Colposcopic Cervical Biopsy Research Articles

Analysis of the clinical characteristics and surgical methods of high-grade squamous intraepithelial lesions of the cervix in postmenopausal women: A retrospective case study.

The purpose of this study was to thoroughly evaluate the clinical features and surgical options for high-grade squamous intraepithelial lesions (HSIL) in postmenopausal women. A total of 308 patients diagnosed with HSIL through colposcopic cervical biopsy and endocervical curettage were included. Their clinical characteristics, surgical treatments, and postoperative pathology were analyzed. Key findings include: 1. Patients with positive preoperative thinprep cytologic test (TCT) results and postoperative pathology indicating HSIL or squamous cell carcinoma (≥HSIL) were significantly more frequent than those with negative preoperative TCT results (P < .05). 2. Univariate analysis indicated significant impacts of TCT, human papillomavirus (HPV) type, transformation zone (TZ) location, and surgical technique on postoperative pathology (P < .05). 3. Logistic regression analysis confirmed significant influences of TCT, HPV type, TZ location, and surgical method on postoperative pathology outcomes (P < .05), showing that each unit increase in TZ raised the probability of ≥HSIL in postoperative pathology by 49.7%. In surgical comparisons, cold knife conization (CKC) and extrafascial hysterectomy resulted in 8.379 and 4.427 times higher probabilities of ≥HSIL in postoperative pathology, respectively, compared to loop electrosurgical excision procedure (LEEP). 4. Surgical methods significantly influenced margin results (P < .05). After LEEP, 17.5% of cases had positive margins, compared to 9.4% after CKC, and 3.7% after extrafascial hysterectomy, indicating the highest rate of positive surgical margins occurred with LEEP. 1. Combined TCT and HPV screening is crucial for cervical cancer prevention, early detection, and management in postmenopausal women. Women with positive results for both TCT and HPV should undergo colposcopic cervical biopsy and endocervical curettage. 2. For patients with TZ3, CKC is the recommended surgical option. 3. CKC is the preferred treatment for postmenopausal women with HSIL, as it effectively diagnoses and treats the lesion, showing superior outcomes in managing postmenopausal HSIL.

Assessment of Cervicovaginal Smear and HPV DNA Co-Test for Cervical Cancer Screening: Implications for Diagnosis and Follow-Up Strategies.

Cervical cancer is a major cause of cancer-related mortality, necessitating effective screening and diagnostic methods. This study aimed to assess the performance of cervicovaginal smear (CVS) and human papillomavirus (HPV)-DNA co-test. The pathology results of 225 female patients who underwent HPV-DNA testing with CVS between 2014 and 2022 and were subsequently diagnosed by colposcopic cervical biopsy or second CVS were retrospectively analyzed. CVS samples showed atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL), and cervical cancer. Concordance between the first and second diagnoses demonstrated moderate agreement for LSIL. ASCUS cases exhibited a significant correlation with HPV-DNA positivity and higher-grade cervical lesions. In biopsy, sensitivity and specificity for CIN1/LSIL were 87.5% and 53.3, respectively, while for CIN2-3/HSIL, they were 83.87% and 58.49%. HPV testing showed significant correlation with histopathologic results. In women over 40 years, more intraepithelial lesions were diagnosed compared to younger women (p < 0.005). The conventional smear technique proved reliable in detecting high-grade lesions. Despite the limitations of our study, our results emphasize the value of HPV-DNA testing to avoid unnecessary interventions and to establish appropriate follow-up strategies.

Does the New National Cervical Screening Programme Guideline Detect Cases of High-Grade Squamous Intraepithelial Lesions That Previously Would Have Been Missed?

The aim of this study was to determine the number of patients undergoing large loop excision of the transformation zone (LLETZ), for biopsy-confirmed high-grade squamous intraepithelial lesions (HSIL), where the original cervical screening test (CST) reported oncogenic human papillomavirus (HPV) and negative liquid-based cytology (LBC). This reflects the number of patients where a LLETZ procedure would not have occurred under the previous guideline. Retrospective observational chart review of all patients (n = 477) who underwent LLETZ procedure in a single tertiary unit over a 36-month period. Prevalence of negative histopathology, positive margins, incidental cervical cancer, and accuracy of HSIL identification at colposcopy were measured. Diagnostic accuracy of HSIL diagnosis from initial colposcopic impression was calculated; factors influencing accuracy were evaluated using multivariable logistic regression analysis. There were no comparators. Of 477 LLETZs, 5.9% (n = 28) were for oncogenic HPV and normal LBC on referral CST. Demographics between the "study" (oncogenic HPV and normal LBC on referral CST) and the "standard" group were similar, except the study group was less likely to be using contraception (25% vs 47%, p = .023). In the study group, initial colposcopic cervical biopsy confirmed HSIL in 91.6% (n = 27) and low-grade squamous intraepithelial lesions in 3.6% (n = 1). Histopathological analysis of LLETZ specimens confirmed HSIL in 20 patients (71.4%) and low-grade squamous intraepithelial lesions in 2 (7.1%). No microinvasion was detected. The renewed National Cervical Screening Programme (NCSP), is detecting more "at risk" patients, predicted to lead to a further reduction in incidence of cervical cancer in adequately screened patients.

