Colposcopy Research Articles

Microendoscopy in vivo for the pathological diagnosis of cervical precancerous lesions and early cervical cancer

BackgroundCervical cancer is an important public health problem. Conventional colposcopy is inefficient in the diagnosis of cervical lesions and massive biopsies result in trauma. There is an urgent need for a new clinical strategy to triage women with abnormal cervical screening results immediately and effectively. In this study, the high-resolution microendoscopy combined with methylene blue cell staining technology was used to perform real-time in vivo imaging of the cervix for the first time.MethodsA total of 41 patients were enrolled in the study. All patients underwent routine colposcopy and cervical biopsy, and high-resolution images of methylene blue-stained cervical lesions were obtained in vivo using microendoscopy. The cell morphological features of benign and neoplastic cervical lesions stained with methylene blue under microendoscopy were analyzed and summarized. The microendoscopy and histopathology findings of the high-grade squamous intraepithelial lesion (HSIL) and more severe lesions were compared.ResultsThe overall consistency of microendoscopy diagnosis with pathological diagnosis was 95.12% (39/41). Diagnostic cell morphological features of cervicitis, low-grade squamous intraepithelial lesion (LSIL), HSIL, adenocarcinoma in situ, and invasive cancer were clearly demonstrated in methylene blue stained microendoscopic images. In HSIL and more severe lesions, microendoscopic methylene blue cell staining technology can show the microscopic diagnostic features consistent with histopathology.ConclusionsThis study was an initial exercise in the application of the microendoscopy imaging system combined with methylene blue cell staining technology to cervical precancerous lesions and cervical cancer screening. The results provided the basis for a novel clinical strategy for triage of women with abnormal cervical screening results using in vivo non-invasive optical diagnosis technology.

Cost-Conscious Colposcopy: A Single-Institution Review of Biopsy Submission Practices and Outcomes.

Distribution of cervical dysplasia may influence approach for excisional procedures. Separating colposcopy biopsies into multiple specimen cups for pathologic evaluation incurs additional costs. The authors aimed to determine whether the practice of separating biopsy specimens impacts patient outcomes. A retrospective review of all colposcopy cases from a single institution was performed. A total of 1,331 cases were reviewed from January 1, 2017, to December 31, 2019. Multibiopsy cohorts were separated by number of specimen cups received by pathology (single or multiple). Cohorts were compared for histology, need for excisional procedure, and final excisional pathology results. Specimen processing fees were acquired from the Department of Pathology ($70/specimen). Statistical analysis performed on MINITAB using Pearson chi-square and Fisher exact tests. Excisional procedures were required by 30.4% (86/283) of multiple specimen submissions compared with 28.2% (154/547) of single specimen cup submissions ( p = .50). There was a higher, although not statistically significant, rate of additional procedures in the multiple specimen cup cohort (8.8 vs 2.9% [ p = .08]). Malignancy diagnosis was equivalent in each cohort. Cost analysis revealed adopting a single specimen cup model would reduce costs up to approximately $30,000/year. Patient outcomes were not improved by the practice of submitting multiple specimen cups. Given the additional cost associated with separating specimens, the authors recommend during routine colposcopy that all cervical biopsies be sent for evaluation as a single pathology specimen unless a lesion of concern is identified in an area not normally excised during traditional excisional procedures.

Meta-analysis on the Diagnostic Performance of p16/Ki-67 Dual Immunostaining for Cervical Cancer Screening

