Colposcopic Findings Research Articles

Evaluation of coloscopic and Pap’s smear findings among visual inspection with acetic acid cases in detection of precancerous lesion of cervix against histopathology

Background: Cervical cancer is the commonest cancer in women in developing countries. Visual inspection with acetic acid (VIA) is much popular method as primary screening modalities in low resource setting.Whereas Pap smear is well recognized and popular in developed countries. Colposcopy is recognized as the best method for detection of cervical cancer and cervical intraepithelial neoplasia (CIN) as secondary screening. The present study was intended to compare the accuracy of Pap smear and colposcopy in the detection of pre-invasive cervical lesion in VIA positive cases.
 Methods: This cross sectional study was carried out in the Colposcopic Clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka over a period of 1 year from August 2015. All consecutive VIA positive cases were included the study.
 Results: Mean age of the VIA positive women was 36.9 years with peak age group being 31-40 years (44.0%). Nearly three-quarters of the women (74.0%) were in their 3" and 4 decades of life. Among VIA positive women, 35.0% were Pap positive and 55.0% were colposcopically positive and 41.0% were histopathologically positive. Pap smear had low sensitivity (53.7%) and high specificity (78.0%). Using Pap smear nearly half (46.3%) of the precancerous lesion were escaped. Whereas colposcopy findings, revealed high sensitivity (90.2%) and specificity (69.5%). Both Pap and colposcopy was judged against histopathological diagnosis. Over 40.0% of the VIA positive women were diagnosed as CIN confirmed by histopathology. Strength of agreement test using Kappa statistics revealed a moderate agreement between Pap smear test and colposcopy (49.5%).
 Conclusion: The study concluded that colposcopy has a high sensitivity, optimum specificity and moderate agreement against histopathology in relation to Pap smear. Pap smear has very little role whereas colposcopy has significant role for diagnosis of CIN. So, it would be adopted and encouraged to do the colposcopy where it is possible.
 Bangladesh Med Res Counc Bull 2019; 45: 103-107

The role of performing a routine four-quadrant cervical biopsy in patients with negative colposcopic findings in increasing the identification rate of cervical intraepithelial neoplasms

Aim: In patients with high-risk human papilloma virus (HPV), there is no consensus on the inclusion of cervical biopsy for diagnostic purposes in cases whereas there is no pathological finding in colposcopy. In this study, we aimed to investigate the effect of simultaneous routine cervical biopsy in patients with normal colposcopic findings on the rate of cervical intraepithelial neoplasia diagnosis. Methods: This retrospective study included 119 patients with colposcopy indications who had no cervical pathology between January 2015 and March 2017 and the histopathological results were evaluated. Results: The mean age of the population was 45.75±9.52 years. The histopathological results obtained in our study patients are as follows; 38.7% (n=46) LSIL, 28.7% (n=33) chronic cervicitis, 15, 3 % (n=19) coilositosis, 9.2% (n=11) HSIL, 2.5% (n=5) adenocarcinoma, 1.7% (n=2) carcinoma in situ and 2.1% (n=3) squamous carcinoma. LSIL 33 (27.5%), HSIL and advanced lesion 11 (9.2%) were detected in patients with normal cervical cytology before colposcopy. LSIL 26 (21.7%), HSIL and advanced lesion were found to be 13 (10.8%) in patients with abnormal cervical cytology. There was no significant difference in terms of biopsy pathology results between normal and non-normal cervical cytology results. Conclusions: In patients with HPV positive and normal colposcopic findings, adding simultaneous routine four-quadrant cervical biopsy to the colposcopy might increase the detection rate of cervical intraepithelial lesions.

Diagnostic excision of the cervix in women over 40 years with human papilloma virus persistency and normal cytology.

