Colposcopic Assessment Research Articles

Screening for cervical cancer in younger women may be an issue - A comparative study

Cervical cancer is a burning issue in our health sector. A project on cervical & breast cancer screening has been running already in Bangladesh. All sexually active women of 30-years and above or those who are married for 10 years or more are included in this project. But significant numbers of women, less than 30 years of age were referred to Colposcopy clinic for evaluation. They also had high grade lesion. The purpose of this study was to identify the need for cervical cancer screening programme in younger women who are less than 30 years old. This is a comparative retrospective study conducted in 30 years old women and less than 30 years old (21-29 years) women, who were attending Colposcopy clinic for evaluation & treatment in Khulna Medical College & Hospital (KMCH) from January 2013 to December 2013. We analysed 235 Colposcopies in 225 women (30 years old in Group-A; less than 30 years old in Group-B) who were attending at Colposcopy clinic in Khulna Medical College Hospital in 2013. Among group A (n=90), colposcopic findings were: normal-36 (40%), CIN I-30 (33.33%), CIN II-15 (16.67%), CIN III-2 (2.22%), invasive carcinoma-3 (3.33%). Among group B (n=135), colposcopic findings were: normal-52 (38.52%), CIN I-38 (28.14%), CIN II-26 (19.25%), CIN III-3 (2.22%), invasive carcinoma-2 (1.48%). There characteristics were analysed and compared with each other. Although cervical cancer is extremely rare at younger age, there is increasing rate of younger women with high grade cervical lesion who may need treatment. It seems that these lesions have comparable behaviors as in older women. Early age of marriage is responsible for developing cervical cancer & precancerous conditions. So screening should be started in earlier. Careful colposcopic assessment and evaluation before treatment remain indispensable in this regard.
 Mediscope Vol. 7, No. 2: July 2020, Page 82-88

Diagnostic accuracy of colposcopic examination in patients with oral dysplastic lesions

Colposcopy is a direct microscopic method and is the gold standard tool to detect early cervical dysplastic lesions. In the past, many attempts have been made to use gynecologic methods to examine the oral mucosa. The aim of this study was to detect the diagnostic accuracy of oral colposcopy in diagnosing oral dysplastic lesions in comparison with microscopic evaluation based on biopsy and compare Reid's Colposcopic Index (RCI) and the Swede scoring system in diagnosing oral dysplastic lesions. Twenty-five patients who presented for diagnosis of oral leukoplakia to the Oral Medicine and Periodontology Department, Faculty of Dentistry, Cairo University (Cairo, Egypt) and met the selection criteria were recruited in this study. Each patient was subjected to colposcopic examination, followed by biopsy to confirm the results of colposcopy. The sensitivity and specificity of oral colposcopy were calculated after colposcopic assessment by using the Swede scoring system and the RCI. The diagnostic accuracy of oral colposcopy with use of the Swede scoring system was superior to that of oral colposcopy with the use of the RCI. Colposcopic examination using the Swede scoring system is very specific for diagnosing oral epithelial dysplasia and for using the "see-and-treat" method, whereas the RCI is a very sensitive screening method for the diagnosis of oral epithelial dysplasia in oral potentially malignant disorders.

Prevalence of cervical intraepithelial neoplasia and its associated factors among women attending healthcare services in Eastern Uganda