Background: This article discusses cervical cancer and its higher incidence in LMIC compared to HIC due to limited resources and poor prevention strategies. It is preventable through early detection of persistent high-risk HPV infection, which is a critical promoter. Screening methods have evolved from pap smear cytology to HPV-DNA testing and currently to co-testing, but these methods still result in false positives and high colposcopy referrals. p16/Ki-67 dual immunostaining was proposed as a biomarker for cervical cancer triage due to its ability to detect HPV-mediated neoplastic transformation. The aim of the study was to evaluate the sensitivity and specificity of this dual staining method through a review and meta-analysis of published data.Material and Methods: The search was based on PRISMA guidelines using specific MeSH terms and keywords. The search was limited to publications that compared p16/Ki-67 dual immunostaining to Pap cytology and/or high-risk HPV-DNA and included colposcopy biopsy results as the diagnostic standard. The study focused on diagnostic performance outcomes such as sensitivity, specificity, and diagnostic odds ratio. To be eligible for meta-analysis, a publication must report the diagnostic performance at predicting CIN2+. Results: A total of 24 studies were included in the review and 21,450 samples were used for dual immunostaining. The results showed that dual immunostaining was significantly more sensitive than pap cytology (75.9% compared to 71.1%) and had a higher specificity (79.7% compared to 64.3% for pap cytology and 48.9% for HPV-DNA). A meta-analysis showed that dual immunostaining had a higher pooled diagnostic odds-ratio compared to pap cytology and HPV-DNA, indicating a better test power. Conclusions: The study suggested that dual immunostaining is a better approach for detecting HPV-induced cervical cancer compared to traditional screening methods. The authors suggest that despite its reduced sensitivity, dual immunostaining should be considered as a promising alternative, especially in large-scale testing.

The Relationship between Cervical Smear and HPV Results with Colposcopic Biopsy Results

The Relationship between Cervical Smear and HPV Results with Colposcopic Biopsy Results

Comparison of the Clinical Performance of Aptima HPV Assay and the Cobas 4800 Platform in Women with Normal Cytology and Positive High-Risk HPV

Introduction: According to the current American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines, patients with normal cytology results may be referred for colposcopy according to their high-risk human papillomavirus (hrHPV) test results. A higher positive predictive value (PPV) of hrHPV has significance for preventing unnecessary colposcopic examinations. Several studies have compared the performance of the Aptima assay and the Cobas 4800 platform among patients who had minor cytologic abnormalities. However, in our English literature search, we found no other study that had been conducted to compare these two methods in patients with normal cytology. We thus aimed to compare the PPV of the Aptima assay and the Cobas 4800 platform among women with normal cytology. Methods: Between September 2017 and October 2022, we retrospectively identified 2,919 patients who had normal cytology and hrHPV positivity and had been referred for a colposcopy. Among them, 882 agreed to undergo a colposcopy; on examination, 134 had target lesions revealed and underwent a colposcopic punch biopsy. Results: Among the patients who underwent a colposcopic punch biopsy, 49 (38.9%) were tested with Aptima, and 77 (61.1%) were tested with Cobas. In the Aptima group, 29 (59.2%) patients showed benign histology, 2 (4.1%) patients had low-grade squamous intraepithelial lesions (LSILs), and 18 (36.7%) patients had ≥high-grade squamous intraepithelial lesions (HSILs) biopsy results. The false-positivity rate and PPV of Aptima were 63.3% (31/49) and 36.7% (95% confidence interval [CI]: 0.232–0.502), respectively, for a histopathologic diagnosis of ≥HSIL. In the Cobas group, 48 (62.3%) biopsies were benign, 11 (14.3%) reported an LSIL, and 18 (23.4%) biopsies were ≥HSIL. The false-positivity rate and PPV of Cobas were 76.6% (59/77) and 23.4% (95% CI: 0.139–0.328), respectively, concerning a ≥HSIL tissue diagnosis. The false-positivity rate of Aptima HPV 16 positivity was 40% (4/10). The false-positivity rate of Cobas HPV 16 positivity was 61.1% (11/18). The PPVs of HPV 16 positivity for Aptima and Cobas were 60% (95% CI: 0.296–0.903) and 38.9% (95% CI: 0.163–0.614), respectively, concerning ≥HSIL tissue diagnosis. Conclusion: We recommend analyzing the performances of hrHPV platforms in future, larger studies in patients with normal cytology rather than only in cases with abnormal cytology.

