant advancement in women’s healthcare worldwide.

Utility of colposcopy for the screening and management of cervical cancer in Africa: A cross-sectional analysis of providers’ training and practices.

10555 Background: Cervical cancer is a public health issue in Africa with devastating socioeconomic consequences due to the lack of organized screening programs. The success of screening programs depends on the appropriate investigation and management of women who test positive for screening. Colposcopic assessment following positive screening results is a critical issue in Africa. This study aimed to assess the utilization of colposcopy by providers in the region. Methods: A cross-sectional study was conducted in 2021-2022 among healthcare providers involved in cervical cancer prevention activities in Africa. They were invited to report prior colposcopy training, whether they performed colposcopy and the indications of colposcopy in their practice. Results: Of the 130 providers from 23 African countries who responded to the survey (mean age [SD]: 39.0 years [9.4]), half were female (65 [50.0%]), and 90.7% were working in urban areas. Overall, only 12.6% of respondents indicated having received prior training on colposcopy, and 11.7% reported that they were performing colposcopy in their current practice. Among the providers who reported performing colposcopy in their practice, colposcopy was indicated for routine visual screening in 21.2% of clinicians, to visualize the transformation zone in 15.2% of respondents, to assess vascularization of cervical mucosa in 33.3% of respondents, and to determine treatment modality in 12.1% of respondents. Conclusions: Providers’ training and utilization of colposcopy for cervical cancer screening remain suboptimal in Africa. To address this situation in the region, further training is needed to improve providers' knowledge and engagement. With the development of lower-cost and portable colposcopes, efforts to equip cervical cancer prevention programs and facilities with colposcopy should be enhanced to ensure that women can be screened and managed appropriately.

Predictors factors of the absence of high-grade intraepithelial lesion in excisional therapy specimen.

To identify predictive factors of the absence of high-grade intraepithelial lesion (HGSIL) in cervical excisional therapy specimen. Data from 835 women who underwent excisional therapy for a cervical intra epithelial lesion at the department of Gynaecology from two university hospitals, between January 2015 and December 2020 were reviewed. Demographic data, referral cytology, colposcopic findings, results of cervical biopsy and endocervical curettage were retrieved. Primary outcome was the absence of HGSIL on cervical excisional specimen analysis defined by the identification of no intraepithelial lesion or of low-grade lesion only. The absence of HGSIL on specimen was observed in 137 (16.4%) cases. Three factors were identified to have a significant and independent impact on the probability of the absence of HGSIL on specimen: age higher than 40 years (aOR: 1.8; 95%CI: 1.1-3.0; p=0.024), a small abnormal transformation zone (TZ) (aOR: 2.3; 95%CI: 1.4-3.7; p=0.001) and the result of the cervical biopsy at the time of colposcopic assessment not showing HGSIL (aOR: 8.6; 95%CI: 4.7-15.5; p < 0.001). No significant impact of the referral cytology nor of the colposcopic impression were observed. Although the result of cervical biopsy performed at the time of colposcopic assessment is the key risk factor for the absence of HGSIL on excisional specimen, age over 40 and a small abnormal TZ are the two other identified risk factors. Practitioners should consider these findings when deciding for excisional therapy.

Accuracy of colposcopy in the Swedish screening program.

Sensitivity and specificity of colposcopy vary greatly between studies and efficacy in clinical studies seldom corresponds with effectiveness in a real-life setting. It is unclear whether colposcopists' experience affects assessment; studies show divergent results. The study's objective was to investigate the accuracy of colposcopies in the Swedish screening program, the variability in colposcopists' assessments and whether degree of experience affects accuracy in a routine setting. Cross-sectional register study. All colposcopic assessments with a concomitant histopathological sample from women aged at least 18 years, performed between 1999 and September 2020 in Sweden. The main outcome measure was accuracy. The accuracy of colposcopic assessments was calculated as overall agreement with linked biopsies, with three outcomes: Normal vs Atypical, Normal vs Low-Grade Atypical vs High-Grade Atypical, and Non-High-Grade Atypical vs High-Grade Atypical. A time-trend analysis was performed. The accuracy of identifiable colposcopists related to experience was analyzed. In total, 82 289 colposcopic assessments with linked biopsies were included for analysis of the outcome Normal vs Atypical; average accuracy was 63%. Overrating colposcopic findings was four times more common than underrating. No time trend in accuracy was noted during the study period. Accuracy in distinguishing High-Grade from Non-High-Grade lesions was better: 76%. Among identifiable colposcopists, overall accuracy was 67%. Some had significantly better accuracy than others, but no correlation with experience was found. Colposcopy, including in a referral setting, has low accuracy in distinguishing Normal from Atypical. Increased experience alone does not lead to improvement. This is supported by the substantial differences in performance between colposcopists.