The role of multiple high-risk human papillomavirus infections for cervical biopsies and findings in colposcopic procedures

The clinical outcome of high-risk HPV (hr-HPV) infection varies according to genotype(s). Patients may harbor either one single hr-HPV (s-HPV) or multiple HPV (m-HPV) genotypes. Recently, the relationship between m-HPV infections and high-grade dysplasia has been investigated, and controversial results have been obtained. Therefore, the clinical significance of m-HPV is not clear. This study aimed to evaluate which group is associated with higher grade dysplasia by analyzing colposcopic punch biopsies. A total of 690 patients who were scheduled for a diagnostic excisional procedure between April 2016 and January 2019 due to the detection of high-grade cervical intraepithelial neoplasia (CIN 2/3) in colposcopy were included. Patients who were not scheduled for colposcopic examination or cervical punch biopsy, or who were scheduled for an excisional procedure due to smear-biopsy incompatibility or persistent low-grade dysplasia were excluded. Patients with a negative HPV test and an unknown HPV genotype were also excluded. Among the patients scheduled for excision (n=404), 74.5% had a s-HPV and 25.5% had a m-HPV infection. The proportion of CIN 1, 2 and 3 per patient in the m-HPV group was significantly higher than the s-HPV group (p=0.017). When this analysis was made for the number of CIN 2+3 per patient in the s-HPV and m-HPV groups, it was 1.29 (389/301) and 1.36 (140/103), respectively, and no difference was found (p=0.491). Patients in the m-HPV group, who underwent more colposcopic cervical biopsies, had higher numbers of CIN lesions, regardless of age and cytology results.

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.

Does intravenous lidocaine added to nonsteroidal anti-inflammatory drugs reduce pain during colposcopy? A prospective randomized double-blind study.

In recent years, lidocaine infusion for pain management during long operations is becoming more widespread in anesthesiology practice. However, only a limited number of studies have reported the intravenous use of lidocaine for short-term interventions. The aim of this study was to investigate the effectiveness of intravenous lidocaine use in pain management during colposcopic cervical biopsy and endocervical curettage (ECC). Patients between the ages of 18 and 65 years with abnormal cytological findings or who were determined to be human papillomavirus (HPV)-positive were included in this randomized double-blind study. The lidocaine group (Group L, n = 30) was intravenously administered 50 mg dexketoprofen + 1.5 mg/kg lidocaine in 10 mL saline for 3 min 30 min before the procedure. The control group (Group C, n = 30) was intravenously administered 50 mg dexketoprofen in 10 mL saline for 3 min, 30 min before the procedure. During the procedure, pain scores were assessed using the visual analogue scale (VAS). In addition, patients, operator satisfaction and duration of procedure were assessed. There were no differences in the demographic data of the groups. Pain scores during biopsy and ECC were significantly lower in Group L than in Group C (p < 0.001). The duration of the procedure was significantly shorter in Group L than in Group C (5.00 ± 0.78 vs 6.12 ± 1.16, respectively; p < 0.001). Patient and operator satisfaction were significantly higher in Group L than in Group C (p < 0.001). Intravenous lidocaine administration can be used as an alternative approach to reduce pain and increase operator and patient satisfaction during colposcopy-directed biopsy and ECC procedures in office settings.