Prevalence of HPV and Assessing Type-Specific HPV Testing in Cervical High-Grade Squamous Intraepithelial Lesions in Poland.

The prevalence and distribution of oncogenic human papillomavirus (HPV) genotypes in women who underwent screening for cervical cancer in the Wielkopolska region, Poland, were assessed, and the correlation of genotypes with the histological results was evaluated. Cervical samples were collected from 2969 women for cervical cancer screening. Participants were screened by liquid-based cytology and HPV genotyping (n = 1654) and referred to colposcopy and punch biopsy (n = 616) if recommended. HPV genotypes 16, 31, 52, 66, 53, and 51 are the most frequent types in the studied population. Genotypes 16 and 31 account for nearly one-fifth of the infections of diagnosed HPV infections. HPV 16, 31, and 52 are found in nearly 80% of premalignant HSIL lesions (CIN 2 and CIN 3). That leads to the conclusion that vaccination programs should cover as many types of HPV as possible and shows the urgent need to vaccinate the Polish population with a 9-valent vaccine.

Effects of photodynamic therapy in the treatment of high-grade vaginal intraepithelial lesions following hysterectomy and HPV infection

BackgroundNon-invasive treatment therapy, such as 5-Aminolevulinic acid photodynamic therapy (ALA-PDT), has gained attention for its effect on select cervical and vaginal lesions. To investigate the effect of ALA-PDT on high-grade vaginal intraepithelial lesions (HG VAIN) after hysterectomy and high-risk human papillomavirus (HR-HPV) infection, in this study, we evaluated the clinical efficacy and safety of ALA-PDT in 23 patients with HG VAIN following hysterectomy and HPV. Methods23 patients with HG VAIN after hysterectomy were selected for photodynamic therapy, and the therapeutic effect, adverse reactions, recurrence rate and HPV clearance rate were analyzed respectively. The patients were followed up at 3, 6, 9, and 12 months after ALA-PDT. HPV, thinprep cytologic test (TCT) and reid colposcopic index (RCI) score should be performed 3 months after treatment. When the RCI score is higher than or equal to 3, a colposcopy biopsy should be conducted, the additional ALA-PDT should be continued if residual lesions were detected. When the RCI score is lower than or equal to 2, HPV and TCT should be reviewed every 3 months. ResultsAfter 3 months of photodynamic therapy, 21 patients were cured, with the cure rate of 91.3% (21/23). Two patients (8.7%) had residual lesions, which had degraded compared with the previous. After treatment, the overall HR-HPV clearance rate was 56.5% at 3 months, 65.2% at 6 months, 69.5% at 9 months, and 74% at 12 months. No obvious adverse reactions were found during and after treatment. Moreover, no recurrence occurred during the whole follow-up period. ConclusionsCompared with other therapies, ALA-PDT is a novel therapy with non-invasive procedure in HG VAIN after hysterectomy. ALA-PDT can be used for the treatment of HG VAIN after hysterectomy, moreover, it can not only effectively clear HR-HPV, but also can prevent the recurrence and progression of vaginal lesions caused by persistent HR-HPV infection.

Analysis on the Effect of Radiofrequency Ablation and Electrocautery in the Treatment of Vaginal Intraepithelial Neoplasia.