ObjectivePersistent infection with human papillomavirus (HPV) is recognized as the main risk factor of cervical cancer. Investigation via cytology and colposcopy have lower sensitivity than HPV testing in the diagnosis of high-grade cervical intraepithelial neoplasia (CIN2+). Despite normal cytology and colposcopy findings women with persistent HPV infection have an increased risk of CIN2+. The aim of the study was to evaluate the proportion of histologically confirmed CIN2+ in women with persistent HPV infection and normal Pap smears.Study designFrom April 2013 until March 2016 we prospectively recruited 91 women over 40 years with persistent HPV infection without any abnormalities in cytology. Of these, 40 women attended a gynecological examination including an HPV test, Pap smear, endocervical cytology, colposcopy with biopsies and diagnostic loop electrosurgical excision procedure (LEEP). Biopsy and LEEP samples were subjected to histological examinationResultsCIN2+ was verified by histological examination of the LEEP sample in 6/40 (15%) of the women. All the cytological samples were normal and none of the biopsies confirmed CIN2+. Only 19/40 women still had a persistent HPV infection at the study visit. None of the 21/40 women who had cleared their HPV infection at the study visit had CIN2+ in histology of the LEEP sample.ConclusionsA persistent HPV infection needs to be monitored despite normal Pap smears, since 6/40 (15%) women older than 40 years, was revealed to have an undiagnosed CIN2+ when LEEP was performed. Counseling women regarding the risk of cervical cancer and the expected effect of an eventual LEEP can help them to make an optimal informed choice.

Histologic correlation between smartphone and coloposcopic findings in patients with abnormal cervical cytology: experiences in a tertiary referral hospital

Smartphones recently have been applied in the medical setting. However, the literature evaluating the utility of smartphones in gynecologic oncology is limited. To evaluate the utility of a smartphone in the detection of uterine cervical lesions in patients with abnormal cervical cytology. Seventy-five women with abnormal cervical cytology were enrolled. Two doctors independently inspected the uterine cervix by using smartphone or colposcopy. Images were captured using acetic acid, and biopsies were taken as standard-of-care procedures. The diagnostic performance of the smartphone for cervical intraepithelial neoplasm 1 or worse and cervical intraepithelial neoplasm 2 or worse were evaluated, and the kappa value was calculated to determine the chance corrected agreement of the histologic diagnoses based on the smartphone and colposcopic findings. There was a substantial agreement between histologic diagnoses based on the smartphone and colposcopic findings, with a kappa value of 0.67 (95% confidence interval, 0.43-0.90). The sensitivity, specificity, positive predictive value, and negative predictive value of the smartphone in the diagnosis of cervical intraepithelial neoplasm 1 or worse were 0.89 (95% confidence interval, 0.79-0.96), 0.33 (95% confidence interval, 0.08-0.70), 0.91 (95% confidence interval, 0.81-0.97), and 0.30 (95% confidence interval, 0.07-0.65), respectively. The sensitivity, specificity, positive predictive value, and negative predictive value in the diagnosis of cervical intraepithelial neoplasm 2 or worse were 0.92 (95% confidence interval, 0.81-0.98), 0.24 (95% confidence interval, 0.09-0.45), 0.71 (95% confidence interval, 0.58-0.81), and 0.60 (95% confidence interval, 0.26-0.88), respectively. We found that there was a substantial agreement between the histologic diagnoses based on the smartphone and colposcopic findings. The smartphone seems to be useful and may be an alternative to colposcopy.

Evaluation of Abnormal Cervix with Visual Inspection under Acetic Acid and Colposcopy

