Suspicious Cervical Lesions Research Articles

Lessons in Cultural Adaptations: Translation of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Cervical Cancer Module From English to Chichewa in Malawi

IntroductionTo complete a culturally appropriate translation of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Cervical Cancer module (QLQ-CX24) from English to Chichewa (one of the official languages of Malawi) in preparation for postsurgical outcomes research in rural Malawian cervical cancer patients. MethodsFollowing the EORTC translation procedure manual, two distinct forward translations from English were reconciled into a preliminary Chichewa translation, followed by two distinct back-translations to English. The English back-translation was reconciled and the translation report sent for discussion and proofreading by EORTC; this was followed by pilot testing. All translators were physicians fluent in English and Chichewa. ResultsOf 24 questions in QLQ-CX24, three had prior translations available; all three required revision to clarify tense or wording. Three discussion exchanges with EORTC refined the translation and ensured faithfulness to the original English meaning; proofreaders contributed minor changes. Pilot testing was completed on 10 female patients (three with cervical cancer, four suspicious cervical lesions, and three screening only). Three patients were illiterate. During pilot testing, translation of question 46 (Q46) was misunderstood as referring to vaginal discharge instead of feeling “feminine”. The remaining questions were understood, with minor feedback for six questions. Final revision of Q46 yielded a phrase describing “feminine” as “appearance or activities as a woman”. Concepts comparable to “feminine” were absent in the Chichewa language/regional Malawian culture. The final revision of Q46 was pilot-tested on five patients (three illiterate) and found acceptable. ConclusionsTranslation of the QLQ-CX24 module was completed successfully and revealed absence of the modern concept of femininity in Chichewa language and regional Malawian culture. Care should be taken when creating and translating healthcare-related documents for surgical research to ensure broad applicability across cultures.

Juvenile high grade squamous intraepithelial lesion (HGSIL): A rare case

Human papillomavirus (HPV)infection consists the majority of cervical precancerous lesions and cancers. Various screening programmes aim in indentifying HPV infection and preventing cervical cancer. We present a 20-year-old female patient whose first pap smear revealed atypical squamous cells of undetermined significance (ASCUS). Pap smear, followed by genotyping evaluation, revealed high-risk HPV 33 infiltration. Colposcopy and cervical biopsies were performed due to suspicious cervical lesions, revealing cervical intraepithelial neoplasia grade II and focal high grade squamous intraepithelial lesion.(Grade III.) Patient underwentloop electrosurgical excision procedure (LEEP) due to assiduous imaging findings. Histopathologic establishment revealed anatomic areas of CIN III. (Cervical Intraepithelial Neoplasia) Aim of our study represents proper diagnosis and therapeutic mapping of a juvenile high grade cervical intraepithelial lesion, depending always on fertility preservation.

High-risk human papillomavirus in Turkish patients with clinically suspicious cervical lesions analyzed by multiplex-PCR.

Human papillomavirus (HPV) infection is known to be the main cause of cervical cancer. This study aimed to determine the prevalence of high-risk HPV genotypes in smear specimens taken from women who had normal or abnormal cytology using a multiplex PCR method. The study included 270 women aged between 19 and 69 yr with or without suspicious cervical abnormalities. A Pap smear sample from each patient was cytologically examined, and HPV typing was performed using a multiplex fluorescent PCR method. Those who were high-risk HPV positive and had a normal or abnormal cytology were further evaluated by colposcopy and biopsy. The total HPV positivity was 43 per cent (116/270). HPV positivity in the patients with an abnormal cytology was 77 per cent (33/43), whereas it was only 37 per cent (83/227) in women with normal cytology, which showed a significant difference (P<0.05). HPV positivity was also related to the age group when all the subjects were considered (P<0.05), and the highest prevalence of HPV infection was in the 30-39 yr age group. High-risk HPV types 16, 18, 31, 35, 51 and 56 were more common in the normal cytology patients, whereas high-risk HPV types 16, 31, 35, 45, 58 and 68 were commonly found in the abnormal cytology patients. The determination of high-risk HPV genotypes in women with clinically suspicious cervical lesions should be conducted during an annual follow-up, irrespective of a normal or abnormal cytology by the age of 30 years or above.