This research intends to investigate the clinical efficacy of radiofrequency ablation and electrocautery in treating grade I or II vaginal intraepithelial neoplasia (VaIN). This is a single-center retrospective study, which collected the clinical data of 100 patients with VaIN diagnosed by colposcopy and pathological biopsy in the Gynecology and Cervical Center of Xiangzhu Branch of the Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region between January 2020 and June 2021. Patients were divided into the study group (radiofrequency ablation treatment) and the control group (electrocautery) according to differences in treatment approaches. 6- and 12-month follow-ups were performed on all patients. Gynecological examination results, liquid-based thin-layer cytology (TCT), negative conversion of human papillomavirus (HPV), curative effects, and prognosis were recorded. All patients completed regular follow-ups that lasted for 6 and 12 months. The 6- and 12-month cure rates of the study group were 76.0% and 92.0%, respectively, and the data in the control group were 70.0% and 82.0%, respectively. In terms of the 6- and 12-month negative conversion rates of HPV, the data in the study group were 68.0% and 78.0%, versus 60% and 68% in the control group, respectively. The lesion duration rate showed no statistical significance between the study group (8.0%) and the control group (P > 0.05). The analysis of postoperative follow-up complications revealed that the study group had a statistically lower overall incidence of vaginal bleeding, excessive vaginal discharge, vaginal burning sensation, and decreased vaginal elasticity than the control group (8.0% vs. 24.0% P < 0.05). Both radiofrequency ablation and electrocautery have obvious clinical effects in patients with grade I or II VaIN, but the former contributed to fewer operative complications and a good prognosis, which deserves clinical promotion.

Clinical and Morphological Study of Cervical Squamous Intraepithelial Lesions.

Squamous intraepithelial lesions (SILs) are cancer precursors targeted by secondary prevention of cervical cancer programs that are sometimes difficult to grade accurately. Mena is an actin regulatory protein involved in membrane protrusion, cell motility, in tumor invasion and metastasis. We studied retrospectively 68 cases of patients diagnosed with squamous intraepithelial lesions that received expedited treatment (treatment without colposcopic biopsy). We analyzed demographic, behavioral data, obstetrical and medical history, from the patients' medical charts and we studied the cervical fragments or cones harvested after the excisional procedure. Our study failed to identify a correlation between SILs and risk factors such as low socioeconomic status, combined oral contraceptive use, intrauterine device use, parity, gravity, except for the tobacco smoking habit that proved to be related to the cervical lesions' development. Mena was expressed in most of the analyzed SILs and its expression was correlated with lesions' grade in terms of both area and intensity, suggesting that Mena stains especially abnormal cells and that its expression intensity correlates with the risk of malignant transformation. Further studies are needed to validate Mena as an early stage of cervical carcinogenesis marker.

COLPOSCOPIC EVALUATION OF POST-MENOPAUSAL WOMEN WITH NORMAL CERVICAL CYTOLOGY

1. Introduction The most common genital cancer seen in Indian women is Carcinomacervix Its incidence is approximately 1 in 53 Indian women during their lifetime compared to 1 in 100 in developed countries. In women ≥ 50 years where the lifetime risk of cervix cancer is estimated as 3.5%, which can be reduced to 0.8% with screening. Pap smear evaluation alone is inadequate for predicting the precancerous lesions in postmenopausal women due to hypoestrogenic changes of menopause which makes it difcult to differentiate atrophic cellular changes from other pathologic conditions, giving more false negative results which can be reduced if combines with colposcopy examination and guided biopsy wherever needed 2. Aim &amp; Objective To diagnose intraepithelial lesions in postmenopausal patients with normal cytological ndings and to assess the usefulness of cytological screening, colposcopy, and colposcopy-directed biopsy in these patients. 3. Material And Method- A retrospective study was carried out from 1st January 2018 to 31 October 2022 at a colposcopy clinic, in district Shivpuri M.P. on 104 post-menopausal females of age group 45-68 years. After detailed history and examination, a pap smear in all 104 patients was taken. All patients with negative cytology reports for Intra epithelial lesions with persistent symptoms and suspicious signs were subjected to colposcopy. 23 Patients with positive Colposcopic ndings were subjected to Colposcopic guided biopsy. histopathological evaluation was done. 4. Result This study analyzed 104 postmenopausal patients who had Pap smear reports with NILM (Negative for intraepithelial Lesion or Malignancy). 58% of the patients were referred by other Doctors. The most common post-menopausal age group nd in this study was between 45-55 (52.88%), Most of the patients were of a low socioeconomic group (54.81%), Multipara (3-5 parity 66.35%). with a history of menopause of 5-10 years (49.04%) duration. Only 5.77% of patients had 3 Pap smear reports with them, and a history of smoking was present in 6.73% of cases. The most common presenting symptom was discharge PV (47.11%) followed by Foul smelling bloody discharge (14.42%). Post-coital bleeding (12.5%), Post-menopausal bleeding (8.65%), and dyspareunia (4.80%). On colposcopy, (77.89%) of cases had normal Colposcopic ndings while (22.11%) had abnormal Colposcopy ndings. In 17.30% of cases, LSIL was suspected, in 4.80% of cases HSIL was suspected on colposcopy Colposcopy-guided biopsy was done in 23 (22.11%) patients with suspected CIN. On histopathology 9.61% of cases were positive for intraepithelial lesions, CIN1 was found in 7.69%, and CIN2 in 1.92%. Carcinoma in situ and Invasive carcinoma were not found in any case. 10(9.61%) out of 104 patients had cervical intraepithelial neoplasia diagnosed on colposcopy-guided biopsy and histopathology report. 5. Conclusion- In our study, despite the Pap smear report as NILM (Negative for intraepithelial lesion or malignancy). ,10(9.61%) out of 104patients had cervical intraepithelial neoplasia diagnosed on colposcopy guided biopsy, thus we recommend, the combined use of cervix cytology, colposcopy, and histopathology in postmenopausal cervix cancer screening evaluation to improve the diagnosis of the cervical intraepithelial lesion.