Number of colposcopic cervical biopsies and diagnosis of cervical intraepithelial neoplasia: a prospective study

Number of colposcopic cervical biopsies and diagnosis of cervical intraepithelial neoplasia: a prospective study

Number of colposcopic cervical biopsies and diagnosis of cervical intraepithelial neoplasia: a prospective study

Number of colposcopic cervical biopsies and diagnosis of cervical intraepithelial neoplasia: a prospective study

Clinical analysis of cervical intraepithelial lesion in postmenopausal women

Objective: To investigate the pathological escalation after cervical cone resection in postmenopausal women, and analyze the related influencing factors. Methods: A retrospective cohort study was conducted at the Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University between July 2013 and January 2015. Seven hundred and fifty cases of cervical cone-cut were enrolled in this study, 129 cases of them were postmenopausal women, and 621 were premenopausal women. All results of patients' liquid-based thin-layer cytology (TCT) , HPV test, colposcopy and biopsy pathology, cervical cone resection and postoperative pathological examination were collected. Then the compliance with the pathological examination results after colposcopic cervical biopsy and cervical cone resection, and the related factors affecting the pathological escalation after cervical cone resection were analyzed. The pathological escalation of patients with different menopausal conditions after cervical cone resection was also analyzed. Results: (1) Of the 750 patients, there were 329 patients had the same pathological examination results after colposcopic cervical biopsy and cervical cone resection, which accounted for 43.9% (329/750) . And 216 cases demonstrated pathological escalation after cervical cone resection, which accounted for 28.8% (216/750) . The results of TCT examination and menopause were significantly correlated with the pathological escalation after cervical cone resection (P<0.05) . However, the condition of HPV infection was unrelated to pathological escalation after cervical cone resection (P>0.05) . (2) Compared with the different results of TCT examination [including non-intrusive load monitoring (NILM) , atypical squamous cell of undetermined signification (ASCUS) , low-grade squamous intraepithelial lesion (LSIL) , high-grade squamous intraepithelial lesion (HSIL) ], the ratio of pathological escalation after cervical cone resection was not statistically significant difference between postmenopausal and non-menopausal patients (P>0.05) . The proportion of pathological escalation of patients with >5 years of menopause was significantly higher than that of patients with menopause time ≤5 years (40.3% vs 27.7%, OR=1.8, 95%CI: 1.1-2.8, P=0.029) . Among them, when the result of TCT examination was LSIL, the rate of pathological escalation in patients > 5 years of menopause was significantly higher than that in menopause time ≤5 years (6/10 vs 26.3%, OR=4.2, 95%CI: 1.1-15.8, P=0.033) . While the results of TCT examination were NILM, ASCUS or HSIL showed there was no statistically significant difference between two groups (P>0.05) . (3) Among the 143 cases, of which the result of TCT examination was LSIL, 9 cases of the pathological examination results after cervical resection were escalated to cervical cancer, which accounted for 6.3% (9/143) . Among 10 cases of menopause time >5 years, 2 cases (2/10) of the pathological examination results after cervical cone resection were escalated to cervical cancer. Among 133 cases with menopause time ≤ 5 years, 7 cases (5.3%) were upgraded to cervical cancer after cervical cone resection. The ratio of pathological escalation to cancer in postmenopausal patients with >5 years was higher than that of menopause time ≤5 years. Due to the data volume limitation, the comparison was not statistically significant difference (χ2=0.460, P>0.05) . Conclusions: In postmenopausal women, especially when menopausal time is > 5 years, the proportion of pathological escalation after cervical cone resection following colposcopic cervical biopsy is increased. And the pathological escalation after cervical cone resection is significantly correlated with the results of TCT examination and menopausal status. Therefore, doctors should treat the colposcopic biopsy pathological results with caution during clinic. Depending on TCT results, loop electrosurgical excision procedure (LEEP) sampling could be administrated directly in case of avoid missing diagnosis.

Association between human papillomavirus infection and atypical cervical squamous cells

Introduction. The aim of the study was to confirm the association between human papillomavirus infection and atypical cervical squamous cells. Material and Methods. This cross-sectional study, conducted in the period from January 2016 to June 2017, included 128 sexually active women, aged 20 to 59 years with squamous cell abnormalities of the cervical cytology, who came to their annual gynecological exam at the University Clinic of Gynecology and Obstetrics in Skopje. All patients underwent human papillomavirus testing and colposcopic cervical biopsy with endocervical curettage for histopathological analysis. Results. Data analysis showed an increase in the human papillomavirus infection alongside with cytological (p = 0.029296) and histopathological (p = 0.029443) increasing grades of cervical lesions. It showed an association between the oncogenic potential of the virus and the cytological (p = 0.000086) and histopathological (p = 0.00001) grades of cervical lesions. A human papillomavirus infection was detected in 75.00% of the examined women. The relationship between the prevalence of high-risk and low-risk human papillomavirus genotypes was 56.25%: 10.94%. Mixed human papillomavirus infection was detected in 32.03% of all patients, in 42.71% of human papillomavirus positive patients. The most common human papillomavirus genotypes, in descending order, were human papillomavirus-16 (43.75%), human papillomavirus-31 (15.62%), human papillomavirus-18 10.4%), human papillomavirus-45 (9.37%), human papillomavirus-33 (7.29%), etc. Conclusion. This study has confirmed an association between human papillomavirus infection and squamous cell abnormalities of the uterine cervix. Young women under 30 years of age were the most affected group.