Cervical malignancy is still the leading cause of death for middle-aged women in the developing world. In Uganda, literature has shown that, cervical cancer incidence and death rates was 45.6 and 25 per 100,000 women respectively. However, the actual magnitude of cervical malignancy in Uganda might be higher since most of the cases are never reported. This study assessed the prevalence of cervical intraepithelial neoplasia among women from hospitals in Eastern Uganda. This was a longitudinal study, with follow-up until diagnosis of high-grade cervical intraepithelial neoplasia (CIN). One thousand and seventy seven women aged 15-55 years were recruited into the study. Pap-smear tests were conducted on all study participants. Women who had abnormal cytology were referred for immediate colposcopic and histological assessment. Surveillance was maintained on these women, and treatment postponed, until there was histological evidence of high-grade CIN (CIN2 or CIN3). At that point women were treated. Those that were pap smear negative were advised to return for screening for three consecutive negative smears before they were allowed to leave the study. Factors associated with cervical cancer were obtained by use of questionnaires. The general prevalence of CIN among women in Eastern Uganda was 416/1077 (38.6%). Two hundred and fourteen, 214/1077(19.9%) had severe CIN3, 180/1077(16.7%) had moderate CIN2, and 22/1077(2.0%) had mild CIN1. Older women aged 45-55-years were frequently diagnosed with the advanced disease stage as compared with young adults aged 15-24 who were less commonly diagnosed with the disease. The study showed that age, use of contraceptives, history of STI and HIV status had statistical significant association with development of cervical intraepithelial neoplasia among the studied participants. There is need for routine surveillance of precancerous lesions and treatment in a timely manner. Key words: Cervical intraepithelial neoplasia, risk factors, cervical cancer.

Alterations of HPV-Related Biomarkers after Prophylactic HPV Vaccination. A Prospective Pilot Observational Study in Greek Women

The objective of this study was to investigate the hypothesis that HPV vaccination administered in patients with low-grade (LG) cytology shortly after an initial colposcopic assessment could prospectively alter HPV-related biomarkers. This was a prospective pilot observational study involving women attending a colposcopy clinic for evaluation of abnormal LG cytology that were advised to undergo HPV vaccination and proceeded accordingly. These women were compared with a matched unvaccinated group. Women requiring cervical biopsies or CIN treatment were excluded. Intervention: A full three-dose HPV vaccination was undertaken with either the 2-valent or the 4-valent anti-HPV VLP vaccine. LBC samples were obtained prior and after the completion of the vaccination regimen and tested for HPV DNA genotyping (CLART-2 HPV test) and E6 and E7 mRNA (NASBA technique). Results: Alterations of HPV-related biomarkers at a colposcopy reassessment appointment 12 months later. Analysis: The p-values, relative risk (RR), absolute relative risk (ARR), number needed to treat (NNT) and 95% confidence intervals for each biomarker in each group were assessed. Results: A total of 309 women were included in the analysis. One hundred fifty-two women received the vaccine. HPV vaccination reduced in a statistically significant manner (p < 0.05) HPV DNA positivity rates for genotypes 16, 18, and 31, RR = 1.6 (95% CI: 1.1 to 2.3), RR = 1.7 (95% CI: 1.1 to 2.8), and RR = 1.8 (95% CI: 1.0 to 2.9), in women who only tested DNA-positive for HPV16, 18, and 31 genotypes, respectively, prior to vaccination. A less pronounced, statistically insignificant reduction was shown for women who tested positive for both HPV DNA and mRNA E6 and E7 expression for HPV16, 18, and 33 subtypes. Statistically significant reduction in HPV mRNA positivity was solely documented for genotype 31 (p = 0.0411). Conclusions: HPV vaccination appears to significantly affect the rates of HPV16, 18, and 31 DNA-positive infections in the population testing HPV DNA-positive for the aforementioned genotypes. The above findings deserve verification in larger cohorts.

How long is too long? Application of acetic acid during colposcopy: a prospective study