Analysis of the current situation and related influencing factors of cervical precancer screening under the COVID-19

ABSTRACT Objective: This study aims to compare the results of cervical cancer screening in Shanghai General Hospital before and after the COVID-19 epidemic, and analyze the current status and related influencing factors of precervical cancer screening in our hospital under the COVID-19 pandemic. Methods: The data of 13,748 women of cervical precancer screening with HPV in Shanghai General Hospital were selected.The data included human papillomavirus (HPV), thin-layer liquid-based cytology test (TCT), colposcopy and cervical biopsy, and pathological diagnosis results after trachelectomy in 2019 and 2020, and were analyzed and compared. Results:The detection rates of precancerous lesions and cervical cancer were 2.9061/10,000 and 29.26/10,000 respectively. There was a significant difference in the rate of comparison (χ 2 = 30.361, P = 0.000; χ 2 = 7.682, P = 0.006);(2) Missing detection rate: In 2020, other positive subtypes other than HPV 16 and 18 who need TCT, the colposcopy, and the histopathological examination missing detection rate were higher than those in 2019 (P < 0.05);(3) Abnormal rate of examination: the abnormal rate of HPV, TCT, and histopathology in 2020 was higher than those in 2019 (P < 0.05);(4) Histopathological analysis: The detection rate of high-grade lesions and invasive cancer in 2020 was higher than those in 2019, and the detection rate of low-grade lesions was lower than that in 2019 (P < 0.05); Conclusion: Health authorities should formulate intervention measures to cope with the safe and timely implementation of cervical cancer screening and subsequent follow-up management during public health emergency.

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.

Pap Smear and Colposcopic Examination of the Cervix in Pelvic Inflammatory Disease and other Gynaecological Conditions: A Prospective Analytical Study