Prognostic Value of Endocervical Curettage at the Time of Colposcopic Assessment of the Uterine Cervix: Cross-Sectional Analytical Research

Objective: This study aimed to investigate the necessity and diagnostic value of endocervical curettage (ECC) in cervical preneoplastic and neoplastic lesions. Material and Methods: A total of 296 patients who were admitted to the gynecologic oncology outpatient clinic at a single tertiary care center and who simultaneously underwent colposcopic biopsy and ECC between 2018 and 2020 were included in the study. Hematoxylin-Eosin (H&E), p16, and ki-67-stained preparations obtained from biopsy and curettage samples of the patients were analyzed by light microscope. Demographic data of the patients were obtained from the hospital system. Results were statistically and comparatively analyzed. Results: Cervical premalignant/malignant lesion was detected in 125 out of 296 patients and premalignant/malignant lesion was detected in 42 patients on ECC. Out of these 42 patients, 19 were diagnosed by ECC material alone. It was striking that all of the 5 HPV-18- positive patients were diagnosed with ECC material. When conization materials of CIN 2-3 patients were assessed with ECC results, it was observed that adenocarcinoma and glandular involvement were remarkably significant in ECC-positive patients. Conclusion: Our study involves important findings in the determination of the role of ECC in diagnosing cervical premalignant lesions. ECC simultaneously performed with colposcopic biopsy for appropriate women increases the diagnosticity of colposcopic biopsy procedure and gives information about glandular involvement. Moreover, it can decrease the risk of recurrence and minimize surgical margins.

Characterization and clinical management of abnormal cytology findings in pregnant women: a retrospective analysis

PurposeThe diagnosis of cervical intraepithelial neoplasia during pregnancy poses a great challenge to the treating clinician and the patient. According to the current guidelines, watchful waiting during pregnancy can be justified. Only in cases of invasion, immediate treatment may be indicated. However, few data are available on the management of cervical dysplasia during pregnancy. Further research is important for counselling affected women.MethodsData of pregnant patients with suspected cervical dysplasia who presented to the University Women’s Hospital Tübingen between 2008 and 2018 were evaluated retrospectively. Colposcopic, cytologic, and histologic assessment was performed for diagnosis. Data on remission, persistence and progression of disease based on histologic and cytologic assessment and the mode of delivery were correlated.Results142 patients were enrolled. Cytology at first presentation was PAPIII (-p/-g) in 7.0%, PAPIIID (IIID1/IIID2) in 38.7%, PAPIVa (-p/-g) in 50.0%, PAPIVb (-p) in 2.8%, and PAPV (-p) in 1.4%. All cases with suspected invasion were recorded at the initial presentation. Complete histological or cytological remission was observed in 24.4%, partial remission in 10.4%, persistence in 56.3%, and progression in 8.9%. In two cases (1.5%) progression to squamous cell carcinoma occurred.ConclusionsWatchful waiting for cervical intraepithelial neoplasia during pregnancy seems to be sufficient and oncologically safe. It is important to exclude invasion during pregnancy, to perform frequent colposcopic, cytologic and histologic examinations and to ensure a postpartum follow-up examination to initiate the treatment of high-grade lesions. Spontaneous delivery seems to be safe in patients with cervical dysplasia, Caesarean section is not indicated.

Cervical Cancer Prophylaxis-State-of-the-Art and Perspectives.