Background: Cervical cancer is a major public health problem especially in developing countries. It can be prevented through implementation of routine screening program. There are different screening methods but their efficacy are still questionable. So the purpose of this study is to evaluate the efficacy of visual inspection of cervix with acetic acid and colposcopy to detect precancerous lesion in women with clinically unhealthy or abnormal cervix.Methods: Forty patients with abnormal cervix (35) and abnormal pap smear results (5) were enrolled for the study in outpatient department of Kathmandu Model Hospital. Patients were evaluated with visual inspection of cervix with acetic acid and colposcopy in the same sitting. Cervical punch biopsy were taken from suspected lesion or from four quadrant if colposcopy findings were normal and sent for histopathological examination. The finding of visual inspection of cervix with acetic acid and colposcopy were correlated with histopathological finding and compared with each other.Results: The age of participants ranged from 24 to 68 years with mean age of 38.17 years and mean parity of 2.25. visual inspection of cervix with acetic acid and colposcopy were positive in eight (20%) and ten (25%) respectively. There were five (12.5%) cases of histopathologically proven lesion. The sensitivity of visual inspection of cervix with acetic acid and colposcopy were 80% and 100 % respectively and that of specificity were 88.5% and 85.5%.Conclusions: visual inspection of cervix with acetic acid is an effective screening tool with comparable sensitivity and specificity. It can be used as alternative screening methods especially in low income resource countries where the burden of disease is high.Keywords: Cervical cancer; Colposcopy; screening; VIA.

Evaluation of Abnormal Cervix with Visual Inspection under Acetic Acid and Colposcopy.

Cervical cancer is a major public health problem especially in developing countries. It can be prevented through implementation of routine screening program. There are different screening methods but their efficacy are still questionable. So the purpose of this study is to evaluate the efficacy of visual inspection of cervix with acetic acid and colposcopy to detect precancerous lesion in women with clinically unhealthy or abnormal cervix. Forty patients with abnormal cervix (35) and abnormal pap smear results (5) were enrolled for the study in outpatient department of Kathmandu Model Hospital. Patients were evaluated with visual inspection of cervix with acetic acid and colposcopy in the same sitting. Cervical punch biopsy were taken from suspected lesion or from four quadrant if colposcopy findings were normal and sent for histopathological examination. The finding of visual inspection of cervix with acetic acid and colposcopy were correlated with histopathological finding and compared with each other. The age of participants ranged from 24 to 68 years with mean age of 38.17 years and mean parity of 2.25. visual inspection of cervix with acetic acid and colposcopy were positive in eight (20%) and ten (25%) respectively. There were five (12.5%) cases of histopathologically proven lesion. The sensitivity of visual inspection of cervix with acetic acid and colposcopy were 80% and 100 % respectively and that of specificity were 88.5% and 85.5%. visual inspection of cervix with acetic acid is an effective screening tool with comparable sensitivity and specificity. It can be used as alternative screening methods especially in low income resource countries where the burden of disease is high.

Could interleukin-33 and its suppressor of tumorigenicity 2 (ST2) receptor have a role in cervical human papillomavirus (HPV) infections?

Why most women can clear human papillomavirus (HPV) infections while others can develop permanent infections. The stimulation of immunotolerance of the immune system of the host by the persistent HPV infection may be the answer to this question. Interleukin-33 (IL-33) may play a role in the pathogenesis of HPV infection, this hypothesis was thought to be due to the rapid release of IL-33 from damaged cells following tissue damage, necrosis, and activation of the inflammasome. Thus, in this study, the role of IL-33/suppressor of tumorigenicity 2 (ST2) was emphasized in HPV positive and HPV negative cervical tissues. A total of 80 were assessed. The reduced levels of IL-33 and ST2 are associated with cervical HPV infections. There was a statistically significant 42% positive correlation between IL-33 and ST2 in the HPV-positive group. Surprisingly, our data showed no significant difference between the expression levels of IL-33 or ST2 and working status, type of delivery, pre- and post-operative pathology, cigarette, educational status, locality, birth control method, gynecological, and colposcopic findings. We found that as a result of our study; low IL-33 and ST2 levels were associated with HPV infections