Introduction: Pap smear and colposcopy are commonly done procedures in gynaecology practice. The Pap test is a low-cost, straight forward, and widely used tool for detecting cervical cancer and preinvasive cervical abnormalities. Colposcopy is also widely used to detect Cervical Intraepithelial Neoplasia (CIN) to guide cervical biopsy sites with clinical symptoms of suspected cervical diseases. Aim: To evaluate the diagnostic implications of Pap smear and colposcopy in inflammatory cellular changes and to estimate the incidence of Cervical Intraepithelial Neoplasia (CIN)/invasive carcinoma in the study population through biopsy. Materials and Methods: This prospective analytical study was conducted at JNU Medical College, Jaipur, India, where Pelvic Inflammatory Disease (PID), and other gynecology Out Patient Department (OPD) patients without any previous diagnosis of cervical malignancy, were included in the study. A total of 150 study patients, underwent Pap smear and colposcopic examination with biopsy as the gold standard. Descriptive analysis of data was done using means and standard deviation for continuous variables and nominal variables as frequencies. The Chi-square test was applied to categorical variables to find out the association and Receiver Operating Characteristic (ROC) analysis was done to predict the diagnostic ability of Pap smear, and colposcopy in cervical pathology. Results: The mean age of the patient population was 36±3 years. The mean age at first coitus and marriage of all the women were 18.9±2.7 years and 19.5±3.4 years, respectively. Twenty (13.3%) and 5 (3.3%) cases were reported as CIN and carcinoma, respectively after colposcopic biopsy. Pap smear results showed a sensitivity of 87.7% and a specificity of 78.2%. The Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were 72.8% and 68.7%, respectively. Sensitivity of the colposcopic report was 89.4% and the specificity was 98.8%. The PPV is 96.6% and NPV is 82.3% for colposcopic report. Conclusion: This study suggested that PID and gynaecology OPD patients can be better targeted with a good opportunity for screening the potential premalignant changes in the cervix by using Pap smear and colposcopy.

Could HPV Type 33 Be More Risky Than We Thought?

Objective: The distribution of human papilloma virus (HPV) genotypes varies by country and region. HPV is the most important risk factor for cervical cancer and HPV 16/18 is the most common genotype. Other high risk HPVs (hrHPVs) other than HPV 16 and 18 contribute significantly to invasive disease. In this study, we aimed to reveal the frequency of association of HPV 16, 18 and other high-risk-HPV types with CIN 2 + (CIN 2 and above) cervical lesions in patients with cervical intraepithelial neoplasia (CIN) and to support the literature especially on the management of high-risk-HPV types other than 16 and 18. Materials and Methods: This retrospective study, which was conducted on 264 patients and 202 patients after the exclusion criteria, was conducted in the gynecology oncology outpatient clinic of the tertiary care hospital between March 2020 and May 2022. HPV 16, HPV 18 and other high-risk-HPV types with negative cytology between the ages of 25-65 were compared by taking a biopsy accompanied by colposcopy performed by the same gynecologist. As a result of colposcopy, CIN2 + patients who underwent excisional procedure were distributed according to HPV type. During this procedure, the patients who were positive for more than one HPV type were considered positive for the group with all subtypes (For example, if the patient was type 31 and 33 positive, they were included in both the 31 and 33 positive groups). The genotype distribution in the high-risk-HPV group was examined. Results: Colposcopy results showed HPV 16 positivity in 43.3%, HPV 33 positivity in 30% and HPV 18 positivity in 10% of the patients with CIN2 + and above lesions. It was observed that the incidence of CIN2 + lesions in the patients with HPV 33 positive was higher than the incidence of a lower-grade lesion (such as CIN1, chronic cervicitis) (p < 0.05). While HPV 33 (r = 0.290, p < 0.000) results were positively correlated with CIN2 + and above lesions, there was a negative correlation with HPV 45 (r = - 0.172, p < 0.015) results (p < 0.05). It was observed that HPV 33 and HPV 45 positivity was a statistically significant variable in predicting the probability of CIN2 + lesions in colposcopy results. It was determined that a HPV 33 positive patient increased the probability of having a CIN2 + lesion by 4.999 times (p < 0.000). Conclusion: In the literature, the role of high-risk -HPV types other than HPV 16 and HPV 18 with negative cytology in the women at risk of cervical preinvasive lesions has still not been fully determined. According to the results of the stuy, especially in women infected with high-risk -HPV types other than HPV 16/18, the relationship between HPV 33 type and CIN 2 + lesions was found to be high, and it was seen that colposcopic biopsy should be performed immediately instead of follow-up after 1 year.