Correlate Abnormal Pap Smears with Colposcopic Findings, HPV Testing, FHACT and Cervical Biopsy Findings

Correlate Abnormal Pap Smears with Colposcopic Findings, HPV Testing, FHACT and Cervical Biopsy Findings

Effects observation of colposcopic cervical biopsy in the company of nurses

Objective To investigate the effects of nurse companion on reducing complications of colposcopic cervical biopsy and improving satisfaction. Methods 724 patients who had cervical biopsy by colposcopy during August of 2014 in Maternal and Child Health Care Hospital of Wuxi were collected as control group, and another 932 cases in August of 2015 were sampled as observation group. Same doctor conducted the biopsy for all the patients in two groups. Each patient in observation group were accompanied by one nurse during the procedure. Results There were significant differences between the two groups on the incidence of pre-syncope, syncope, vaginal bleeding and patients′ satisfaction (P<0.05). Conclusions Nurse companion can reduce the incidence of pre-syncope, syncope, vaginal bleeding greatly during colposcopic cervical biopsy and improve patients′ satisfaction. Key words: Colposcopy; Cervical biopsy; Company of nurses

Comparison of Topical Lidocaine Spray With Placebo for Pain Relief in Colposcopic Procedures

To compare the effectiveness of topical lidocaine spray compared to a placebo for relieving pain during colposcopic cervical biopsies and endocervical curettage. This randomized, placebo-controlled, double-blind study included patients with abnormal cervical cytologic results requiring colposcopy and directed cervical punch biopsy with or without endocervical curettage (ECC). The patients were randomly assigned to either the 10% lidocaine spray or the placebo group. The patients were asked to rate the pain level immediately after the cervical biopsy and ECC, and mean pain scores of the 2 groups were compared. A total of 214 women were included in the study: 104 in the lidocaine group and 110 in the control group. Age, parity, and history of previous vaginal delivery and cesarean section were similar in both groups. Mean ± SD age was 41.5 ± 10.6 years in the lidocaine group and 43 ± 11.3 years in the control group. Pain scores after cervical biopsy and ECC were also similar between the 2 groups. Mean ± SD pain scores associated with cervical biopsy were 2.18 ± 1.7 in the lidocaine group and 2.31 ± 1.6 in the control group. In our population, there is no evidence to recommend the use of routine locally sprayed lidocaine anesthesia before cervical punch biopsy or ECC.

Tissue Detection and Typisation of Human Papillomavirus in Women with Squamous Intraepithelial Lesions and Squamous Invasive Carcinoma of the Cervix

AbstractIntroduction. The most common risk factor for intraepithelial lesions and cervical carcinoma is infection with human papillomavirus (HPV), especially with high-risk HPV genotypes. Only persistent, high-risk HPV infections represent a major risk factor for intraepithelial lesions and cervical cancer. The aims of the study were: detection and typisation of HPV genotypes, which are the most common causes of intraepithelial lesions and cervical cancer, determination of the correlation between HPV infection and histopathological diagnosis, and the correlation between the grade of lesion of the cervix and oncogenic potential of the virus as well as determination of the most affected age group of patients.Methods. This cross-sectional study included 100 sexually active patients with an abnormal Pap test at the age from 20 to 69 years (39±10.77), and was conducted at the University Clinic of Gynecology and Obstetrics in Skopje and University Clinic of Radiotherapy and Oncology in Skopje in the period from January 2014 to August 2014. In all patients colposcopic cervical biopsy was made with endocervical curettage for histopathological analysis and cervical biopsy for detection and HPV typisation. HPV detection and typisation were done using polymerase chain reaction (PCR) and reverse hybridization.Results. HPV DNA was detected in 81.0% (81/100) of the examined women. The relationship between the prevalence of high-risk and low-risk HPV DNA genotypes was 72.0%:9.0%. The frequency of high-risk HPV DNA genotypes ranged from: 54.5% (12/22) in productive HPV infection-mild dysplasia, 86.4% (19/22) with moderate dysplasia, 91.2% (21/23) in severe dysplasia to 100% of squamous cell carcinoma in situ (6/6) and invasive squamous cell carcinoma (5/5). Mixed HPV infection was detected in 19.0% (19/100) of all patients, in 23.5% (19/81) of HPV DNA positive patients. The most common HPV DNA genotypes, in descending order, were HPV 16 (43.2%), HPV 31 (28.4%), HPV 18 (14.8%), etc. The highest frequency of HPV infection was found in patients under 30 years of age.Conclusion. There was an association between HPV infection and squamous intraepithelial lesions and squamous invasive carcinoma of the cervix. There was a correlation between the grade of cervical lesion and the oncogenic potential of the virus. The results of this study may be useful for building a national strategy in the fight against cervical cancer.