Background: Each year 604,127 new cases of cervical cancer (CC) are diagnosed, and 341,831 individuals die from the disease. It is the fourth most common cancer among women and the fourth most common cause of death from female cancers worldwide. The pathogenesis of CC is associated with human papillomavirus (HPV) infections and consists of several steps involving cell proliferation outside the human body’s control mechanisms. Strategies to prevent CC are based on screening and vaccination. Scope of the Review: The aim of this paper was to collect and analyze the available literature on the issue of CC prevention and the impact of the COVID-19 pandemic on its implementation. For this purpose, PubMed and Google Scholar databases were searched using keywords, such as “cervical cancer”; “HPV”; “prevention”; “prophylaxis”; “vaccination”; “screening” and “COVID-19” in different variations. Only articles published since 2018 were included in the study. Conclusions: Selected European countries have different CC prevention programs funded by national budgets. This translates into observed differences in the risk of death from CC (age-standardized rate Malta = 1.1, Poland = 5.9). COVID-19 pandemic due to disruption of CC screening may exacerbate these differences in the future. To improve the situation, new screening methods, such as p16/Ki67, HPV self-testing, and the use of artificial intelligence in colposcopic assessment, should be disseminated, as well as free HPV vaccination programs implemented in all countries. The search for new solutions is not without significance and entails ultra-sensitive screening tests for risk groups (mRNA E6/E7, SOX1/SOX14), HPV vaccines with shorter dosing schedules, and new therapeutic pathways using nanotheranostics.

Colposcopic findings in human immunodeficiency virus positive patients in Port Harcourt

Colposcopy is an outpatient procedure that involves visualization of the cervix, vagina and vulva using a magnifying optical instrument called the colposcope. Human Immunodeficiency Virus infection is associated with increased incidence of cervical malignancies which can be detected by colposcopy. To determine prevalence of premalignant and malignant lesions of the cervix using colposcopic assessment among HIV positive women at the University of Port Harcourt Teaching Hospital (UPTH), Alakahia between June 2015 and August 2015.One hundred HIV positive women were recruited by simple random sampling (by balloting) with an uptake rate of 97%. Informed consent was obtained from each individual and data was collected using a semi-structured interviewer administered questionnaire. They all had colposcopic examination. Data analysis was done using SPSS. Ethical approval was obtained from the hospital’s ethical committee before the research was commenced.Ninety seven out of one hundred subjects had satisfactory colposcopy. The prevalence of premalignant lesions from colposcopy was 53.6%. The mean age respondents; 37.44 ±7.20 years, mean age for premalignant lesions; 37.73 ±7.49 years.The age range was 21-56 years.Thirty-four (35.4%) had coitarche before eighteen years of age, fifty-five (57.3%) had it after the age of eighteen, seven (7.3%) had no idea. Majority (68.8%) have had two or more sexual partners in their lifetime. The mean CD count was 543.77cells/mm.There was high prevalence of premalignant lesions among the HIV positive women. This indicates that a routinely scheduled colposcopic examination of the cervix, together with directed may aid early detection and treatment of the lesions, which will further decrease the incidence of cervical cancer among this population.

Improving colposcopic accuracy for cervical precancer detection: a retrospective multicenter study in China

BackgroundColposcopy alone can result in misidentification of high-grade squamous intraepithelial or worse lesions (HSIL +), especially for women with Type 3 transformation zone (TZ) lesions, where colposcopic assessment is particularly imprecise. This study aimed to improve HSIL + case identification by supplementing referral screening results to colposcopic findings.MethodsThis is an observational multicenter study of 2,417 women, referred to colposcopy after receiving cervical cancer screening results. Logistic regression analysis was conducted under uni- and multivariate models to identify factors which could be used to improve HSIL + case identification. Histological diagnosis was established as the gold standard and is used to assess accuracy, sensitivity, and specificity, as well as to incrementally improve colposcopy.ResultsMultivariate analysis highlighted age, TZ types, referral screening, and colposcopists’ skills as independent factors. Across this sample population, diagnostic accuracies for detecting HSIL + increased from 72.9% (95%CI 71.1–74.7%) for colposcopy alone to 82.1% (95%CI 80.6–83.6%) after supplementing colposcopy with screening results. A significant increase in colposcopic accuracy was observed across all subgroups. Although, the highest increase was observed in women with a TZ3 lesion, and for those diagnosed by junior colposcopists.ConclusionIt appears possible to supplement colposcopic examinations with screening results to improve HSIL + detection, especially for women with TZ3 lesions. It may also be possible to improve junior colposcopists’ diagnoses although, further psychological research is necessary. We need to understand how levels of uncertainty influence diagnostic decisions and what the concept of “experience” actually is and what it means for colposcopic practice.

