Colposcopic Examination Research Articles

Comparative study of effectiveness of colposcopic examination versus visual examination for determining the biopsy site of potentially premalignant oral epithelial lesions

Diagnosis of oral malignant and potentially premalignant oral epithelial lesions (PPOELs) cannot be based solely on clinical findings. Tissue biopsy with histopathologic examination remains the gold standard in diagnosis. Selection of a representative biopsy site becomes essential to arrive at an early and precise diagnosis which substantially reduces the incidence of morbidity and mortality from oral cancer. The site for biopsy, however, is always a subjective choice that sometimes raises doubts about its representativeness. Among various techniques developed to complement clinical examination and facilitate early diagnosis, colposcopy can be a simple, reliable diagnostic method available for the selection of the most appropriate biopsy site based on the vascular patterns. Hence, this study has been planned to assess the role of colposcopic examination in the selection of the most representative specimen for histopathologic examination from the oral lesions.

Clinical Significance of Detection of Human Papilloma Virus DNA and E6/E7 mRNA for Cervical Cancer Patients.

This study aimed to explore the clinical significance of detection of human papillomavirus (HPV) DNA and E6/E7 mRNA for cervical cancer patients. For this purpose, a total of 300 patients with cervical lesions who performed the colposcopy examination for the cervix between January 2018 and January 2020 were divided into three groups according to the level of cervical intraepithelial neoplasia (CIN): Low-level group (Group A, n = 101), high-level group (Group B, n = 149), cervical cancer group (Group C, n = 50) and gynecological inflammation group (Group D, n = 60). Tissue samples were collected from subjects above to perform the immunohistochemistry for E6/E7 protein and detection of HPV DNA and HPV E6/E7 mRNA. The results showed that HPV DNA copies and the positive rates of protein, DNA and mRNA of HPV E6/E7 in Groups A, B and C were significantly higher than those in Group D (all P<0.05), while no significant difference was identified in the comparison of the positive rate and copies of DNA among Group A, B and C (P> 0.05); in the Group A, B and C, patients had a higher positive rate of E6/E7 mRNA than those in the Group D (P<0.05), while in the Group B and C, the positive rate and copies of mRNA of HPV E6/E7 and HPV E6/E7 proteins were all higher than those in the Group A (P<0.05). In addition, the specificity of HPV E6/E7 mRNA was inferior to HPV DNA in the detection of the low-level intraepithelial neoplasia, but it performed better in the detection of the high-level intraepithelial neoplasia and cervical cancer. In general, HPV E6/E7 mRNA shows promising value in the detection of the development and progression of cervical cancer.

The Predictors for Non-Adherence to Colposcopy among Women in an Underserved Community in Rural Southern Western Nigeria.

Cervical cancer is the fourth most common cancer in women. It is a major public health problem in developing countries. Effective cervical cancer screening requires that women adhere to the screening program. The factors that influence adherence to colposcopy in rural areas of Nigeria are unknown. The objective of the study was to determine the factors that 0determine adherence and the sexual and reproductive factors that are associated with non-adherence of women to colposcopy. This is a cross-sectional study of a project undertaken to determine the age- specific incidence of Human Papillomavirus (HPV) infection in Irun Akoko, a rural town in Ondo state of Nigeria. A total of 492 women with abnormal results from 1420 women that were screened were recalled for colposcopy examination. The non-adherence rate for colposcopy in this study was 25.8%. Women younger than 40years (p=0.0011) and those with number of living children ≤2 (p=0.04) are more likely to be non-adherent to colposcopy. The non-adherence rate to colposcopy was high. Younger women and those with fewer children were more likely not to adhere to colposcopy.

How Can a High-Performance Screening Strategy Be Determined for Cervical Cancer Prevention? Evidence From a Hierarchical Clustering Analysis of a Multicentric Clinical Study