Evaluation of the diagnostic accuracy of the cervical biopsy under colposcopic vision.

This study was conducted to evaluate the diagnostic accuracy of the cervical biopsy under colposcopic vision. This retrospective study was performed on 190 women, who were selected from a total of 412 cases referring for colposcopy in one year. All patients underwent colposcopy and loop electrosurgical excision procedure (LEEP). After the investigation of demographic characteristics and data confirmation, colposcopic characteristics were examined. Then, the diagnostic indicators and diagnostic accuracy of the cervical biopsy under colposcopic vision were determined. The mean age of patients was 35.51± 5.91 years. In smokers, the percentage of cancer and CIN3 cases was higher than in normal individuals, and this difference was statistically significant in terms of the frequency of cancerous lesions (P = 0.2). A comparison of colposcopic biopsy with LEEP has shown that the frequency of advanced cases in LEEP has been detected more, and the correlation coefficient (kappa) indicated the weak agreement between the findings of colposcopically directed biopsy (CDB) and LEEP methods. (k = 0.23). The diagnostic accuracy of the cervical biopsy under colposcopic vision for cervical cancer is effectively high. It is recommended that this procedure be performed to diagnose cancerous lesions; however, contrary to what is seen in colposcopy, malignant cases may be spreading and follow-up of patients can affect therapeutic performance.

Value of TCT combined with HPV and CA125 in early cervical cancer screening in a medical examination population.

This research aimed to explore the clinical value of thin prep cytologic test (TCT) combined with human papillomavirus (HPV) and carbohydrate antigen 125 (CA125) in early cervical cancer screening in the physical examination population. For this purpose, a total of 3587 females who received gynecological physical examination in the outpatient department of Ganzhou people's Hospital from January 2018 to March 2022 were included and underwent TCT, HPV and carbohydrate antigen 125 upon admission. Colposcopy biopsy was performed on patients who tested positive for any of the three indicators. Then using pathological diagnosis as the gold standard, the three methods applied alone or in combination were evaluated in terms of sensitivity, specificity, diagnostic yield and Youden index. Results showed that Among the 3587 females, 476 (13.27%) were HPV positive, 364 (10.14%) CA125 positive, and 314 (8.75%) TCT positive. Furthermore, 738 tested positive for any of the three indicators and underwent cervical biopsy. Among the 738 cases, 280 (39.94%) developed chronic cervicitis, 268 (36.31%) low-level cervical intraepithelial neoplasia (CIN), 173 (23.44%) high-level CIN, and 17 (2.30%) cervical cancer. HPV+TCT+CA125 combined screening showed higher sensitivity (94.54%), specificity (83.92%), diagnostic coincidence rate (87.46%) and Youden index (0.760) than single-indicator examinations. Also, it had the largest area under the receiver operating characteristic (ROC) curve, 0.673 (0.647, 0.699), compared to any other screening method. In conclusion, The combined detection of CA125, HPV and TCT is of clinical significance due to its higher sensitivity and accuracy in early screening of cervical cancer in the physical examination population.

The possibilities of opportunistic cervical screening in the assisted reproductive technology clinic

Secondary prevention of cervical cancer in the conditions of opportunistic cervical screening by co-testing in 5618 women over 30 years of age allowed to identify a high-risk group of cervical cancer for further examination using viral load assessment, immunocytochemical determination of the level of cancer proteins p16INK4a and Ki-67, extended video colposcopy and cervical biopsy with histological examination of surgical material. The obtained data demonstrated the expediency of changing the testing strategy by integrating the methods tested in the framework of opportunistic screening into the nationwide population screening program for cervical cancer.