Cytological and colposcopic evaluation of abnormal cervix

The second most common cancer among women worldwide is cancer of the cervix commonly develop due to abnormal cervix. To evaluate abnormal cervix by cytology and colposcopy, a prospective study was undertaken among 100 women attending at the colposcopy clinic in Mymensingh Medical College Hospital (MMCH) from January 2008 to July 2008. Cytological and colposcopic evaluation were done in all the patients attending the colposcopy clinic with various complaints like per vaginal discharge, post-coital bleeding, dyspareunia, irregular per vaginal bleeding, backache and abnormal cervix on examination. A biopsy was taken from 53 cases of colposcopically abnormal or clinically doubtful cervices. Cytology and colposcopy findings were compared with the histological results. Study results revealed that 26 apparently healthy cervices in naked eye examination showed abnormal cytology in 8 cases and premalignant and malignant changes was seen in 9 among colposcopically abnormal 11 cases. Among the 40 cases of ectropion, abnormal cytology found in 11 and premalignant and malignant changes in 13 cases. In 11 cases of nabothion cyst, 4 had abnormal cytology and premalignant changes in 2 cases. Among 10 erythema cases, 3 showed abnormal cytology and 6 showed premalignant and malignant changes. One ulcer case revealed malignancy on cytology, colposcopy and histopathology. The other 12 cases, abnormal cytology found in 7, premalignant and malignant changes found in 8. On cytological examination, abnormal cytology found in 34 cases, among these 26 revealed premalignant and malignant on biopsy report. Out of 66 negative cytological smear cases, 23 colposcopically positive and biopsy showed 13 cases as premalignant and malignant. So, 13% cases of premalignant and malignant lesion may be overlooked if cytology alone was used for screening. This study revealed that colposcopy examination significantly reduces false negative cytology. Results of this study concluded that combined procedures enhance diagnostic accuracy.
 CBMJ 2019 January: vol. 08 no. 01 P: 3-11

Prospective cohort study examining cervical cancer screening methods in HIV-positive and HIV-negative Cambodian Women: a comparison of human papilloma virus testing, visualization with acetic acid and digital colposcopy

ObjectivesLogistical and economic issues make traditional cytology-based cervical cancer screening challenging in developing countries. Alternative, cost-effective, screening strategies must be developed to screen millions of women in resource-poor countries such...

Assessment of pap smear and colposcopic findings in patients with vaginal discharge

Assessment of pap smear and colposcopic findings in patients with vaginal discharge

A retrospective analysis of women diagnosed with unclassified HPV genotypes

IntroductionThis study primarily aimed to investigate the associations between unclassified HPV genotypes and cervical lesions.Material and methodsThis was a retrospective review of 411 patients with HPV positivity. The participants were divided into two groups: Group X contained HPV genotypes 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68 while group Y contained unclassified HPV genotypes such as 42, 54, 61, 62, 71, 81, 83, 84 and 89. The X and Y groups were compared in terms of demographic characteristics and related cervical pathologies. We investigated the potential of HPV genotypes in group Y to develop cervical neoplasia.ResultsHPV 16 is the most common genotype in group X (28.5%) whereas HPV 83 is the most common genotype in group Y (4.9%). Group X and group Y were statistically similar with respect to age (p = 0.231), parity (p = 0.617), occupation (p = 0.535), marital status (p = 0.644), education level (p = 0.316), smoking (p = 0.352), gynecological findings (p = 0.201), Pap smear results (p = 0.427), and colposcopy findings (p = 0.476). When compared to group X, normal cervical biopsy was significantly more frequent (18.6% vs. 39.1%), chronic cervicitis was significantly less frequent (49.5% vs. 36.9%), CIN 1 was significantly less frequent (12.9% vs. 8.7%) and CIN 2 was significantly less frequent (5.6% vs. 2.2%) (p = 0.012). Cervical cancer was diagnosed in three patients of group X and one patient of group Y (1.6% vs. 2.2%).ConclusionsScreening programs for cervical cancer are generally performed to detect HPV genotypes with high oncogenic potential. The importance of unclassified HPV genotypes should be investigated in large scale studies so that the success of screening programs and vaccination can be improved.