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.

High‐risk human papilloma virus management in pregnancy with cervical intraepithelial neoplasia during pregnancy and postpartum in China

To investigate the relationship between cervical intraepithelial neoplasia (CIN) and high-risk human papilloma virus (HR-HPV) during pregnancy and postpartum in China. In this prospective case-control study, 168 pregnant women with CIN and cervicitis were diagnosed by colposcopic cervical biopsy. All the cases underwent hybrid capture assay version II (HCII) to detect HR-HPV DNA load amounts and the tests were completed in 3-6 months after childbirth. During pregnancy: as the CIN grade increased, the HR-HPV infection rates increased (P = 0.002), but HR-HPV DNA load amounts (in logarithms) did not change obviously (P = 0.719). 3-6 months postpartum: as the CIN grade increased, the natural negative rate of HR-HPV decreased (P = 0.000), while the amount of HR-HPV DNA (in logarithms) increased (P = 0.036); especially the amount of HR-HPV DNA in pregnant women with CINIII was significantly higher than that of other grades. During pregnancy and 3-6 months postpartum : the amount of HR-HPV DNA (in logarithms) during pregnancy was higher than that of 3-6 months postpartum with the same grade of CIN. The findings emphasize the importance of undergoing the HCII test 3-6 months postpartum. It should be noted that HR-HPV may turn negative in pregnancy with CINIII 3-6 months after childbirth. Further treatments of pregnancy with CIN should be considered according to the CIN grade diagnosed by cervical biopsy via colposcopy 3-6 months after birth, but not according to the persistence of HR-HPV during pregnancy.

Detection of HPV positivity by immunohistochemistry in colposcopic cervical biopsies with a cytological diagnosis of ASCUS.

Many epidemiological studies have shown that human papillomavirus related infections play a major role in cervical preinvasive and invasive lesions. ASCUS (atypical cells of undetermined significance) observed in about 4-5% of all cervical cytology specimens. We searched for the presence of HPV with immunohistochemical methods in the biopsy material of patients diagnosed with ASCUS using cytology. The colposcopic biopsy or Loop Electro Excisional Procedure (LEEP) material of 115 patients with a diagnosis of ASCUS were evaluated. HPV (type 6,11,16,18,31,33,42,51,52,56 and 58) immunohistochemistry was applied to all materials. The relationship between the biopsy results and HPV positivity was investigated. Cervical intraepithelial neoplasia (CIN) I was found in 34.8%, CIN II in 13% and CIN III in 9.6% of the patients and cervicitis was present in 42.6% of the patients. HPV immunohistochemistry was positive in 11 cases (9.6%) and no staining was seen in 104 cases (90.4%). No positive staining was seen in the chronic cervicitis cases. The rate of positive staining was 15% (6/34) in the CIN I diagnosed group, 20% (3/12) in the CIN II diagnosed group and 18.2% (2/9) in the CIN III diagnosed group. HPV positivity was found to be lower compared to the literature both in total and in cases diagnosed by biopsy. No staining occurred in any patient with cervicitis. In conclusion, we believe that immunohistochemical examination is not an appropriate method for the determination of HPV.