Application of acetic acid to the cervix followed by colposcopic assessment with or without colposcopically directed biopsy is the standard test used to detect dysplastic lesions of the cervix. However, there is no evidence-based common standard defining how exactly to perform this test. To prospectively define the optimal timing for the colposcopic assessment of acetowhite lesions. Consecutive women referred to our colposcopy unit were recruited. Using a standardized colposcopy protocol, we recorded the most severe colposcopic lesion 1, 3, and 5 minutes after application of acetic acid (primary study end point). The time to first appearance of the most severe colposcopic lesion, highest staining intensity, and fading of the most severe colposcopic lesion were video documented (secondary study end points, assessed independently by 3 raters). Results were compared using parametric and nonparametric tests. A total of 300 women were included. After 1 minute, 290 of 300 patients (96.7%) were diagnosed with the most severe colposcopic lesion. This proportion did not improve after 3 minutes (290/300 [96.7%]) or after 5 minutes (233/264 [88.3%]). The proportion of minor and major changes continuously declined over time from 142 in 300 (47.3%; 1 minute) to 107 in 264 (40.5%; 5 minutes) and from 110 in 300 (36.7%) to 91 in 264 (34.5%), respectively. The median time until the first appearance of the most severe colposcopic lesion was 13.5 (interquartile range, 3-27.25) seconds and was significantly lower in high-grade squamous intraepithelial lesion (7 [interquartile range, 1-20] seconds) compared to low-grade squamous intraepithelial lesion (19 [interquartile range, 9-39.5] seconds; P < .001). We observed fading of acetowhite lesions in 78% of cases, occurring at a median of 191 (interquartile range, 120-295) seconds after application of acetic acid. Fading started earlier in high-grade squamous intraepithelial lesion compared to low-grade squamous intraepithelial lesion (179.5 [interquartile range, 110- 253.25] versus 212.5 [interquartile range, 146.5-300]; P= .044). Overall, the net difference between colposcopic assessments at 3 minutes versus at 1 minute was 1 more high-grade squamous intraepithelial lesion and 1 less low-grade squamous intraepithelial lesion. It is reasonable to conclude that the best time to identify lesions is 1 minute after the application of acetic acid. Continued evaluation for up to 3 minutes may be considered reasonable for an optimal high-grade squamous intraepithelial lesion yield. However, fading of acetowhite lesions is common, especially in high-grade squamous intraepithelial lesions, and supports a recommendation of not prolonging colposcopy beyond 3 minutes.

Performance of colposcopic scoring by modified International Federation of Cervical Pathology and Colposcopy terminology for diagnosing cervical intraepithelial neoplasia in a low-resource setting.

Introduction:Colposcopy is a tool to evaluate women with cervical pre-cancer and cancer. To interpret the colposcopic findings, various scoring systems are used but with inter observer variations. To improve the quality of colposcopy, International Federation of Cervical Pathology and Colposcopy (IFCPC) has introduced a colposcopic nomenclature in 2011. Colposcopic scoring helps to select patients who need treatment for cervical intraepithelial neoplasia.Aim of the Study:The study aimed to evaluate the agreement between colposcopic diagnosis with the modified IFCPC terminology and cervical pathology in patients with abnormal screening tests and to assess the utility of this colposcopic scoring system in low resource settings.Methodology:Patients with abnormal screening tests who underwent colposcopic assessment in the department of Gynaecological oncology were included in the study. Colposcopic scoring was done by the modified IFCPC nomenclature. The results were compared with cytology and the final histopathology.Results:56 patients were included in the study. The colposcopic scoring when compared to histopathology showed agreement in 65.7% which indicated the agreement was substantial and was statistically significant (P = 0.0001). With cytology the colposcopic score showed agreement in 35.6% indicating a fair agreement and this was also statistically significant (P = 0.001).Conclusion:Colposcopic scoring by modified IFCPC 2011 criteria showed substantial agreement with cervical histopathology. Compared to traditional methods, 2011 international terminology of colposcopy could improve colposcopic accuracy.

Cervical Cancer Prevention in Racially Disparate Rural Populations.