Mechanical dilatation of the stenosed cervix under local anesthesia: A prospective case series

AimCervical stenosis is traditionally managed by mechanical dilatation under general anesthesia (GA). We aimed to assess the safety, effectiveness, and patient acceptability of dilatation in the outpatient setting under local anesthesia (LA).MethodsData were collected prospectively from all patients attending the outpatient department with cervical stenosis from March 20, 2015 to September 23, 2020. Mechanical dilatation of the cervix was performed using Hegar dilators under LA. Subsequent colposcopic assessment, cytology, histology, and management were recorded.ResultsOne hundred forty‐nine cases were referred for cervical dilatation, 63 (43%) of which had complete stenosis. One hundred eighteen (79%) patients had previously undergone cervical procedures. Successful dilatation under LA was achieved in 119 (83%) patients; 5 (3%) declined (requesting GA), 6 (4%) did not tolerate speculum examination, and 19 (13%) had unsuccessful procedures. The median Hegar size used was 8 mm. Dilatation under LA was acceptable in 93% attempted procedures. Thirteen episodes of restenosis were recorded with no major adverse events. Younger age (p = 0.045) and severe (compared to complete) stenosis (p < 0.0001) were associated with procedure success, with improved results over time (p = 0.003). Successful dilatation permitted cervical assessment; eight patients required cervical excisions, two underwent hysterectomies, with one confirmed case of adenocarcinoma.ConclusionRigid cervical dilatation in the outpatient setting provides effective, instantaneous treatment for women who have failed cytological or colposcopic assessment. For the vast majority of women, the procedure was well tolerated and preferred to using GA. However, given that 1 in 10 women experienced restenosis, patients should be counseled about the possibility of requiring further management.

Colposcopic assessment by Swedescore, evaluation of effectiveness in the Swedish screening programme: a cross-sectional study.

To evaluate the effectiveness and performance of Swedescore in the Swedish screening programme. Cross-sectional register study. All Swedish women aged over 18years with a colposcopic assessment linked to a biopsy in the Swedish National Cervical Screening Registry, 2015-20. Colposcopies with Swedescore were compared with the histopathological diagnosis of cervical intraepithelial neoplasia grade 2 or higher (CIN2+). The respective influence of cytology and human papillomavirus (HPV) testing, at referral for colposcopy and concurrently with colposcopy, were investigated in regression models. CIN2+. A total of 11317 colposcopic assessments with Swedescore were included. Odds ratios for CIN2+ increased for every step in the Swedescore scale. At Swedescore ≥0-1, the proportion of CIN2+ was 9.8%. At Swedescore ≥8, the specificity was 93.3% and the positive predictive value was 60.1%, Area under the receiver operating characteristics curve (AUC) was 0.71. If the smear had been abnormal at referral, a normal colposcopy (Swedescore 0-1) was still associated with a CIN2+ risk of more than 5%. In the regression model, cytology and HPV had higher odds ratio for CIN2+ than colposcopy; the combination resulted in an AUC of 0.88. Swedescore works well in a routine clinical setting but colposcopy assessed with Swedescore was inferior to that reported in previous clinical studies. No safe cutoff level was identified for refraining from biopsy. See-and-treat at Swedescore 8-10 is feasible only if referral cytology showed high-grade squamous intraepithelial lesion. No safe cutoff level for refraining from biopsy nor for see-and-treat with Swedescore.

