Satisfactory Colposcopy Research Articles

Evaluation of the Cervical Canal With the Endocervical Brush

To evaluate and compare the cytologic information obtained from the endocervical brush and the histologic information obtained from the standard endocervical curettage (ECC) used to evaluate the endocervical canal in patients with an abnormal Papanicolaou test. Three hundred eighty-eight patients underwent evaluation of an abnormal Papanicolaou test with a repeat Papanicolaou test, a separate endocervical brush test, colposcopy, directed biopsies, and ECC. The study group comprised 101 patients who subsequently underwent conization and/or hysterectomy. The brush and ECC results were evaluated against the final pathologic findings. Sixty-five patients had a satisfactory colposcopy and 36 had an unsatisfactory colposcopy. Results for these two groups are reported separately. For the total group, the sensitivities of the ECC and brush were 49 and 93%, respectively (P < .001); the specificities were 82 and 26% (P < .001), the positive predictive values were 69 and 52% (P = .99), and the negative predictive values were 65 and 82% (P = .004). The endocervical brush appears to be a sensitive test for disease in the endocervical canal but yields a high false-positive rate. The role of the brush in this setting will require further study. The ECC is more specific but is also a suboptimal test for identifying disease in the endocervical canal.

子宮頚部病変のレーザー蒸散療法

Between 1979 and 1991, three hundred and sixty-five patients with biopsy proven cervical intraepithelial neoplasia (CIN) with satisfactory colposcopy were treated with the carbon dioxide laser in an outpatient setting and 293 have been followed for one year to 12 years after the laser vaporization. There have been 43 treatment failures, of which 56%of the patients had the second lesion detected during the first year of follow-up. The second lesion consisted of 22 mild dysplasias, 14 moderate dysplasias, 4 severe dysplasias, and 3 CIS. In 6 cases, the grade of the second lesions were higher than that before the laser treatment. There have been no case diagnosed as invasive cancer after laser treatment. The estimated 5-year remission rates calculated by Kaplan-Meier methods were 81.6%for mild dysplasia, 8 2.2%for moderate dysplasia, 82.6%for severe dysplasia and 92.0%for CIS. Of the 43 failures, 11 of the lesions disappeared spontaneously, 26 were treated with repeated laser vaporization, and 6 were treated by conization and/or hysterectomy. Four of the patients with repeated laser recurred and were treated by conization or TVH. All the failure cases have been followed for more than one year after the last treatment and found to have no evidence of disease. Consequently, 283 of 293 cases (96.6%) have been managed satisfactorily by laser treatment alone at outpatient setting. No patients experienced postoperative infection or bleeding requiring hospitalization. These results reconfirm the efficacy and safety of laser vaporization for all form of CIN.

Laser excision of the transformation zone as treatment of cervical intraepithelial neoplasia with satisfactory colposcopy

A series of 123 patients with histologically confirmed cervical intraepithelial neoplasia (CIN) with satisfactory colposcopy were treated with outpatient laser excision of the transformation zone. Punch biopsy and/or endocervical curettage proved CIN III in 111 patients (90%). Histology of the laser excision specimen showed microinvasive disease in 3 patients. Operative hemorrhage occurred in 2 patients. The follow-up ranged from 12 to 59 months (median, 30 months). Four patients were found to have residual/recurrent CIN during the observation period, resulting in a cure rate of 97%. All patients with recurrence are free of disease after a second laser treatment. Only 1 patient out of 26 with involved resection margins relapsed. Laser excision of the transformation zone is proposed as a suitable replacement for laser vaporization in patients with CIN with satisfactory colposcopy, offering the major advantage of providing a histological specimen without an increase in morbidity.

Clinical significance of endocervical curettage as part of colposcopic evaluation. A review.

This paper addresses the role of endocervical curettage (ECC) as an adjunct of colposcopic evaluation of patients with abnormal cervical cytology. In a meta-analysis of literature data the contribution of ECC to the diagnostic accuracy of colposcopic examination and in the predictive value with regard to the final histologic diagnosis is discussed. The clinical impact of the application of ECC appears to be limited. Figures suggest a reduction in underdiagnosis of (micro)carcinoma in patients with satisfactory colposcopy and an increase of predictive value in diagnosis of invasive disease in unsatisfactory colposcopy.

Laser excision of the transformation zone as treatment of cervical intraepithelial neoplasia with satisfactory colposcopy

A series of 123 patients with histologically confirmed cervical intraepithelial neoplasia (CIN) with satisfactory colposcopy were treated with outpatient laser excision of the transformation zone. Punch biopsy and/or endocervical curettage proved CIN III in 111 patients (90%). Histology of the laser excision specimen showed microinvasive disease in 3 patients. Operative hemorrhage occurred in 2 patients. The follow-up ranged from 12 to 59 months (median, 30 months). Four patients were found to have residual/recurrent CIN during the observation period, resulting in a cure rate of 97%. All patients with recurrence are free of disease after a second laser treatment. Only 1 patient out of 26 with involved resection margins relapsed. Laser excision of the transformation zone is proposed as a suitable replacement for laser vaporization in patients with CIN with satisfactory colposcopy, offering the major advantage of providing a histological specimen without an increase in morbidity.