BackgroundThis study aimed to explore the cluster patterns of cervical cancer screening strategies for detecting high-grade precancerous lesions in terms of benefits, costs, and efficiency.MethodsA total of 2,065 referral women aged 25–64 years were recruited and underwent human papillomavirus (HPV) testing, liquid-based cytology with manual reading, and cytology with artificial intelligence (AI)-assisted reading. All women were assessed by colposcopy and histological examination. We formed 14 screening strategies based on primary cytology screening, primary HPV screening incorporating HPV-16/18 genotyping triage, cytology triage, or both, and co-testing. The primary outcomes were cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and grade 3 or worse (CIN3+). The hierarchical clustering method was applied to multifaceted indicators, and then, the resulting clusters were described in terms of benefits, costs, efficiency, and their interaction. This study was registered (No. ChiCTR2000034131).ResultsThe relative sensitivity of HPV-based strategies compared with cytology alone with the threshold of LSIL+ ranged from 0.68 to 1.19 for CIN2+ detection and from 0.72 to 1.11 for CIN3+ detection, whereas the relative specificity ranged from 0.55 to 1.43 for CIN2+ detection and from 0.51 to 1.51 for CIN3+ detection. Five significant clusters according to the trade-off among benefits, costs, and efficiency were identified. The cluster including four primary HPV screening strategies showed the optimal balance. HPV testing with HPV-16/18 genotyping and AI-based cytology triage presented the optimal trade-off for CIN3+ detection relative to cytology alone in terms of relative sensitivity (1.06), relative specificity (0.72), colposcopies for 1 CIN3+ (3.7 vs. 3.1), a load of follow-up for women with HPV-positive and normal cytology (7.0% vs. 22.3%), and the work of manual cytology reading (35.1% vs. 100%).ConclusionsOur study provided clinical and methodological evidence on the choice of HPV-based screening strategies. The cluster including primary HPV screening with genotyping and cytology triage showed an optimal balance among benefit, cost, and efficiency.

Prospective Evaluation of Correlation between Modified Reid’s Colposcopic Index (RCI) and Histopathology Result from Colposcopic Directed Biopsy

Objective: To evaluate correlation between Modified Reid Colposcopic Index and histopathology from colposcopic directed biopsy. Materials and Methods: At least atypical squamous cell of undetermined significance (ASC-US) according to the Bethesda classification 2001 was diagnosed in 60 eligible women. At the time of colposcopic examination, the four colposcopic criteria used are: 1) margin of cervical lesion, 2) color of acetowhite, 3) appearance of vessels on cervical lesion, and 4) location of the lesion. Each criterion was assigned in score between 0 to 2 and the summation of all four criteria made a total score ranging from 0 to 8. A score of less than or equal to 2 was classified as low grade lesion indicating of human papillomavirus (HPV) infection or cervical intraepithelial neoplasia (CIN)1. Intermediate grade was 3 to 5 indicating of CIN2 while, high grade lesion as a reflection of at least CIN3 is 6 to 8. Colposcopic directed biopsy on all lesions were performed for histopathologic examination. Results: The strength of agreement with Spearman rank correlation was 0.69. Sensitivity, specificity, positive and negative predictive value for differentiate high from low grade lesion were 91.7%, 66.7%, 64.7% and 92.3%, respectively. The overall accuracy of modified RCI after adjusted was 76.7%. Accuracy in a subgroup of low and high grade lesion were 92.3% and 64.7%, respectively. Conclusion: Modified Reid&rsquo;s colposcopic index had a good positive correlation to cervical histopathology and also had high accuracy to differentiate low from high grade lesion. Keywords: Modified Reid&rsquo;s Colposcopic Index; Colposcopic directed biopsy; Colposcopy; Intraepithelial cervical neoplasia

Phototheranostics of Cervical Neoplasms with Chlorin e6 Photosensitizer.

Simple SummaryNeoplasms of the cervix are the most common types of oncological pathology. Photodynamic therapy with intravenous administration of the photosensitizer chlorin e6 shows high efficiency in the treatment of precancerous lesions of the cervix with complete eradication of the human papillomavirus. The treatment method can reduce deaths from cervical cancer and preserve fertility in patients. Spectral and video fluorescence diagnostics allows intraoperatively assessing the degree of photosensitizer accumulation and photobleaching and visualizing the boundaries of pathologically altered tissues.(1) Purpose: Improving the treatment effectiveness of intraepithelial neoplasia of the cervix associated with human papillomavirus infection, based on the application of the method of photodynamic therapy with simultaneous laser excitation of fluorescence to clarify the boundaries of cervical neoplasms. (2) Methods: Examination and treatment of 52 patients aged 22 to 53 years with morphologically and cytologically confirmed mild to severe intraepithelial cervix neoplasia, preinvasive, micro-invasive, and squamous cell cervix carcinoma. All patients were carriers of human papillomavirus infection. The patients underwent photodynamic therapy with simultaneous laser excitation of fluorescence. The combined use of video and spectral fluorescence diagnostics for cervical neoplasms made it possible to control the photodynamic therapy process at all stages of the procedure. Evaluation of the photodynamic therapy of intraepithelial cervical neoplasms was carried out with colposcopic examination, cytological conclusion, and morphological verification of the biopsy material after the photodynamic therapy course. The success of human papillomavirus therapy was assessed based on the results of the polymerase chain reaction. (3) Results. The possibility of simultaneous spectral fluorescence diagnostics and photodynamic therapy using a laser source with a wavelength of 660 nm has been established, making it possible to assess the fluorescence index in real-time and control the photobleaching of photosensitizers in the irradiated area. The treatment of all 52 patients was successful after the first photodynamic therapy procedure. According to the PCR test of the discharge from the cervical canal, the previously identified HPV types were not observed in 48 patients. Previously identified HPV types were absent after repeated PDT in four patients (CIN III (n = 2), CIS (n = 2)). In 80.8% of patients, regression of the lesion was noted. (4) Conclusions. The high efficiency of photodynamic therapy with intravenous photosensitizer administration of chlorin e6 has been demonstrated both in relation to eradication therapy of human papillomavirus and in relation to the treatment of intraepithelial lesions of the cervix.