Screen-and-treat approach in managing cervical cancer precursor lesions: An observational study with 524 women

ObjectiveTo detect factors related to overtreatment with the “Screen-and-treat” approach (S&T) in women with suspicious cervical precancerous lesions. Study designA retrospective observational study of 524 women with high-grade squamous intraepithelial lesions (HSIL) or more severe (HSIL+) in cytology, treated by the Large Loop Excision of the Transformation Zone (LLETZ): 161 without a previous biopsy (S&T group) and 363 with a previous biopsy (biopsy group) from January 2017 to July 2020. The main outcome was a diagnosis of LLETZ: negative (negative or low-grade squamous intraepithlelial lesion LSIL) or HSIL+. A negative diagnosis was interpreted as “overtreatment.” Results were analyzed as a function of the S&T approach (whether previous biopsy or not). Variables were obtained from medical records, and were compared with Chi-square or Fisher's exact test (p, p-value), to estimate the chances of a logistic regression analysis (Odds Ratio, OR, or admitting a Confidence Interval (CI) of 95 %). ResultsNo differences were observed in groups regarding menopausal status, smoking, hormonal contraceptive use, colposcopy findings, LLETZ diagnosis, and recurrence. Comparing biopsy vs S&T groups, the frequency of women over 40 years was 28.4 % vs 39.7 % (p = 0.011), and transformation zone type 3 was 12.2 vs 26.8 % (p < 0.001), respectively. In women managed by S&T, when compared to a LLETZ diagnosis, an HSIL+ result was more frequent in women presenting with TZ 1 (93.1 % TZ1 vs 78.5 % TZ2 vs 73.8 % TZ3, p = 0.008) and in women with abnormal colposcopy (92.9 % abnormal vs 38.1 % negative, p < 0.001). Multiple regression analysis found that women with negative colposcopic findings presented a higher risk for negative LLETZ diagnosis (LSIL/Negative final histology) (18.6; 6.18–56.02). ConclusionsNo difference was observed in the LLETZ diagnosis in women who did or did not use the S&T approach: it was adequate for women referred by cytological HSIL along with high-grade colposcopic findings.

Development of a multimodal mobile colposcope for real-time cervical cancer detection.

Cervical cancer remains a leading cause of cancer death among women in low-and middle-income countries. Globally, cervical cancer prevention programs are hampered by a lack of resources, infrastructure, and personnel. We describe a multimodal mobile colposcope (MMC) designed to diagnose precancerous cervical lesions at the point-of-care without the need for biopsy. The MMC integrates two complementary imaging systems: 1) a commercially available colposcope and 2) a high speed, high-resolution, fiber-optic microendoscope (HRME). Combining these two image modalities allows, for the first time, the ability to locate suspicious cervical lesions using widefield imaging and then to obtain co-registered high-resolution images across an entire lesion. The MMC overcomes limitations of high-resolution imaging alone; widefield imaging can be used to guide the placement of the high-resolution imaging probe at clinically suspicious regions and co-registered, mosaicked high-resolution images effectively increase the field of view of high-resolution imaging. Representative data collected from patients referred for colposcopy at Barretos Cancer Hospital in Brazil, including 22,800 high resolution images and 9,900 colposcope images, illustrate the ability of the MMC to identify abnormal cervical regions, image suspicious areas with subcellular resolution, and distinguish between high-grade and low-grade dysplasia.

4553 An investigation into the use of curcumin, a topical herbal agent, for the treatment of cervical intraepithelial neoplasia

4553 An investigation into the use of curcumin, a topical herbal agent, for the treatment of cervical intraepithelial neoplasia

Delivering Cervical Cancer Screening and Treatment to Women Living With Human Immunodeficiency Virus

Background: More than 80% of cervical cancer cases happens in the developing world. The same trend is seen in Burundi, where cervical cancer is the first gynecological cancer and the leading cause of female cancer deaths. In addition to this, Burundi presents high human immunodeficiency virus (HIV) prevalence rate. It is believed that there were 2200 new diagnosed clients in 2016. In spite of this, not all people can have access to desired services due to financial and geographical barriers. To increase access to cervical cancer information and screenings in resource-limited settings, Association Burundaise pour le Bien Etre Familiale (ABUBEF) introduces visual inspection of the cervix with acetic acid (VIA) and Lugol’s Iodine (VILI) plus cryotherapy to vulnerable populations, especially women living with HIV. Aim: To provide VIA/VILI and cryotherapy to women living with HIV in resource-limited settings. Methods: ABUBEF also conducted a training to ensure health providers can independently carry out VIA/VILI and cryotherapy. ABUBEF organized a campaign to raise people's awareness and deliver services to vulnerable populations. Results: Seventeen doctors were trained to perform VIA/VILI. They can also confidently make diagnosis and provide relevant treatment, such as cryotherapy or referral. 337 women were screened during the campaign and 4 of them received positive VIA/VILI results (1.1%). For women living with HIV, the VIA/VILI positivity rates was 4% and 2 of them presented suspicious cervical cancer lesions. All clients received essential treatments. This can be cryotherapy or be referred to specialists for further evaluation and cancer treatment. Conclusion: According to ABUBEF’s operational experience, VIA/VILI and cryotherapy is feasible in resource-limited settings. It is also noticed that women living with HIV has higher VIA/VILI-positive rate and even cancer lesions.

What Is the Justification for the Practice of Examination Under Anesthesia Plus Biopsy for Suspected Cervical Cancer?