Correlation of endocervical curettage with subsequent cone biopsy in the investigation of abnormal cervical cytology

Endocervical curettage and cone biopsy found no high-grade intraepithelial lesions in premenopausal women who had a satisfactory colposcopic evaluation with low-grade cytology and exocervical biopsies.A retrospective analysis was performed of patients who underwent cervical cone biopsy to investigate an abnormal cytology. The histology of the cone was compared with the cervical cytology and the ectocervical biopsies. Over a 6-year period, 346 cone biopsies were performed at the UCLA Medical Center. Of these, 338 cone specimens were available for review, 279 had complete colposcopic records, and 227 had both an endocervical curettage and ectocervical biopsy. No premenopausal patients with low-grade cytology, satisfactory colposcopy and a low grade lesion on ectocervical biopsy subsequently had a high-grade lesion or invasive cancer on the cervical cone biopsy. Thus, in these patients the endocervical curettage did not prove to be of diagnostic value. In contrast, five patients with high-grade cytology, satisfactory colposcopy and low-grade ectocervical lesions had positive endocervical curettages and high-grade lesions on cone biopsy. These data suggest that selective use of endocervical curettage in premenopausal patients with satisfactory colposcopy can be based on whether the cytology is low grade or high grade. In premenopausal patients with low-grade cytology and satisfactory colposcopy, endocervical curettage can be omitted, while any patient who has a high-grade cytology should have an endocervical curettage.

Cervical dysplasia in the postmenopausal female: diagnosis and treatment

Thirty-two postmenopausal women, age 50 years or older, were colposcoped for abnormal Papanicoloau (PAP) smears. Sixteen had mild to moderate dysplasia, six severe dysplasia and the remainder had no dysplasia. Treatment included observation, topical estrogen, cryotherapy, conization or hysterectomy. Based upon our observations, satisfactory colposcopy can be performed in the majority of postmenopausal women. Oral or topical estrogen is a valuable adjunct in the initial evaluation and treatment of abnormal PAP smears in postmenopausal women. Criteria for adequate colposcopy in postmenopausal women are discussed and a management scheme is proposed.

Preventing cervical Ionization by achieving satisfactory colposcopy with hygroscopic cervical dilators

Eighteen women with abnormal cervical cytologic findings and unsatisfactory colposcopic examinations underwent cervical dilatation with Dilapan (Gynotech), a hygroscopic dilator. Dilatation exposed the entire squamocolumnar junction, converting an unsatisfactory colposcopic examination into a satisfactory one and avoiding cervical conization in 17 of the patients.

Role of endocervical curettage in the diagnostic workup of preinvasive cervical lesions

The aim of the present study was to evaluate the clinical value of endocervical curettage in the diagnostic workup of patients with colposcopically suspect lesions, by correlating the findings of colposcopically directed biopsy with the results of endocervical curettage in patients with both satisfactory and unsatisfactory colposcopic examination. Our results (positive curettage findings in 55.6% of the patients with unsatisfactory colposcopy and in 16.7% of the patients with satisfactory colposcopy) indicate that endocervical curettage could be a useful guide to correct management.

Genito‐urinary approach to the management of colposcopic abnormalities of the cervix

SummaryOne hundred and fifty nine patients with abnormal cervical cytology were studied by colposcopy and histologically. Fifty six were attending the Department of Genito‐Urinary Medicine, 103 were referred from elsewhere. The STD clinic patients were younger (73 per cent under the age of 29 years) and 89 per cent had a satisfactory colposcopy. The incidence of cervical intra‐epithelial neoplasia (C1N) for both groups was 87 per cent. This was associated with human papilloma virus in 35 per cent of cases. Treatment by laser vaporisation for CIN with koilocytic change was 100 per cent successful, probably due to the screening and treatment of sexual partners. A distinct genitourinary approach to these patients is suggested. Patients with an unsatisfactory colposcopy (with evidence of CIN) should be referred to the gynaecologist for cone biopsy and treatment without any further investigations such as colposcopic cervical biopsies in the STD clinic. Patients with a satisfactory colposcopy may be investigated, treated and followed‐up in the STD clinic.

Predictive Value of a Positive Endocervical Curettage in Diagnosis and Treatment of CIN

Predictive values of endocervical curettage (ECC) in the investigation of patients with abnormal Pap-smears were calculated with regard to a second histological diagnosis and with regard to results of conservative treatment of CIN. By using the combined follow up data of all 290 patients with colposcopically directed biopsies and ECC, the predictive value of a positive ECC for invasive cancer in patients with satisfactory colposcopy was 2%, and for unsatisfactory colposcopy 15%. Predictive value of a negative ECC was 100% in patients with satisfactory colposcopy, and 98% for unsatisfactory colposcopy. It is concluded that ECC should be used routinely in the investigation of patients with abnormal Pap smears. However, a positive ECC is not considered an absolute contraindication to conservative treatment, provided that colposcopy is satisfactory, that there is no suspicion of invasive cancer, and that a strict follow-up scheme can be maintained during the first year.