Altered Vaginal pH Value and Enterobacteria as a Risk Factor in the Development of Precancerous Lesions of the Cervix

Background: Vaginal microflora plays an important role in cervical carcinogenesis. An increase in vaginal pH is associated with the severity of squamous intraepithelial lesion (SIL) and a decrease in the number of lactobacilli. Microbial dysbiosis contributes to the damage of the epithelial barrier, as well as the reprogramming of immune and metabolic signaling. Dysbiotic bacteria cause damage to the epithelial barrier, immune dysregulation and genotoxicity and create a tumor-permissive microenvironment. Objective: The aim of this study was to determine the presence of risk factors (abnormal colposcopic and microbiological status, elevated pH of the vaginal environment) in regular Pap tests and LSIL. Methods: Retrospective prospective study 2021-2022. 90 women with pap smears were analyzed: 40 with LSIL at the Gynecological Center “Dr. Mahira Jahić” Tuzla and 50 with normal findings at the Tesanj Health Center. General data such as: age of the subjects, reproductive status, contraception, smoking and data on colposcopic examination, microbiological findings and vaginal pH value were analyzed. Statistical data processing was done in the SPSS program. Results: The average age of the test subjects is 39.94, in normal Pap 41.20 years, and in LSIL 38.38 years. The vital characteristics of the subjects did not differ significantly, except for smoking, where in LSIL findings, they consumed cigarettes significantly more often. Abnormal colposcopic examination were found in 85% (N-34) of women with LSIL. In subjects with LSIL, a positive microbiological test for enterobacteria was found in 47.5% (N-19) and a normal pap test in 12% (N-6). Statistically significant difference p=0.00523 p&lt;0.05, E faecalis and E coli had the highest prevalence in LSIL. The mean pH value of the vaginal environment in LSIL is 5.38, and 4.96 in a regular pap test. Subjects with LSIL in 10% (N-4) had a normal pH test, and 48% (N-24) had a normal Pap test. P=0.00129 p &lt; (0.05). A normal pH value was significantly more common in subjects with a normal Pap test. Microbiological flora, especially enterogenic bacteria, are more common in LSIL than in women with a regular pap test. Conclusion: when monitoring women with LSIL, special attention should be paid to the elimination of present enterobacteria (E.faecalis and E.coli) as a possible risk factor in the development of precancerous lesions (SIL) and cervical cancer.

Изменение факторов иммунного ответа при терапии цервикальных интраэпителиальных неоплазий

Th e aim of the research. Assessment of changes in immune response factors during antiviral therapy of cervical intraepithelial neoplasia of severity grades I and II against the background of human papillomavirus. Material and methods. An outpatient examination of 232 female subjects of reproductive age was carried out. Among these, 172 women were with a histologically confi rmed diagnosis of mild to moderate cervical intraepithelial neoplasia (CIN I-II) associated with papillomavirus infection. During the work, each patient underwent cytological and colposcopic examination as well as real-time HPV typing with viral load evaluation. To establish the fi nal diagnosis, if necessary, a multifocal biopsy of the cervix was used. Within the framework of the designated goal, changes in the cervical zone were studied and analysed by means of assessing caspase-3, caspase-9, IFN-γ, IL-18. Results. As part of the study, changes in the caspase and cytokine profi le were analysed in HPV-associated cervical intraepithelial neoplasia of grades I-II, which substantiated the use of immune system correction for successful treatment of patients with mild to moderate dysplastic processes. Conclusion. The results obtained in the study make it possible to optimise management of patients with HPV-associated cervical intraepithelial neoplasia of severity degrees I-II.