Validity of sampling error as a cause of noncorrelation

Sampling error is a common explanation of noncorrelation in women whose Papanicolaou (Pap) tests show high-grade intraepithelial lesions (HSIL) but whose follow-up cervical biopsies show only cervical intraepithelial neoplasia (CIN) 1, koilocytosis, or reactive/inflammatory changes. The purpose of this study was to demonstrate the validity of sampling error in this setting by determining the proportion of negative colposcopic cervical biopsies in women with HSIL who subsequently undergo cone/loop electrode excision procedure (LEEP) biopsies or repeat cervical biopsies that confirm the diagnosis of high-grade CIN (HGCIN). In all, 368 cases of HSIL were retrieved from the computerized database from January 1, 2003 to December 31, 2005. Follow-up was obtained as part of routine quality assurance/quality control activities including cytologic-histologic correlation. A total of 368 HSIL Pap diagnoses were retrieved. Of the 254 cases that were followed up by cervical biopsy, 146 showed HGCIN in the biopsy. Of the remaining 108 patients whose cervical biopsies failed to demonstrate HGCIN, 47 had a subsequent procedure, either cone/LEEP, cervical biopsy, or repeat Pap test. Cone biopsy/LEEP was performed in 34 cases (72.3%) with a diagnosis of HGCIN in 19. Repeat cervical biopsy was performed in 9 cases (19.1%) with HGCIN diagnosed in 5. Repeat Pap test was performed in 4 cases (8.5%) with HSIL diagnosed in 2. In the population of women with HSIL by Pap test followed up by cervical biopsy with or without subsequent cone/LEEP, there was a discordant cervical biopsy rate for HGCIN of 43%. In the subgroup of women with HSIL by Pap test followed up by cervical biopsy and subsequent cone/LEEP or repeat cervical biopsy, the proportion of women with negative colposcopic cervical biopsy and subsequent histology-proven HGCIN was 56%. These figures justify sampling error as a valid cause of noncorrelation in women with HSIL followed up by cervical biopsy alone.

Is It Clinically Useful to Repeat a Pap Smear at Colposcopy?

To assess the role of repeating a Pap smear at the time of colposcopy performed within 6 months of a referent Pap smear. A clinical database was queried to identify colposcopies performed within 6 months of a referent abnormal squamous Pap smear at which time a repeat Pap smear was obtained. All Pap smears and cervical biopsy specimens were interpreted at an affiliated hospital laboratory. Referent Pap smears, repeat Pap smears, colposcopic cervical biopsy results, patient age and ethnicity, and the interval since the referent Pap smear were tabulated. A hierarchy of Pap smear results was defined a priori to characterize the relative differences between the referent and repeat Pap smears. Results of repeat smears and cervical biopsies were contrasted with the referent Pap smears. An assessment was made of the clinical usefulness of the repeat Pap smear. Four hundred ninety-eight patients contributed 536 colposcopies with repeat Pap smears within 6 months of the referent smear. Pap smears obtained at colposcopy predominantly were either of lower severity (52.2%) or unchanged (42%). Management of 8 of 498 patients (1.6%) was influenced by the results of the repeat Pap smear. The outcomes for six recommendations for a loop electrosurgical excision procedure included three cases of diagnoses of potentially reversible conditions. The evidence for the clinical usefulness of repeating a Pap smear at colposcopy for a squamous cytologic abnormality under the defined study parameters is noncompelling. Continued surveillance is a critical component of management.

Discrepancy in the Interpretation of Cervical Histology by Gynecologic Pathologists

Two gynecologic pathologists with board certification in pathology and obstetrics and gynecology, with 8 and 10 years of experience, independently reviewed 119 colposcopic cervical biopsy samples. The biopsies were originally read by a group of 16 general pathologists who made the initial clinical diagnosis. The results of these reviews were compared to determine if subspecialty review improved the diagnostic consensus of cervical intraepithelial neoplasia (CIN). The generalists diagnosed 42% of the 119 biopsies as normal, whereas the subspecialists (GYN I and GYN II) identified 50% and 65% as normal. A diagnosis of low grade (including CIN I and human papillomavirus changes) was made in 41% of the samples by generalists and in 33% and 21% by the subspecialists. There was greater agreement for a diagnosis of high grade (including CIN 2 and 3). The specimens were identified as high grade by the generalists, GYN I, and GYN II in 17%, 17%, and 14% of the cases, respectively. Between the two subspecialists the overall interobserver agreement rate was 76%. The overall agreement rate between the generalists and GYN I and the generalists and GYN II was 72% each. The difference in agreement between GYN I and the generalists was not statistically significant. However, compared with generalists GYN II was significantly more likely to identify a specimen as normal (P <.001) and less likely to diagnose low grade (P <.001). Also, when compared with the other subspecialist, GYN II was significantly more likely to identify the specimen as normal (P < .001) and less likely to diagnose low grade (P <.01).