Predictive value of a positive endocervical curettage in diagnosis and treatment of CIN

Predictive values of endocervical curettage (ECC) in the investigation of patients with abnormal Pap-smears were calculated with regard to a second histological diagnosis and with regard to results of conservative treatment of CIN. By using the combined follow up data of all 290 patients with colposcopically directed biopsies and ECC, the predictive value of a positive ECC for invasive cancer in patients with satisfactory colposcopy was 2%, and for unsatisfactory colposcopy 15%. Predictive value of a negative ECC was 100% in patients with satisfactory colposcopy, and 98% for unsatisfactory colposcopy. It is concluded that ECC should be used routinely in the investigation of patients with abnormal Pap smears. However, a positive ECC is not considered an absolute contraindication to conservative treatment, provided that colposcopy is satisfactory, that there is no suspicion of invasive cancer, and that a strict follow-up scheme can be maintained during the first year.

Necessity of endocervical curettage in colposcopy

The use of endocervical curettage was evaluated in 200 patients undergoing colposcopy, biopsy, endocervical curettage, and conization. It is suggested that endocervical curettage be performed only in cases of satisfactory colposcopy, since patients with unsatisfactory colposcopy should undergo conization.

Comparison of Cryosurgery and Carbon Dioxide Laser Ablation for Treatment of Cervical Intraepithelial Neoplasia

A group of 125 reproductive-age women with cervical intraepithelial neoplasia (CIN) were entered in a trial study comparing cryotherapy and CO2 laser ablation. Of these, 81 patients (39 treated with cryotherapy and 42 treated with laser) were available for evaluation at least one year after therapy and are the subject of this report. In all 81 patients, cytologic examination, colposcopy, and biopsies were used at the four-month follow-up visit to evaluate efficacy and the effects on healing of the two forms of treatment. Cytology, colposcopy, and, if indicated, biopsies were repeated at 8, 12, 18, and 24 months after treatment. Histologically confirmed success rates in the two groups were similar–about 90%. However, the two groups differed significantly with respect to healing. Patients in the cryotherapy group had significantly more frequent retraction of the proximal squamocolumnar junction into the endocervical canal than did patients in the laser group. In only 20 of the 39 patients (53%) treated with cryotherapy was colposcopy satisfactory, whereas in 36 of 42 patients (86%) treated with laser, colposcopic exam was judged satisfactory after healing. Although the relative recurrence rates are comparable for the two forms of treatment, CO2 laser therapy is preferable because of the greater frequency (p <.01) of satisfactory colposcopy that is possible during follow-up of patients with CIN. The CO2 laser and cryosurgery were found equally effective for treatment of cervical intraepithelial neoplasia. Satisfactory colposcopic examination could be accomplished significantly more frequently following laser treatment.

The effect of endocervical gland involvement on the cure rates of patients with cervical intraepithelial neoplasia undergoing cryosurgery

Several authors have reported an increased failure rate using cryotherapy when the endocervical clefts or glands were involved in cervical intraepithelial neoplasia. Over a period of 5 years, November 1973 to November 1978, 248 patients with cervical intraepithelial neoplasia (CIN), satisfactory colposcopy, and colposcopically directed biopsy were treated with cryosurgery. Of the 248 patients, 160 patients had adequate follow-up. The failure rate was 16.3% ( 26 160 ). Sixty-three (39.4%) of the 160 patients had gland involvement. Of those patients with gland involvement, there was a failure rate of 27% (17 of 63 patients). The evidence suggests that the presence of gland involvement in patients with CIN adversely affects cure by cryosurgery. The degree of severity of CIN among patients who failed therapy was not a significant factor.

Diagnostic value of colposcopy in the investigation of cervical neoplasia

Colposcopy and colposcopically directed biopsies were performed in 930 patients with an abnormal Pap smear; 898 patients had satisfactory colposcopic evaluation and 32 patients had unsatisfactory colposcopy, including patients suspected of having invasive carcinoma. The colposcopic impression was accurate when compared to the histology of the colposcopically directed biopsy in 91% of patients. There were 268 patients who had a cone or hysterectomy for the treatment of advanced cervical intraepithelial neoplasia. Evaluation of final histologic specimen in this group revealed a high correlation with colposcopic impression and colposcopically directed biopsy, with misdiagnosis of only three patients with early microinvasive carcinoma. Thirteen cases of occult invasive carcinoma were diagnosed by cone biopsy, five patients had colposcopic impression suggestive of invasive carcinoma, and eight had unsatisfactory colposcopy. No occult or frank invasive carcinoma was missed in those patients who had satisfactory colposcopy. In those patients who had unsatisfactory colposcopy, diagnostic cold-knife conization was performed. Final histologic diagnosis disclosed a more advanced lesion in over 50% of this group. Omission of endocervical curettage from the colposcopic examination of 798 patients with satisfactory colposcopy did not reduce the accuracy of the procedure. The results of this study confirm those of other investigators that satisfactory colposcopic evaluation is a highly accurate method for evaluating abnormal cytologic smears.