ПЕРВЫЕ РЕЗУЛЬТАТЫ ЛЕЧЕНИЯ ЦЕРВИКАЛЬНОЙ ИНТРАЭПИТЕЛИАЛЬНОЙ НЕОПЛАЗИИ В РЕСПУБЛИКЕ ТАДЖИКИСТАН

Objective: To assess the clinical results of cervical intraepithelial neoplasia (CIN) treatment following the outcomes of the first pilot implementation of visual screening in the Republic of Tajikistan. Methods: The study was conducted from 2016 to 2020. The piloting included the population of two large districts of Kushoniyon and B. Gafurov, with a total number of 608,700 people, which is 6.74% of the country's total population. The target group of this screening included healthy women aged 30-49 years, numbering 72574 people. As a result of communication campaigns with the target group of both districts, 69391 women participated in visual screening; the overall screening coverage was 94.2%. Of the 2958 women referred for diagnosis, in 164 cases (0.24%) CIN was identified and morphologically confirmed. Results: Tajikistan, along with piloting imaging screening, has adopted a "detection-diagnosis-treatment" strategy, which involves treatment after histological confirmation of CIN. Additionally, electrosurgical loop excision/conization was adopted as the primary method, regardless of the degree of CIN involvement. Patients with CIN in 136 (82.9%) cases underwent electrosurgical loop excision, in 21 cases – conization (12.8%), and in 7 (4.3%) cases, at the insistence of the women themselves – hysterectomy. In the long-term follow-up period from 6 months to 2 years, in 159 (96.9%) cases, a favorable course of CIN was noted after the above procedures, and in 5 (3.1%) cases, relapse occurred. Patients with relapses received re-surgical treatment using electrosurgical excision/conization with a satisfactory outcome. Conclusion: The "detection-diagnosis-treatment" strategy adopted by Tajikistan has shown its high efficiency in detecting precancerous pathology and the success of CIN treatment by electrosurgical excision/conization, which contributes to the healing of the population from precancerous pathology. Keywords: Cervical intraepithelial neoplasia, visual screening, VIA/VILI visual method, colposcopic examination, electrosurgical loop excision/conizatio.

Clinical correlation of CC screening using Pap smear test

Cervical cancer (CC) has a long preinvasive stage, which allows for preventive detection and possible cure. In this study, this stage was a target stage to investigate women with precancerous lesions by applying the Papanicolaou (Pap) smear test and comduct performing a correlation study.s. A 2-year cross-sectional study was conducted, in which 200 married women (21-60 years old) participated in the investigation, which included women with Pap test abnormal results (atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesions (LSILs), and high-grade squamous intraepithelial lesions (HSILs)). These results were used to perform a polymerase chain reaction (PCR) test to detect the presence of human papillomavirus (HPV) of (6 and 11), a low-risk type, and (16 and 18), a high-risk type with colposcopy examination and colposcopy-guided biopsy, if needed for women with abnormal colposcopy outcomes. The treatment, per severity and disease stage, was applied. The clinical presentation and Pap smear results of women enrolled in the study were as follows: 82.5% women were asymptomatic, postcoital bleeding (PCB) was seen in 17.0%, and intermenstrual bleeding was seen in a single case (0.5%). The history of sexually transmitted diseases was seen in 2.5% of the subjects. Pap smear results were as follows: no remarkable pathology was seen in 36.0%, inflammatory evidence was seen in 32.0%, ASCUS was seen in 19.0%, LSIL was seen in 7.5%, and HSIL was seen in 5.5% of the subjects. Regarding the HPV, the infection was negative in 95.0%, low-risk virus strains were seen in 1.5%, and high-risk viruses were seen in 3.5%. Low-risk HPV included 6, 11, and 42, whereas the high-risk group included five cases of HPV16 and two cases of HPV 18. The present work presents the Pap smear test as a highly useful, easy, technically safe, and cost-effective tool for detecting cervical epithelial precancerous lesions, which can be used as a routine screening technique for better treatment outcomes and reducing mortality rates. The power of detection of these lesions can be potentiated when using the Pap test and HPV-PCR test together.