Comparison of downstaging, pap smear, colposcopy and colpo-directed biopsy in the detection of cancer cervix

Cancer cervix accounts for 80% of female genital cancer and is the most common genital cancer. India accounts for 27% of the incidence all over the world. The mortality due to cancer cervix is 14.7%. To assess the reliability of downstaging in early detection of the precancerous lesion. To correlate the findings in 110 women with unhealthy cervix by cytology, colposcopy directed biopsies. The work was carried out continuously over one year and 2 months. 110 women were evaluated. When Cytology was compared with Colposcopy, Cytology had only 38.8% sensitivity. Cytology showed higher specificity (98.4%). 95% of the patients with abnormal Cytology had abnormal colposcopy. Colposcopy showed a sensitivity of 96.3% and a specificity of 72.3%. Sensitivity was more than a Pap smear, but specificity was less than a pap smear. Thus, colposcopy offers an excellent tool for evaluating cervical lesions. It is an easy and perspective method, and its importance lies in teaching, diagnosis and management of cervical lesions, neoplastic and non- neoplastic.

Evaluation of the relationship between Doppler predictors with human papillomavirus types, smear and cervical biopsy results

Objectives: The study aims to investigate whether there is any difference between human papillomavirus (HPV) types, smear results, and colposcopic biopsy results in terms of iliac, uterine, and cervical artery pulsatility and resistive index values in high-risk HPV positive patients.Methods: Iliac, uterine, and cervical artery pulsatility and resistive index values were determined by pelvic Doppler ultrasonography in patients who applied for high-risk HPV positivity and underwent colposcopyguided cervical biopsy. Results: There was no difference between HPV types and Pap-smear results and the pulsatility and resistive indices of the iliac artery, uterine artery, and cervical artery. It was observed that the mean cervical artery pulsatility index of the patients whose colposcopic cervical biopsy result was cervical intraepithelial neoplasia (CIN) 1 was 1.61 ± 0.43 and the cervical artery pulsatility index of the patients with CIN 2-3 was 1.15 ± 0.28, and a statistically significant difference was found between them (p = 0.038). There was no difference between other Doppler indices and colposcopic cervical biopsy results. Conclusions: Doppler indices such as cervical artery pulsatility index may be helpful in the evaluation of cervical cancer precursor lesions.

Diagnostic Utility of Endocervical Curettage During Colposcopy Among Patients of Varying Risk Factors.

Endocervical curettage (ECC) during colposcopy is recommended in certain circumstances; however, diagnostic use remains unclear. We evaluate the utility of ECC among patients with non-fully visualized squamocolumnar junction (SCJ) and certain patient socioeconomic factors. Retrospective chart analysis was completed for patients aged older than 21 years who underwent a colposcopy at 2 study sites between 2012 and 2021. Demographics and histopathologic results were analyzed. A total of 1,516 colposcopies were reviewed; 73.8% (n = 1,119) had an ECC with colposcopy. Of those, 92.1% (n = 1,031) had benign ECC whereas 13.9% (n = 156) had a positive ECC at time of colposcopy. Most patients with benign ECC had benign/low-grade squamous intraepithelial lesion pathology on colposcopy biopsy (82.3%; n = 914; p < .001), and most patients with high-grade squamous intraepithelial lesion (HSIL) on ECC had HSIL on colposcopy biopsy (63.4%; n = 52; p < .001) However, when looking at patients with high-grade pathology on colposcopy biopsy, it was seen that most had benign or low-grade squamous intraepithelial lesion on ECC (79.5%; n = 205; p < .001). Most patients with adequately visualized SCJ on colposcopy were noted to have HSIL on biopsy and negative ECC (73%; n = 81; p < .001). This result was similar in patients with non-fully visualized SCJ, although not statistically significant. When stratified by socioeconomic status, most patients with high-grade lesions had a benign ECC. Endocervical curettage has been described to increase the identification of high-grade lesions at time of colposcopy. This descriptive study shows that many high-grade lesions at time of excisional procedure had a benign ECC on colposcopy, with no demonstrated clear additional utility in high-risk groups.