Effect of endocervical glandular involvement on residual and recurrent disease in patients with high grade cervical dysplasia

Purpose: The aim of this study was to evaluate the effect of endocervical glandular involvement on residual and recurrent disease in high-grade cervical dysplasia.Material and Methods: Patients underwent Loop Electrosurgical Excision Procedure (LEEP) or Cold Knife Conization (CKC) between January 2015 and June 2016 were identified. Patients that had low grade lesions in conization specimens were excluded. The data were collected for age, menopausal status, cytology, colposcopic findings, conization procedure, HPV positivity and subtype, diameters of specimen, number of pieces, pathologic data including status of margins, endocervical glandular involvement (EGI) and recurrence. Prognostic effect of EGI on residual and recurrent disease were evaluatedResults: Of 282 patients, 204 were eligible. Median age was 41 years in both groups. Age, menopausal status, cytology, diameters of specimen, number of pieces, colposcopy findings and conization procedure did not differ between groups.. Surgical margin positivity was higher in EGI positive group. HPV type 16 positivity was significantly higher in EGI positive patients. EGI was found to be the only prognostic factor for residual disease and was not a prognostic factor for recurrent disease.Conclusion: Our findings showed that EGI appears as a poor prognostic factor for residual disease but not for recurrence in patients with high-grade cervical dysplasia.

Sec62/Ki67 dual staining in cervical cytology specimens: a new marker for high-grade dysplasia.

In the previous studies, we demonstrated that Sec62 is essential for tumor cell migration, epithelial-to-mesenchymal transition, and intracellular stress tolerance. An increase in Sec62 expression correlated with an increase in cervical dysplasia severity in liquid-based cytology specimens. Ki67 is an established proliferation marker. Thus, in this study, we examined a method of Sec62/Ki67 dual staining for the detection of high-grade dysplasia and cancer in cervical liquid-based cytology specimens. Sec62/Ki67 dual staining was performed on 100 cervical liquid-based cytology specimens. The staining results were correlated with cytological, immunocytological (p16/Ki67), colposcopic, and histological findings. All 56 (n = 56, 100%) cases of cervical intraepithelial neoplasia grade 3 and cervical cancer (CIN3+ lesions) were positive for Sec62/Ki67 staining, while low-grade lesions and normal cells were negative. Sec62/Ki67 staining was highly sensitive and specific for the detection of CIN2+ and CIN3+ lesions (94.37%; 100% and 100%; 84.09%, respectively). Sec62/Ki67 dual-staining immunocytochemistry is a promising cytological tool for interpreting high-grade squamous lesions in cytological specimens and for assessing the risk of progression to cancer.

Accuracy of colposcopy-directed biopsy in detecting early cervical neoplasia: a retrospective study.

Colposcopy-directed biopsy is a cornerstone method for diagnosing cervical intraepithelial neoplasia. The aim of this study was to evaluate the accuracy of colposcopy-directed biopsy in comparison with definitive surgery. The accuracy of colposcopy-directed biopsy was compared with the final histology in relation to different types of transformation zone (TZ), the patient's age, and the examiner's level of training. The overall accuracy of biopsy in comparison with definitive surgery was 71.9% for all entities-benign lesions, low-grade squamous intraepithelial lesions, high-grade squamous intraepithelial lesions (HSILs), and cervical carcinoma-with an underdiagnosis rate of 11.8% and an overdiagnosis rate of 16.5%. The accuracy for detecting HSIL was 88% (401/455), with an underdiagnosis rate of 10.5% and overdiagnosis rate of 1.3%. The accuracy rates for detecting HSIL in women with TZ1, TZ2, or TZ3 were 92.2, 90.5, and 76.5%, respectively. The accuracy rates for detecting HSIL in the different age groups were 93.1% (age 0-34), 83.6% (age 34-55), and 80% (age 55 or older). A combination of the colposcopic findings, cytology, human papillomavirus testing, and colposcopy-directed biopsy is necessary for the correct diagnosis of HSIL. The accuracy rate depends on the TZ and the patient's age. The examiner's level of training does not have any substantial influence on the accuracy.