Фотодинамическая терапия предрака и рака шейки матки с лазерным возбуждением флуоресценции с эффектом фотобличинга

Objective. To improve the efficacy of therapy for cervical intraepithelial neoplasia associated with human papillomavirus (HPV) infection using phototheranostics. Patients and methods. This study included 52 patients aged 22 to 53 years with morphologically confirmed diagnoses of cervical intraepithelial neoplasia of varying degrees, preinvasive, microinvasive and squamous cell cervical carcinomas. All women were carriers of HPV infection. Therapy control and HPV elimination were assessed by the results of polymerase chain reaction. Patients underwent photodynamic therapy (PDT) with simultaneous laser-induced fluorescence. Spectral fluorescence diagnostics of cervical neoplasms provided control of PDT at all stages of the procedure. The results of treatment were evaluated by extended colposcopy, cytological and histological examinations of biopsy material. Results. Treatment was found to be clinically effective, with 80.8% of patients showing regression of cervical lesions. Previously identified HPV types were not observed in 48 patients after the first PDT procedure, in 4 patients – after the second procedure. There was also a significant decrease in the expression of Ki67 and p16 markers in the cervical epithelium after PDT. Conclusion. The high clinical efficacy of phototheranostics, including PDT with the use of video and spectral fluorescence diagnostics, was shown both in terms of HPV elimination and treatment of cervical intraepithelial lesions. Key words: human papillomavirus, photodynamic therapy, cervical intraepithelial neoplasia, preinvasive cancer, cervical cancer, fluorescence diagnostics, photosensitizers

Referral mechanism and beneficiary adherence in cervical cancer screening program in Tiruchirappalli district, Tamil Nadu state, India, 2012-2015.

A screening program for cervical cancer was established in 2011 in Tamil Nadu. Since the inception of the program, coverage, and dropout of screening has not been analyzed. We conducted a study to describe the referral mechanism in the cervical cancer screening program implemented in Tamil Nadu, to estimate the level of adherence to the referral process by the beneficiaries, and to identify strengths and weaknesses related to the referral mechanism in the program. ">This descriptive study was conducted during 2015-2016 in the Tiruchirappalli administrative district of Tamil Nadu. All women aged 30 years and above, who were screened in public health facilities, were the participants. Using a structured form, we collected the data maintained in the registers at the district health administration. We estimated the screening coverage, follow-up evaluation, and dropout rates at different stages of the referral mechanism. We used SPSS and Epi Info software for analysis. Coverage of cervical cancer screening was 4,838(41.6%). We estimated 4,838(41.6%) of screened positives were lost to follow-up for a colposcopy examination. Biopsy samples were obtained from 3425(84%) of those who required a biopsy. Cervical cancer was diagnosed in 159(4.6%) and precancerous lesions in 528(15.4%) women. More than half of the target population was screened in public health facilities. The dropout rate was less than half of those screened at the colposcopy evaluation level. Major pitfalls of the program were human resource issues at referral centers and poor maintenance of meaningful data.

Diagnosis Value of Colposcope Combined with Serum Squamous Cell Carcinoma Antigen, Carbohydrate Antigen 125, and Carcinoembryonic Antigen for Moderate to Advanced Cervical Cancer Patients Treated with Modified Fuzheng Peiyuan Decoction.

Objective To explore the diagnosis value of colposcope combined with serum squamous cell carcinoma antigen (SCC-Ag), carbohydrate antigen 125 (CA125), and carcinoembryonic antigen (CEA) for moderate to advanced cervical cancer patients treated with modified Fuzheng Peiyuan decoction. Methods The clinical data of 43 moderate to advanced cervical cancer patients treated in Suzhou Hospital of Traditional Chinese Medicine from July 2018 to July 2019 were selected for the retrospective analysis, and 43 healthy women undergoing physical examination in our medical center in the same period were selected as the control group. The cervical cancer patients accepted the modified Fuzheng Peiyuan decoction treatment, the detection of SCC-Ag, CA125, and CEA and colposcope examination were performed to all research subjects, and the changes in indicators such as KPS scores and lesion perfusion parameters in cervical cancer patients before and after treatment were monitored, so as to analysis the clinical diagnosis value of combined diagnosis in treated patients. Results After treatment, the mean KPS scores were greatly higher and various blood perfusion parameters of lesions and serum SCC-Ag, CA125, and CEA levels were remarkably lower than before (P value <0.001 for all); the area under the curve of combined test was significantly larger than that of single test, and the sensitivity and specificity of the combined test were the highest; and after medication, the total incidence rate of toxic and side effects was 11.63%. Conclusion Fuzheng Peiyuan decoction has significant effect in treating moderate to advanced cervical cancer, and colposcope combined with serum test presents more accurate and credible diagnosis results and has great significance for future treatment, which shall be promoted and applied.