Background: Undergoing a timely Pap smear, high-risk human papilloma virus (HPV)- and colposcopy-based testing can reduce HPV-associated cervical cancer (CC) development in women. However, in rural areas, women and minorities without insurance do not undergo periodic assessment and remain at greater risk of HPV infection and CC. Methods: In this study, 173 women from rural East Texas with various ethnic backgrounds were examined thorough HPV/Pap-based testing and colposcopic assessment. Results: Of the 113 informative cases, 77% (87/113) were positive for high-risk HPV infection and 23% of subjects (26/113) were negative. Associations between HPV positivity with young age (p = 0.002), and a low number of pregnancy (p = 0.004) and births (p = 0.005) were evident. Women with long-term use of contraceptives (OR 1.93, 95% CI, 0.80–4.69) were associated with increased risk of HPV infection. African-American women had a higher risk of abnormal Pap outcome compared to Caucasians (OR 5.31, 95% CI, 0.67–42.0). HPV seemed to be a predictor of abnormal Pap outcome (OR 1.77, 95% CI, 0.48–6.44) in these subjects. Unmarried/widowed/divorced women had an increased abnormal Pap test outcome compared to married women or women living with a partner (p = 0.01), with over 278% increased odds (OR 3.78 at 95% CI, 1.29–11.10). Insured women undergoing periodic checkups were detected early with high-risk HPV infection and abnormal Pap test/colposcopic outcome. Conclusions: Comprehensive and timely screening of uninsured women and minorities in rural East Texas are warranted, which could potentially prevent the onset of HPV-associated CC.

Comparison of the Cervex-Brush alone to Cytobrush plus Cervex-Brush for detection of cervical dysplasia in women with a transformation zone type 3.

Twenty percent of colposcopic assessments are inadequate due to a type 3 transformation zone (TZ3). In the absence of colposcopic or histological assessment, subsequent management is guided by the referral screening test. In the UK, routine cervical screening is completed by a Cervex-Brush alone. This study examines the effectiveness of a Cytobrush in addition to a standard Cervex-Brush when used in TZ3 assessment. An 18-month diagnostic accuracy study in a single National Health Service (NHS) Trust. Women with a TZ3 booked for large loop excision of the transformation zone (LLETZ) with a referral cytology of high-risk HPV and squamous dyskaryosis were recruited. Immediately prior to LLETZ, a Cervex-Brush plus Cytobrush liquid-based cytology sample was taken. Presence of endocervical cells was compared. Predictability of high-grade cervical intra-epithelial neoplasia (CIN2+) was by blind standardised reporting of the LLETZ histology. One hundred and five women were recruited from a total eligible population of 153 cases (68.8%). Endocervical cell yield was increased with the Cervex-Brush plus Cytobrush when compared to the Cervex-Brush alone (99.1% vs 79.1%, P<.001). Irrespective of cytological grade, age or parity, there was no difference in predictability of CIN2+ between sampling methods. When compared to Cervex-Brush sampling alone, the addition of a Cytobrush improves endocervical sampling but does not improve cytological predictability of CIN2+ in women with a TZ3. These data suggest that women who will reliably attend for cytological follow-up can be safely referred to primary care for a Cervex-Brush alone.

Colposcopic, Histologic and Immunohistochemical Assessment in Cervical Intraepithelial Lesions

It is widely accepted that HPV infection precedes the occurrence of neoplastic disease in a varying time frame, and HPV testing can detect 30-100% more cervical precancers than conventional cytology and 20-50% more precancers than liquid-based cytology. Low-grade squamous intraepithelial lesions include the categories of mild dysplasia, respectively cervical intraepithelial neoplasia grade 1, and complementary, various descriptors indicating the presence of Human papilloma virus, such as koilocytotic atypia or condilomatous dysplasia. High-grade squamous intraepithelial lesions cytologically consist of moderate and severe dysplasia, respectively cervical intraepithelial neoplasia grade 2, 3 and carcinoma in situ. The purpose of our paper is to analyze the cytological and colposcopic characteristics in low-grade squamous intraepithelial lesions and high-grade squamous intraepithelial lesions cervical lesions and to accomplish histological and immunohistochemical correlations in these cervical intraepithelial lesions. Systematic three-step colposcopic evaluation using successively, normal saline with or without green filter, acetic acid and Lugol staining provides enhanced efficiency to the colposcopic examination and allows a more individualized and targeted surgical, medical or expectant management. Special microscopic techniques are very important in diagnosing and grading cervical intraepithelial neoplasia.