Can biopsies be omitted after normal colposcopy in women referred with low-grade cervical cytology? A prospective cohort study

BackgroundControversy surrounds whether women with low-risk cytology screening results but a normal colposcopic assessment should have random biopsies taken. The aim of this study was to determine the yield of CIN2+ from one to four cervical biopsies in women with cytology of LSIL or ASCUS and a normal colposcopic impression.MethodsBetween January 2017 and September 2020, women over 18 years old referred for colposcopic examination due to either an abnormal smear (ASCUS+) or follow-up after previous cervical intraepithelial neoplasia (CIN) were invited to participate in the study. All study participants underwent colposcopic examination and had four biopsies taken. The biopsies were analyzed separately.ResultsIn total, 1327 women with abnormal cervical cancer screening results or attending follow-up after a previous CIN diagnosis were enrolled in the study and examined by colposcopy. Of these, 173 were newly referred with cytology of LSIL or ASCUS and had a normal colposcopic impression and four adequate biopsies. Of these, 22.0% were diagnosed with CIN2+. When combining the results of the four biopsies, we found a 100% relative increase in CIN2+ cases compared to using only one biopsy (from 11.0% to 22.0%, P = 0.006).ConclusionAs we found CIN2+ from random cervical biopsies in 22.0% of women with cytology of LSIL or ASCUS who had a normal colposcopic impression, we advocate performing four random cervical biopsies at the squamocolumnar junction in such women.Trial registration NCT04249856, January 31 2020 (retrospectively registered).

The use of biomarkers and HPV genotyping to improve diagnostic accuracy in women with a transformation zone type 3.

Twenty percent of women referred to colposcopy have a type 3 transformation zone-where colposcopic assessment for high-grade dysplasia (CIN2+) is not possible. This study examines the effectiveness of HPV biomarkers and genotyping in combination with techniques that sample an endocervical TZ. A prospective diagnostic accuracy study. Women booked for large-loop excision (LLETZ) with squamous dyskaryosis, high-risk HPV and a TZ3 were recruited. Immediately prior to LLETZ samples were collected for p16/Ki-67 dual-stained cytology, HPV genotyping and H&E, p16- and Ki-67-stained endocervical curettings. In women with low-grade screening (n = 64), 35.9% had CIN2+; dual-stained cytology had the greatest effect on the PPV of routine screening (76.1% vs 35.9%) and perfectly predicted the absence of CIN2+. Inwomen with a high-grade screening result (n = 37); 75.6% had CIN2+ and dual-stained curettings improved the PPV (96.5 vs 75.6%). With high-grade screening and a TZ3, LLETZ appears safest as three quarters have CIN2+ . Women with low-grade screening and a TZ3 have a twofold increased risk of CIN2+ when compared to women where the TZ is visible. The use of dual-stained cytology may help identify those women who can be safely offered surveillance and those who require treatment.

Female genital injury\u2014which findings have to be considered physiological using colposcopy with and without toluidine blue dye?

This study aimed to assess the validity and efficacy of blue dye in colposcopic assessment of genital injury in pre- and postmenopausal women with and without history of consensual sexual intercourse. Two hundred women were prospectively enrolled and examined colposcopically with and without toluidine blue dye in order to detect and categorize genital lesions (laceration, bruise and abrasion). Examination of genital trauma was accomplished in a standardized way and findings were photo documented. A wide range of influencing factors with a potential impact on prevalence and nature of genital injury was recorded beforehand using a questionnaire. The frequency of diagnostic injury differed substantially depending on the examination technique, ranging from 9% using colposcopic magnification only to 28% with the additional use of toluidine blue dye. A vertical laceration affecting the posterior fourchette was the most frequent lesion detected (17%, n = 32). Menopausal status seems to have significant impact on genital injury prevalence (p = 0.0165), as 42% (16/ 38) of postmenopausal compared to 24% (36/ 151) of premenopausal women had at least one genital lesion. Furthermore, vaginal medication (p = 0.0369), vaginal dryness (p = 0.0228), dyspareunia (p = 0.0234) and low frequency of sexual intercourse (p = 0.0022) were found to significantly correlate with the presence of genital lesions. According to our findings, standardized colposcopy in combination with toluidine blue dye facilitates accurate assessment of genital lesions. Genital trauma situated at another site than the posterior part of the vaginal introitus seems to be uncommon after consensual intercourse.

Sequential Application of Lugol's Iodine Test after Acetic Acid for Detecting Cervical Dysplasia: A Prospective Cohort Study.