The use of colposcopic punch biopsy in the management of abnormal cervical cytology: a 5–year retrospective audit

The aim of this study was to determine the accuracy of colposcopic punch biopsy to detect cervical epithelial neoplasia (CIN) II + in patients with abnormal cervical cytology and the major colposcopic findings in patients who underwent a loop electrosurgical excision procedure (LEEP), subsequently. A total of 231 patients with abnormal cervical cytology who underwent a colposcopy guided cervical biopsy and subsequent LEEP were analysed. The mean age was 33.4 ± 8.7 years. CIN II + rate on LEEP pathology was significantly higher in patients with high-grade cytology, compared to those with a low-grade cytology (92 vs. 55%, p < .0001). CIN II + was found in 80, 98 and 100% of colpocopic biopsies of patients with LSIL, HSIL and AGC, respectively. The overall concordance rate between a colposcopic biopsy and LEEP was 41% with a kappa coefficient. The overall underestimation of CIN II + was 10.5%. On a patient-based analysis, the sensitivity, specificity, PPV and NPV of colposcopic biopsy were 89.4, 47.1, 79.5 and 66%, respectively. More than two cervical biopsies had 100% sensitivity for CIN II + on LEEP pathology. The specificity and PPV decreased with increasing number of cervical biopsies. A see-and-treat strategy may be considered for high-grade cytologies. Patients with a low-grade cytology should be managed with more than two colposcopic biopsies.

Sublingual Misoprostol for Unsatisfactory Colposcopic Finding: A randomized controlled trial

Sublingual Misoprostol for Unsatisfactory Colposcopic Finding: A randomized controlled trial

Spontaneous Regression Rate of Low Grade Cervical Intraepithelial Lesions Diagnosed from Colposcopy

Objective: To evaluate the spontaneous regression rate and its associated factors of low grade intraepithelial lesionsafter colposcopy in Thai women.Material and Methods: A retrospective study of the data of Thai women, not younger than 21 years old with liquidbased cervical cytology of atypical squamous cells of undetermined significance (ASC-US) or low-grade squamous intraepithelial lesions (LSIL), who had received colposcopic examination with histologically proven cervical intraepithelial neoplasia grade 1 (CIN1) or human papillomavirus (HPV) infection. All patients underwent cytologic tests as the follow-up method for at least 2 years at the Gynecology Clinic, Siriraj Hospital. Analyzed data included patient characteristics, cervical cytological and pathological results, colposcopic findings and evidence of cytological regression. The correlations between each variable and regression status were then measured.Results: Data of a total of 154 patients who completed 2 years of follow-up were reviewed. One hundred and two patients had cytologic regression, showing a regression rate of 66.2%. There was 31.8% persistent abnormal cytology, and 2.0% progressed to high-grade cervical intraepithelial lesions. All patients with persistence or progression of cervical cytology had no invasive lesion. The only factor significantly related to cytologic regression was the pattern of colposcopic findings (p-value=0.041). The HPV-specific lesion on the colposcopy showed the significant pattern with an odds ratio of 3.5 (95% confidence interval=1.2-10.1, p-value=0.028).Conclusion: Women who had initial cervical cytology of ASC-US or LSIL with colposcopic histological confirmation of CIN1 or HPV infection had spontaneous regression, about two-thirds within 2 years of follow-up time. Thus, conservative management in these patients should be considered.

Reliability of colposcopy during pregnancy.