Acetic Acid and Lugol Tests in Colposcopic Assessment and Surgical Management of Cervical Intraepithelial Lesions

Colposcopy is used predominantly to evaluate women with abnormal Babes - Papanicolaou test results, to locate abnormal appearing epithelium and to direct biopsies as well as the surgical management, in areas in which cervical intraepithelial neoplasia is suspected. The purpose of our study is to analyze the value of acetic acid and Lugol tests in the colposcopic assessment and surgical management of cervical intraepithelial neoplasia, and to evaluate the patient outcome after uterine cervix surgery, by postoperative colposcopic determination of the disease-free resection margins

Self-collected Pap smears may provide an acceptable and effective method of cervical cancer screening.

Background and aimsThe role of the Papanicolou (Pap) smear in the early detection and prevention of cervical cancer is well established. However, many women fail to undertake the test because of embarrassment or other reasons. To address this problem, we evaluated the feasibility of implementing self‐sampling of cervical cytology as an alternative to clinician‐collected Pap smears and compared it with the gold standard of colposcopy in terms of specificity.Materials and methodsA prospective preliminary study of 40 women recruited from the colposcopy clinic of a tertiary referral hospital was undertaken. Participants were instructed in the technique of self‐sampling and asked to collect their own Pap smears. Colposcopic examinations were performed and biopsies taken, if indicated. Clinician‐collected Pap smears were performed 4 weeks later. Pairwise agreement was calculated between the outcomes of self‐collected, colposcopic, and clinician‐collected samples using the weighted κ statistic.ResultsSelf‐collected Pap smear had a high level of acceptability among the women, all of whom were able to collect adequate tissue. The agreement of self‐collected Pap smears with colposcopic assessment was no worse than that of clinician‐collected Pap smears (Cohen's κ statistic 0.54 [95% CI, 0.27‐0.82]; cf 0.49 [0.2‐0.78], respectively). The specificity of self‐collected Pap smears was almost identical to that of clinician‐collected samples (specificity: 86% vs 81%, respectively). Direct comparison between patient and clinician collected Pap smears showed fair agreement (κ statistic 0.38 [0.07‐0.68]). There were no adverse events in either group.ConclusionsSelf‐collection of Pap smears is an effective and acceptable alternative to clinician‐collected samples and may provide a strategy for improving compliance with cervical testing programs.

Prevalence of high-grade cervical intraepithelial neoplasia in women with persistent high-risk HPV genotypes and negative cytology.

Primary HPV screening will be implemented into the English Cervical Screening Programme by 2019. Its impact upon women referred to colposcopy, with negative cytology but persistently positive high-risk HPV (hrHPV), remains unreported from UK Sentinel sites. HPV primary screening was introduced in Sheffield, UK in April 2013; this paper reports its impact on the service. A retrospective cohort study was performed from June 2014 to July 2016 at the Jessop Wing Colposcopy Unit, Sheffield. UK. Data were obtained from the pathology and colposcopy databases and cross-referenced with case-notes and pathology results for women referred with persistently positive hrHPV, cytology negative samples. Patient demographics, hrHPV genotype, biopsy rates, histological diagnoses, management, and outcomes were collected and baseline statistics performed. During the study 1076 women were seen. Most frequent hrHPV genotypes were: hrHPV other, 41%; and HPV16, 33%. The majority (72%) were found to have normal colposcopy; 28% had an abnormal colposcopic assessment (11% low-grade; 11% high-grade; 6% inadequate). The majority were discharged (83%) and only 5% underwent LLETZ. No cancers were detected. High-grade cervical intraepithelial neoplasia (CIN) was found in 7%; overall risk of CIN2 was 1/29; 1/30 for CIN3. Presence of HPV16 was associated with a significantly higher risk of high-grade CIN; 1/9. This is the first study to report results for women referred to colposcopy with cytology negative, persistently positive hrHPV. Disease prevalence is low, although women with HPV16 have a significantly higher likelihood of high-grade disease compared to other HPV subtypes.