Case Report on Cervical Dysplasias

Introduction: Cervical dysplasia is a precancerous disorder in which abnormal cell growth occurs on the cervix's surface lining or endocervical canal, which connects the uterus and the vaginal canal. Cervical intraepithelial neoplasia is another name for it (CIN). Clinical finding:-Abdominal pain, weight loss, fever (Temperature – 101oF).&#x0D; Diagnostic Evaluation: Blood test: HB- 10.8 gm%, Total RBC count- 4.15 millions/cu mm, RDW –13.1%, Total WBC count-6100 /cu mm, Total platelets- 2.381ACS/MM3.&#x0D; Cytopathology Examination: Cervical cytology Smear shows only scattered superficial and intermediated squamous cell with few neutrophils. Colposcopy Examination: Moderated dysplasia, chronic cervicitis. Colposcopy finings- cervical erosion seen on post lip,-Mosaic pattern of blood vessels seen on green filter, Aceto white areas seen at 7o’clock position, Less iodine uptake at 7o’ clock and 12o’clock positions, aceto white areas reduced as compared to previous colposcopy.&#x0D; Therapeutic Intervention: Vaginal hysterectomy lateral Sphincterotomy I/V/O Cervical Dysplasia Inj. Gentamacine 80 mg iv 12 hrly, Inj. Ctax 1 gm IV 12hrly, Inj. Pan 40 mg iv 12 hrly, Inj Metro 100 ml /8 hrs, Inj. Neomal 100 ml Iv 12 hrly, Inj Pause 8 hrly, zonac suppository TDS, Tab-Gabapentin 300 mg HS, Glucose powder, protein powder 2tbsp BD with milk.&#x0D; Outcomes: After treatment the patient shows improvement. Her abdominal pain and fever were relived and the surgery precancerous cells are removed, Patient condition was improved.&#x0D; Conclusion: My patient was hospitalized to AVBRH gynecology unit with abdominal pain, fever, weight loss. After receivingproper therapy, her condition has improved.

Colposcopic performance in a birth cohort previously eligible for human papillomavirus vaccination

Sweden started subsidized quadrivalent human papillomavirus vaccination for girls aged 13 to 17 in 2007. Since 2012, vaccination has been offered to all girls aged 10 to 12 within a school-based vaccination program, with a coverage of 80% or more. In addition, the vaccine has been offered on-demand as catch-up vaccination for girls aged 13 to 18, with a cumulative coverage of 55% to 60%. Since the first women in Sweden eligible for human papillomavirus vaccination entered the cervical screening program, questions on how to evaluate colposcopic findings among vaccinated women have arisen. Evidence is inconsistent on whether colposcopic features for the detection of cervical lesions are influenced by specific human papillomavirus genotypes and what role they can play in the prevention of invasive cervical cancer in vaccinated women. The primary objective of the study was to compare colposcopic evaluation in vaccinated and unvaccinated women entering the organized cervical screening program. Women in the 1994 and 1995 birth cohorts who entered the cervical screening program at age 23 in 1 region in Sweden were identified. Colposcopy was performed within 2 to 4 months after a positive screening result in accordance with national guidelines. Colposcopic performance was evaluated according to national guidelines with the Swede score and colposcopic impression. Punch biopsies were taken from colposcopic lesions and as "random biopsies" in the absence of lesions. These biopsies were used as the gold standard for the analysis. An endocervical sample was analyzed for cytologic findings and detection of 14 high-risk human papillomavirus genotypes. All colposcopic imaging was saved digitally for re-review. Vaccination status was obtained through linkage to national vaccination registries. Results were compared between vaccinated and unvaccinated women. In 2018 and 2019, 160 out of 165 (98%) women with a positive screening result attended colposcopy, of which 90 (56%) were vaccinated and 70 (44%) were unvaccinated. Only 7 out of 90 (5%) women in the vaccinated group were human papillomavirus 16/18-positive, compared with 23 out of 70 (33%) in the unvaccinated group (P<.001). There was a total of 61 out of 160 (38%) women with high-grade lesions-33 out of 90 (37%) in the vaccinated group and 28 out of 70 (40%) in the unvaccinated group (P=.697). There was 64% (21/33) of vaccinated women and 75% (21/28) of unvaccinated women with high-grade squamous intraepithelial lesions who had a Swede score of 6 to 10 (indicating high-grade squamous intraepithelial lesions) (P=.124). The sensitivity was slightly higher for the detection of high-grade squamous intraepithelial lesions in unvaccinated women using both colposcopic tests (Swede score, 0.67 vs 0.75; colposcopic impression, 0.67 vs 0.68), but the difference was not statistically significant. We found no statistically significant difference between the colposcopic evaluation of vaccinated and unvaccinated women, although human papillomavirus vaccination reduced the prevalence of human papillomavirus 16/18 infection in human papillomavirus-vaccinated women. Our results indicate that colposcopic examination is still a useful tool in vaccinated women entering the organized cervical screening program.