To investigate the reliability of colposcopy during pregnancy and to evaluate the concordance between colposcopic patterns and histopathological findings in these women. Multicenter observational study of women diagnosed with an abnormal cervical cytology, who subsequently underwent a colposcopic evaluation with cervical biopsy during pregnancy. The "colpo-histopathological concordance‿ was evaluated. The "colposcopic overestimation and underestimation‿ were evaluated as well. 69 women, fulfilling the study inclusion/exclusion criteria, constituted the study cohort. Among them, on colposcopic examination, 14 women (20.3%) showed "grade I abnormal colposcopic findings‿, 52 (75.4%) showed "grade II abnormal colposcopic findings‿ and the remaining 3 women (4.3%) had a "suspicious for invasion‿ colposcopy. The histopathological diagnosis showed 2 negative biopsies, 12 (17.4%) cases of CIN1, 50 (72.5%) cases of CIN2 and 5 (7.2%) cases of invasive cervical cancer. We found a colposcopic overestimation in 10 cases (14.5%), underestimation in 12 cases (17.4%), and a concordance in 47 cases (68.1%). A better reliability of colposcopy in women in the firsts two trimesters and in particular in women ≤20 weeks pregnant was found (Cohen's weighted kappa: 0.65). When performed by gynecologists with expertise, colposcopy is a reliable diagnostic tool, even during pregnancy. Whenever possible, a colposcopic evaluation during the first half of pregnancy is preferable.

A Study on Cervical Cancer Screening Using Pap Smear Test and Clinical Correlation

Objective:The objective of the study is to evaluate the use of the Pap smear screening method for detection of precancerous lesions.Methods:All women who visited the outpatient gynecology clinic of the Department of Obstetrics and Gynaecology at King Georges Medical University, Lucknow, UP, India, over 1 year for different clinical problems were recruited for the study. A total of 1650 women who were sexually active and over 21 years of age were enrolled in the study. A clinical examination, an examination per speculum, and a vaginal examination were performed and a history taken for all women. A Pap smear was used for all women to screen for cervical cancer. The smear was obtained using an Ayre spatula and spread over a marked glass slide, which was placed in 95% ethyl alcohol and sent to the Department of Pathology for cytopathological examination. All data were recorded using a predetermined pro forma. Women who had visible malignant cervical lesions were excluded from the study.Results:Most women were in the age range of 30–50 years and multiparous. Vaginal discharge was the most common complaint, occurring in 36.96% of the women. An irregular menstrual cycle was the complaint of 12.78% and abdominal pain of 25.63% of women, while 15.15% were asymptomatic. The Pap smear test of 93.57% of the women was adequately taken, while 6.42% of the individuals had an inadequate sample. The test was negative for malignancy in 48.84%, and 42.66% had infection or inflammation. Atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), and high-grade squamous intraepithelial lesion (HSIL) were detected in 2.90%, 5.09%, and 0.48%, respectively. Women with Pap tests positive for ASCUS, LSIL, and HSIL underwent a colposcopy and guided biopsy.Conclusions:Women with an abnormal Pap test should undergo a colposcopy, and those with abnormal colposcopy findings should be advised to undergo a biopsy. A Pap smear is simple, noninvasive, cost-effective, and easy to perform for detection of precancerous lesions in a gynecological patient.

The efficacy of vaginal suppository based on myrtle in patients with cervicovaginal human papillomavirus infection: A randomized, double-blind, placebo trial.

Human papillomavirus (HPV) can be detected in most of cervical cancers. Due to antiviral, antimutagenic, and proapoptotic activities of myrtle, this study was designed to investigate the effect of a herbal suppository based on myrtle in cervicovaginal HPV infections. This study was performed as a double-blind randomized trial at the Clinic of Traditional Medicine in Mashhad University of Medical Sciences between 2016 and 2017. Sixty women, 18 to 50years old, with cervicovaginal HPV infection, were included and randomly allocated to two groups. Sixty placebo or herbal vaginal suppositories were prescribed for 3months (20 suppositories at each menstrual cycle). Each herbal vaginal suppository contained 10% of myrtle aqueous extract and 0.5% of myrtle essential oil. The HPV test and colposcopic findings were evaluated after treatment. There was no difference between two groups as regards lesion site, diagnosis time of disease, and HPV type before intervention (p≥0.05). At the end of the study, the HPV test was negative in 92.6% and 62.6% of the intervention and placebo groups, respectively (p=0.036). The change in cervical lesion size was 71.4% and 30.4% in the intervention and placebo groups, respectively, based on colposcopic findings (p=0.015). It seems that herbal suppository can speed up virus clearance and can be effective in treating HPV infection.