Colposcopic assessment and outcome in low grade cervical intraepithelial neoplasia treated with loop electrosurgical excision procedure

The aim of the research was to assess the outcome of persistent (≥two years) low-grade cervical intraepithelial neoplasia (CIN 1) medicated with loop electrosurgical excision procedure (LEEP). An analysis of 38 topics with persistent biopsy-confirmed CIN 1 diagnosed after low-grade squamous intraepithelial lesion (LSIL) or atypical squamous cells of undetermined significance (ASC-US) on Pap test and treated using LEEP was performed. Post-LEEP follow-up were scheduled in 6 months, 1 year, and yearly thereafter: cytology, colposcopy, and plasma diagnostic examinations. There were 38 LSIL patients treated with LEEP conization. About 6 patients were excluded from the study due to subsequent hysterectomy and 2 patients never attended the follow-up schedule in the rest. The remaining 30 patients were retrospective studied for the incidence of recurrent rate. The mean age of the patient was 44 years. About 50% of patients were multiparity and nearly one - third used oral contraceptive pill. The results of this study suggest that the incidence of CIN 2+ lesions during follow-up of persistent biopsy-confirmed CIN 1 after ASC-US/LSIL treated by LEEP is very low.

Pain Sensation During Colposcopy and Cervical Biopsy, With or Without Local Anesthesia: A Randomized Trial.

The aim of the study was to determine whether an injection of a local anesthetic is more painful than a cervical punch biopsy without local anesthesia. The study was a randomized controlled trial, conducted at the Helsinki University Central Hospital. It consisted of 204 women referred for colposcopic assessments. Half of them were randomized to receive local anesthesia before their cervical punch biopsies. After the injection of the local anesthetic, the cervical punch biopsy, and the endocervical curettage, the women scored their actual pain using a 10-cm visual analog scale (VAS).To measure the difference in VAS scores between two groups, a linear regression model was used. Binomial regression model was applied for comparing the probability of experiencing unbearable pain between the groups. Applying modeling approach allowed also for proper adjustment for other potential risk factors. The mean VAS score for the injection of the local anesthetic was 2.7, the VAS score for the cervical punch biopsy without local anesthesia was 3.5, and the difference was 0.8 (p = .017; 95% CI = 0.1-1.5). The mean VAS for the biopsy with local anesthesia was 0.8, which was significantly lower than the mean VAS for the biopsy without local anesthesia (difference = 2.7; p < .001; 95% CI = 2.2-3.3). The relative risk for experiencing moderate or severe pain (VAS ≥ 5) was 0.6 (p = .03; 95% CI = 0.3-0.9) for the injection of local anesthetic versus the biopsy without local anesthesia. Injection of a local anesthetic for colposcopy is less painful than biopsies without local anesthesia, and local anesthesia decreases the pain perceived.

Intra and Inter-Observer Variability of Transformation Zone Assessment in Colposcopy: A Qualitative and Quantitative Study.

Colposcopy is an important tool in the diagnosis of cervical precancer and early cancer. The assessment of women with abnormal cytology and selection of those who require further therapy or follow up depends on the colposcopic assessment of the Transformation Zone (TZ). Identification of the TZ is thus an important part of this examination. Intra and inter-observer variability is known to be relatively high in the colposcopic interpretation of abnormal features. However, there are hardly any studies on the observer variability in the assessment of the type of TZ. The present study was conducted with the aim to compare the intra and inter-observer variability of the TZ type classification and the Squamo-Columnar Junction (SCJ) visibility and to quantitatively measure the intra and inter-observer correlations of tracing of the TZ contours. Colposcopy images were obtained for a total of 170 cases. They were reviewed by three colposcopists independently. The colposcopists classified the TZ type and also marked the SCJ contours on the images. Each observer independently reviewed the cases on two different instances (few weeks apart) and the result was compiled for intra-observer variation. The intra and inter observer variability on the TZ type was compared using Cohen's Kappa. This was followed by a quantitative measurement of TZ observation variability using Hausdorff distance. The inter-observer agreement for the TZ type classification was moderate (Kappa= 0.53 to 0.66). The Intra-observer agreement was moderate to strong (0.60 to 0.86). Colposcopic in vivo examination increases the variability in the identification of the TZ when compared to the analysis of recorded images. The disagreement in the TZ type was mostly in categories Type 2 vs Type 3 followed by Type 1 vs Type 2. A computerized quantification method can be used for quality control and training purpose in colposcopy.