Applying Lugol’s iodine solution to the cervix followed by colposcopic assessment is an established standard test to identify low grade/high grade squamous intraepithelial lesions (LSIL/HSIL). Here, we assessed the performance of Lugol’s iodine test during colposcopy using a standardized protocol with 5% acetic acid followed by 5% Lugol’s iodine solution and recording the most severe acetowhite (MSAWL) and iodine-negative (MSINL) lesions in a prospective cohort of consecutive women referred to our specialized colposcopy unit. The primary study endpoint was the sensitivity/specificity of MSINL for the detection of LSIL/HSIL. Secondary endpoints were the time to first appearance of the MSINL, MSINL staining intensity, and fading of MSINL. Three hundred and twenty women were included. The sensitivity and specificity of MSINL for the detection of LSIL/HSIL was 81.4 (95%—confidence interval (CI) 77.3–85.0)% and 29.5 (24.2–35.5)%, respectively. Ninety-six MSINL were identified exclusively by Lugol’s iodine test (no pathology, n = 46; LSIL, n = 29; HSIL, n = 21) (number needed to biopsy to identify one additional LSIL/HSIL = 1.9). In 17/320 (5.3%) patients, the clinical management was changed based on the result of Lugol’s iodine test. Video analysis showed an instant appearance of the MSINL within 10 s in 100% of cases. Intensity of MSINL significantly correlated with the presence/absence of LSIL/HSIL (Spearman rank order correlation; p < 0.0001). Fading of iodine-induced staining intensity over time was not observed. Thus, Lugol’s iodine showed moderate sensitivity and poor specificity, but changed clinical management in 5% of cases when used in addition to acetic acid.

Opportunities of Interferon Therapy in Pregnant Women with Cervical Intraepithelial Neoplasia

Objective: Due to hormonal and immune response changes, pregnancy contributes to their adverse stimulating effect on the progress of already existing hyperplastic processes in the cervix. The resulting aggravation of severity in their clinical course and intensity of the pathological process relatively frequently leads to precancerous conditions and cervical cancer developing further on. Some authors note the upward trend in the number of pregnant women having been diagnosed with pre-cancer and cancer of the cervix, as women postpone their maternity decisions increasingly more often. Currently, the tactics of managing pregnant women with cervical dysplasia consists in dynamic observation, including cytological study, colposcopic assessment of the state of surface cervical epithelium taking into account physiological particularities which are characteristic of pregnancy. The use of interferon therapy in pregnant female patients with HPV-associated cervical neoplasia is also expedient owing to its positive effect for reducing the CIN progression frequency, the probability of infecting the fetus with human papillomavirus, and the frequency of perinatal complications. Methods: The study involved pregnant women in their second and third trimesters of gestation who have been diagnosed with cervical neoplasia (L-SIL, H-SIL). In comparison groups, behavior of cervical neoplasia was monitored against the background of the therapy conducted with interferon alpha-2b or without treatment. Results: Against the background of the therapy conducted with interferon alpha-2b drug, higher frequency of the pathological process improving and lower frequency of its progressing into more severe dysplasia forms have been registered in the pregnant women with HPV-associated cervical neoplasia. However, it must be noted that efficiency of the treatment is higher in the group of pregnant women with L-SIL than in the H-SIL female patients. Conclusion: In managing the CIN pregnant women, it is expedient to prescribe interferon therapy systemically and topically in the form of gel (Viferon®) which allows reducing inflammation, viral load, ensuring regression of L-SIL and stabilization of H-SIL.

Effects of Orally Administered Preliminary Analgesic Therapy in Diagnostic Colposcopy Patients: A Prospective Questionnaire Study