Cervical diseases after subtotal hysterectomy (modern aspects of diagnosis and tactics of management)

Aim. To study the state of the cervical stump after subtotal hysterectomy (STGE) without uterine appendages with and without excision of the endocervix in patients with myoma to justify the choice of a rational volume of surgical operation.&#x0D; Materials and methods. Examination and treatment of 140 women was carried out with the formation of three groups: 1st 40 patients after laparoscopic STGE with excision of the endocervix; 2nd 38 patients after laparoscopic STGE without excision of the endocervix; 3rd (comparison group) 62 patients with uterine myoma that do not require surgical treatment.&#x0D; Results. The study of the state of the cervical stump was carried out 5.10.3 years after surgery. The number of patients with cervical pathology after STGE with excision of the endocervix (in group 1) was 1.8 times less in percentage terms than after STGE without excision of the endocervix (in group 2), and 3.2 times less than in patients with uterine fibroids who do not require surgical treatment (in the 3rd comparison group).&#x0D; Conclusion. Out of 3 (3.8%) patients after surgical treatment with diagnosed HPV type 16.1 (1.3%) in the STGE group without endocervical excision was diagnosed with grade II intraepithelial neoplasia (CIN II). In patients with uterine myoma, STGE can be performed only after a comprehensive preoperative examination, including: diagnosis and treatment of urogenital infections, DNA typing of HPV of high oncogenic types, cytological and colposcopic examination of the cervix, targeted biopsy of the cervix with histological examination of the material. If a subtotal hysterectomy is performed, it must be supplemented with excision of the endocervix. In the future, these women require careful follow-up to improve early diagnosis and treatment of underlying and precancerous diseases and reduce the risk of developing cervical stump cancer.

Anxiety in women referred for colposcopy: a prospective observational study

PurposeTo evaluate the occurrence of anxiety in women attending a colposcopic examination within the new cervical cancer screening in Germany.MethodsOne hundred and fifty-six patients were asked to fill out Spielbergers STAI inventory form prior to their colposcopic examination. For the statistical analysis, a two by two between-group design was applied including the following group factors: the repeat factors included patients, who presented to our centre of dysplasia for the first time (new) and patients who have had an examination in our centre before (repeat). Further, the factor diagnosis included two groups: first, patients with cervical dysplasia and second, patients with vulva diseases.ResultsThe analysis of the STAI results showed that patients presenting with cervical dysplasia for the first time had the highest levels of anxiety, directly followed by new patients in the vulva group. The ANOVA revealed a main effect of the repeat factor, F(1,140) = 7.53, p = 0.007. There was no significant effect of diagnosis.ConclusionRegardless of the diagnosis, patients being transferred for a colposcopy within the cervical cancer screening program for the first time have very high anxiety levels. The prospect of a potentially painful examination seems to be a key factor. Only a scientific evaluation of the new cervical cancer screening will be able to show if the rising numbers of colposcopic examinations is really worth the risk of exposing so many more women to the emotional distress of a colposcopy.

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

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

Screening History in Vaginal Precancer and Cancer: A Retrospective Study of 2131 Cases in China.