Dynamic Spectral Imaging Colposcopy

INTRODUCTION: Women with abnormal cervical screening results have colposcopic assessment that may include diagnostic biopsy or excisional treatment. We are evaluating the adjunctive use of Dynamic Spectral Imaging (DSI) that quantifies and maps the cervical acetowhitening during colposcopy. METHODS: IMPROVE-COLPO is an on-going two-arm study on patients referred for colposcopy according to current guidelines. A prospective arm collects outcomes of colposcopy with the adjunctive DSI. A second arm will collect a matched retrospective data-set of standard colposcopy outcomes for comparisons. Here we present prospective-arm data from two community clinics in Texas. Colposcopic predictions, DSI indications and biopsies are recorded and compared with histology, using Cervical Intraepithelial Neoplasia grade 2 (CIN2+) as the disease threshold for analysis. RESULTS: 131 patients were recruited between 12/2014 and 08/2015; 130 are included (data missing for one). Histological outcomes come from 162 punch and 95 endocervical biopsies and 24 treatment specimens. High-grade dysplasia was found in 16 patients (12.30%). Only 5 of them (31.25%) were predicted as high-grade when using standard visualization (without DSI), increasing to 14 (87.50%) with the adjunctive use of the DSI assessment. Colposcopy-directed biopsy found 10 and the adjunctive DSI-guided biopsies an additional 5 of the 16 CIN2+ patients. One case was identified by excisional treatment. CONCLUSION: The adjunctive use of the DSI mapping to predict high-grade dysplasia and select biopsy sites has led to statistically significant improvement in predictive performance and yield of CIN2+ (P=.002 and 0.025, respectively, McNemar chi-squared test).

Outcomes of a Decade of Routine Cervical Screening in a Canadian Adolescent Obstetrics Clinic

New recommendations from the Ontario Cervical Cancer Screening Program indicate that initiation of screening should be delayed to age 21. However, there is sparse evidence pertaining to pregnant adolescents. Our objective was to determine whether early cervical cancer screening in pregnant adolescents confers an advantage over delayed screening in the prevention of cervical carcinoma. We conducted a retrospective cohort study of cervical cancer screening in all pregnant adolescents receiving antenatal care through an obstetrics clinic for adolescents between 2000 and 2010. Clinic attendees had an antenatal and/or postpartum Pap smear, with follow-up according to standard recommendations. Results were recorded together with information on regression, persistence, or progression of abnormal cytology, colposcopy referrals, and cervical biopsies. There is a single regional colposcopy clinic. At least one Pap smear result was documented in 365 of the 388 patients. Of these 365 smears, 88 had abnormal cytology, 76 (86.4%) of which were reported as atypical cells of undetermined significance/low-grade squamous intraepithelial lesion, 11 (12.5%) high-grade squamous intraepithelial lesion (HSIL), and one atypical glandular cells (1.1%). Follow-up cytology was available for 78 patients. No patient lost to follow-up had subsequent referrals for colposcopic assessment in the region. Overall, cytologic abnormalities regressed in 75 (96.1%), persisted in two (2.6%), and progressed in one patient (1.3%). Twenty-three patients (of 365) required a total of 68 colposcopy visits and 17 biopsies, but ultimately only three loop electrosurgical excision procedures (LEEPs) and one laser vaporization were performed. Only one LEEP in a 20-year-old demonstrated HSIL. This population of pregnant adolescents had a high incidence of low-grade cervical abnormalities with a high rate of regression. Routinely screening these pregnant adolescents resulted in numerous repeat visits, repeat Pap smears, and colposcopy referrals, and led to patient anxiety and systemic costs. Not a single case of cervical cancer was prevented that would not otherwise have been identified by adherence to the new guidelines.