Background: Colposcopy has a key role in the diagnostic work-up and management of abnormal cervical cytology, but it might generate negative feelings of mainly anxiety and pain to the patients undergoing such examination. These feelings are interrelated, with the anxiety fueling the painful sensations. The aim of our study was to investigate the effects of preliminary administration in terms of pain and anxiety relief that the preliminary administration of paracetamol would have on patients undergoing diagnostic colposcopy. Materials &amp; Methods: We conducted a single center prospective study which enrolled 112 patients with diagnosed or suspected cervical pathology who were examined at the Outpatient Colposcopy Clinic of Patras University Hospital, over a 7-months period. Patients were randomly assigned to one of the two groups. The interventional group received 1gr of paracetamol (acematiminofen) in pill form, 30 to 60 minutes before colposcopic assessment; the control group received no medication. At the end of consultation, all participants completed a 2-page questionnaire. Results: More patients of the interventional arm did not experience any pain at all during colposcopy compared with the control group. However, this difference was statistically not significant, probably because of the small number of patients. Moreover, there were no differences in mild and moderate pain rates between the interventional and control groups. Severe pain was only experienced by patients in the control group. Further data analysis from the first time as and for repeat colposcopy patients showed similar findings regarding pain intensity rates in the interventional and control group. When considering anxiety levels, no differences were observed between the two groups. Conclusion: The preliminary administration of low dose paracetamol in a pilot sample of colposcopy patients did not illustrate significant benefits in terms of experienced pain and anxiety levels.

Colposcopic assessment of the normal cervix in pregnant women

Background. Colposcopy in a pregnant woman is carried out to rule out the presence of invasive cervical cancer and to determine the need for targeted biopsy. Indications for colposcopy include pathological cytological smear, abnormal appearance of cervix, or bleeding of unknown origin.&#x0D; Objective. To describe the features of colposcopic examination in pregnant women.&#x0D; Materials and methods. Analysis of own experience and literature sources on this topic.&#x0D; Results and discussion. Literature data indicate the reliability and safety of colposcopic examination of pregnant women. It should be noted that the examination of pregnant women requires a higher qualification from the colposcopist than the examination of non-pregnant women, although the assessment is based on the same principles. Simple colposcopy allows to assess the vascular pattern and color of the epithelium. For a more thorough assessment acetic acid and aqueous Lugol solution probes are carried out. The tasks of colposcopy are to identify the causes of deviations from the norm of cytological examination, to determine the location and boundaries of the pathological area, to choose the location of the targeted biopsy, to carry out medical manipulations within healthy tissues, and to monitor treatment results. To improve the planning of the necessary treatment options for excisions, a Nomenclature of colposcopic terms for cervix was created. Features of the cervix in pregnant women include the increased cervix vascularization, edema and hypertrophy of the papillae of the cervical canal, increased secretory activity of the cervical canal, eversion of the cervical mucosa, dehiscence of the cervical canal, increased metaplasia, deciduosis, prolapse of the vaginal walls. These physiological changes may cause overdiagnosis of pathological conditions. Thus, hypervascularization can mimic atypical vessels, and deciduosis – malignant tumors. Conversely, hypervascularization and bleeding, increased mucus production and prolapse of the vaginal walls can mask the manifestations of the disease, being the causes of underdiagnosis. The progression of eversion during pregnancy allows to visualize the lesion, which was previously localized in the cervical canal, better and better. Deciduosis in pregnant women is divided into decidual ectopia and decidual polyps of the cervical canal. The tumor-like form of deciduosis visually and colposcopically mimics exophytic tumors. The ulcer form is characterized by dense whitening when applying acetic acid, but is not stained with Lugol solution. Manifestations of the papillary form become the most pronounced after the acetic acid test. The vesicular form is the most common and most easily diagnosed by colposcopists. Decidual polyps become densely whitened during the acetic acid test, but unlike cervical cancer, blood vessels do not disappear. These polyps are not stained with iodine. Decidual polyps are usually localized in the areas of the original epithelium; they are multifocal and small in size. Instead, malignant tumors are localized within the atypical zone of transformation; they are single and have a bumpy uneven surface. Polymorphism and variety of lesions, young age, pregnancy, normal results of cytological examination are more typical for deciduosis. If the colposcopist is unsure of the benign nature of the process, a targeted biopsy should always be performed.&#x0D; Conclusions. 1. The purpose of colposcopy in a pregnant woman is to rule out the presence of invasive cervical cancer and to determine the need for targeted biopsy. 2. Indications for colposcopy include pathological cytological smear, abnormal cervix appearance, or bleeding of unknown origin. 3. Physiological changes during pregnancy can be the cause of hyper- and hypodiagnosis of pathological conditions. 4. If the colposcopist is unsure of the benign nature of the process, a targeted biopsy should always be performed.