PurposeTo examine the screening history of vaginal intraepithelial neoplasia (VaIN) and vaginal cancer.Patients and MethodsWe included women with histologically confirmed VaIN or vaginal cancer by colposcopy-directed biopsy between 1 January 2019 and 31 December 2019. The results of cytology, hrHPV, colposcopic examination and history of hysterectomy were retrospectively analysed.ResultsA total of 26,432 colposcopies were performed during the study period, among which 2131 women (1835 [86.1%] with VaIN 1; 268 [12.6%] with VaIN 2/3; and 28 [1.3%] with vaginal cancer) were retrospectively studied. hrHPV test positivity was significantly higher than that of cytology for VaIN 1 (84.4% vs 67.3%; P < 0.001) and VaIN 2/3 (92.0% vs 79.9%; P < 0.001) but not for vaginal cancer (84.6% vs 78.6%; P = 0.73). Additionally, the concordance rates for colposcopic impression were 79.5%, 54.5%, and 92.8% for VaIN1, VaIN2/3, and vaginal cancer, respectively. All 372 patients had a history of hysterectomy, and 81.0% (282/348) of indications were related to cervical precancer and cancer. Although cytology test positivity was significantly higher in patients with hysterectomy than in patients without hysterectomy (76.2% vs 67.5%; P < 0.001), cytology combined with hrHPV can help to detect more than 95% of VaIN and vaginal cancer cases in both groups (96.2% for patients with hysterectomy and 96.5% for patients without hysterectomy).ConclusionVaIN and vaginal cancer are not rare diseases. Although cytology was sensitive (67.5%–76.2%) for detecting vaginal lesions regardless of hysterectomy, cytology combined with hrHPV improves detection accuracy up to 95% in both groups.

Кольпоскопічно-цитологічні паралелі у вагітних з безплідністю різного ґенезу в анамнезі

The state of the cervix was studied in pregnant women with a history of infertility of various genesis by colposcopic and cytological research methods. The data obtained indicate an increased level of precancerous pathology of the cervix in pregnant women with a history of tubo-peritoneal and concomitant infertility, compared with pregnant women who had endocrine infertility. Purpose — to determine the relationship between the nature and severity of colpocoscopic and cytological changes in the cervix in pregnant women who had a history of infertility. Materials and methods. 101 women were examined: 14 pregnant women with a history of endocrine infertility, group 1; 27 pregnant women with a history of tuboperitoneal infertility — group 2; 40 pregnant women, had combined infertility — group 3, 20 healthy pregnant women with no history of infertility — group 4. Methods for assessing the state of the cervix in pregnant women — video colposcopic and cytological (on glass). Results. Normal cytological changes (NILM) were found: in group 1–8 (57.2%), in group 2 — in 15 (55.6%), in group 3 — in 23 (57.5%), in group 4, 14 (70.0%) pregnant women. Benign cytological and ASCUS signs were: in group 1 — in 5 (35.7%), in group 2 — in 6 (22.2%), in group 3 — in 10 (25.0%), in group 4 — in 5 (25%) patients. Precancer (LSIL+HSIL): in group 1 — in 1 (7.1%), in group 2 — in 6 (22.2%), in group III — in 9 (22.5%) women, and in group 4, no precancers were found cytologically. Normal colposcopic signs (stratified squamous epithelium) were found: in group 3 — in 11 (27.5%), in group 2 — in 8 (29.6%), and in group 1 — in 7 (50.0%) pregnant women. And benign colposcopic changes (ectopia, open glands, Nabotovi cysts, deciduosis): in group 3 — in 19 (47.5%), in group 2 — in 16 (59.3%), in group 1 — in 6 (42.9%), in group 4 — in 5 (35.7%) patients. Our data indicate that precancers during colposcopy occurred: in group 3 — in 9 (22.5%), in group 2 — in 3 (11.1%), in group 1 — in 1 (7.1%), in group 4 — in 1 (5.0%) women. No colposcopic signs of invasive growth were found in any of the groups. Conclusions. The study revealed an increased level of precancerous pathology of the cervix in pregnant women with a history of tubo-peritoneal and concomitant infertility. A fairly high percentage of precancerous conditions of the cervix in group 2 — in 6 (22.2%) and in group 3 — in 9 (22.5%) women indicates that in the presence of Human papillomavirus (HPV) and other genital infections and with increasing age, the probability self-elimination of the papilloma virus is reduced. After long-term infertility treatment, all pregnant women must undergo a colposcopic examination at the first visit to the antenatal clinic, in addition to taking a cytological smear. If LSIL and HSIL are found in this category of women, colposcopic and cytological control once every 3 months during pregnancy with mandatory HPV PCR HCR. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the author. Key words: pathology of the cervix, pregnancy after infertility, video colposcopy, cytology.