Osseous metaplasia of the cervix: A rare transformation.

Although numerous cases of endometrial osseous metaplasia appear in the literature, only 6 cases of osseous metaplasia of the cervix have been reported since 1982. A 30 years old nulligravida women was referred to our colposcopy clinic with cervical mass. General, gynecologic and colposcopic assessments were done. The patient had an excision biopsy. Diagnosis of cervical osseous metaplasia was confirmed on histologic examination. The cervical epithelium has the potency to differentiate to multiple types of epithelium including osseous epithelium.

Clinical significance of ASCUS and ASC-H cytological abnormalities: a six-year experience at a single center.

To evaluate colposcopic biopsy results of patients with cervical cytological findings of atypical squamous cells of undetermined significance (ASC-US) and atypical squamous cells with high-grade lesions that cannot be excluded (ASC-H). A retrospective evaluation of data from 358 patients, who had cervical cytological findings of ASC-US (n = 335) and ASC-H (n = 23), and had colposcopic assessments between 2005 and 2011. Cervical biopsy results of patients diagnosed with ASC-US cytology (n = 335) revealed cervical squamous cell carcinoma 0.9 % (n = 3) at biopsy, cervical intraepithelial neoplasia 3 (CIN 3) in 3.8 % (n = 13), cervical intraepithelial neoplasia 2 (CIN 2) in 1.1 % (n = 4), cervical intraepithelial neoplasia 1 (CIN 1) in 35.2% (n = 118), and benign lesions in 59 % (n = 197). Cervical biopsy results of patients diagnosed with ASC-H cytology (n = 23) revealed CIN 3 at biopsy in 39.3% (n = 9), CIN 2 in 21.7% (n = 5), CIN 1 in 26% (n = 6), carcinoma in situ in 8.7% (n = 2), and squamous cell cancer in one patient (4.3%). The cytological diagnosis of ASC-US may lead to the diagnosis of cervical intraepithelial lesion of higher grades as well as cervical cancer and should be evaluated by colposcopic cervical biopsy.

Colposcopic-histologic eligibility criteria for fertility-sparing surgical management in early-stage cervical cancer

The decision whether fertility-sparing surgical management may be successfully applied in women with cervical cancer who wish to preserve their fertility remains a great therapeutic challenge. Such management is possible if no node metastases are expected and the risk of cancer spread beyond the cervix is limited. Thus, precise evaluation of tumor size is necessary. The aim of the study was to establish cytologic, colposcopic and histologic eligibility criteria for fertility-sparing treatment in women with early-stage cervical cancer. The study included 119 women (aged 25-43 years) diagnosed and operated on due to malignant changes within the cervix. Each subject underwent cytologic and colposcopic examination, followed by histologic evaluation of a large, target section from the most suspicious area of the lesion. Histologic evaluation revealed stage IA1 in 60 (50.4%), IA2 in 53 (44.5%), and IB1 in 6 (5.1%) patients. Histologic compatibility between target sections and evaluation of the surgical material was 59 (98.4%), 51 (96.2%), and (100%) for stages IA1, IA2, and IB1, respectively Proper colposcopic assessment of early-stage invasive cervical cancer (IA) allows to identify the most adequate area for large wedge biopsy That in turn makes it possible to establish proper histologic pre-treatment diagnosis, with an over 95% compatibility with the final histologic evaluation, what conditions fertility-sparing surgical treatment.