Background: Management of suspected cervical cancer involve diagnosis by way of histologic evaluation of biopsy specimen and subsequent staging to determine spread to guide the choice of treatment modality. It is not uncommon to find examination under anesthesia plus biopsy as a single procedure in an operating theater list in Nigeria. The rationale for combining diagnostic procedure with staging procedure is hereby queried. Aim: To understand the rationale for the practice of combining examination under anesthesia with biopsy of suspected cervical cancer in Nigeria and project possible impact of such practice on quality of care to the patient. Methods: The study adopted combination of structured questionnaire and key informant interview. Structured questionnaires were administered to doctors below the level of consultants in departments of obstetrics and gynecology of 2 tertiary health institutions where examination under aneasthesia plus biopsy is being practiced. The questions were in four domains to assess the following; 1. Demographics 2. Any difference between knowledge and the practice of evaluation of suspected cervical cancer 3. Why combine examination under anesthesia with biopsy 4. Willingness to perform outpatient biopsy while key informant interview was conducted on randomly selected 10 consultants with interest in gynae-oncology. Results: Fifteen doctors from 2 departments of obstetrics and gynecology in 2 tertiary health institutions completed the questionnaire. Majority of the respondent were male 12/15 (80%), with average year of practice experience of 4.7 years (SD 3.5). While 100% of the respondents are duly aware of the role of cervical biopsy in confirming diagnosis of cervical cancer, none, 0% have done or witnessed cervical biopsy as an outpatient procedure. Majority 87% were not comfortable to perform outpatient biopsy of the cervix mainly because of fear of bleeding. While all the consultants were willing to perform outpatient cervical biopsy none routinely does it because of logistics. Conclusion: There is no evidence to support routine combination of examination under anesthesia and biopsy of suspicious cervical lesion. Unfounded fear of uncontrollable bleeding and lack of outpatient biopsy services are the major factors promoting the practice. Consequently, there is need for sensitization of gynecologic departments on safety of outpatient biopsy services.

Comparison of the diagnostic value of cervical cytology and HPV HR DNA testing for the diagnosis of low-grade and high-grade squamous intraepithelial lesions across different age groups.

To assess the diagnostic value of cervical cytology and HPV HR DNA testing for the diagnosis of low grade and high-grade squamous intraepithelial lesions across different age groups. The study included 1103 patients, age 25-70 years. All patients underwent in-depth diagnostic tests following either an abnormal Pap test result or a clinically suspicious cervical lesion. In all women the following examinations were performed: a molecular test detecting 14 high-risk types of HPV, a colposcopy examination, as well as directed-biopsy of the cervix. The studied population was subdivided into four age groups. It was observed that the percentage of high grade squamous intraepithelial lesions (HSIL) and cancers increased with women's age. Sensitivity of both methods for detecting high-grade squamous intraepithelial lesions was highest for women aged 40-49 years. Sensitivity values of HPV testing was higher than that of cervical cytology among women under age 50. Specificity of HPV testing increased significantly with age of women and was several fold higher across all age groups than the specificity of cervical cytology.

Silver Stained Nucleolar Organising Region (AgNOR) Count and its Correlation with Colposcopy in Suspicious Cervical Pathology

Introduction: Colposcopy is considered a sensitive tool for screening of cervical malignancy. Colposcopy directed biopsy helps in confirming diagnosis. Silver stained nucleolar organising region (AgNOR count) of dysplastic cells further enhances the diagnosis. Aim: To study the correlation of AgNOR count and colposcopy in suspicious cervical lesions. Materials and methods: 200 women of reproductive age group were screened for cervical cancer and colposcopy directed biopsy taken. AgNOR count studied and correlated with HPE and Modified Reid’scolposcopic index. Results: There was a good correlation between AgNOR count and the degree of dysplasia. Also there was a good correlation of AgNOR count and Modified Reid’scolposcopic index. Conclusions: AgNOR count is simple, effective method and it adds strength to histopathology and colposcopy

Management of precancerous cervical lesions in iran: a cost minimizing study.

Cervical cancer is a common, preventable and manageable disease in women worldwide. This study was conducted to determine the cost of follow-up for suspicious precancerous cervical lesions within a screening program using Pap smear or HPV DNA test through the decision tree. Patient follow-up processes were determined using standard guidelines and consultation with specialists to design a decision tree model. Costs of treatment in both public and private sectors were identified according to the national tariffs in 2010 and determined based on decision tree and provided services (visits to specialists, colposcopy, and conization) with two modalities: Pap smear and HPV DNA test. The number of patients and the mean cost of treatment in each sector were calculated. The prevalence of lesions and HPV were obtained from literature to estimate the cost of treatment for each woman in the population. Follow-up costs were determined using seven processes for Pap smear and 11 processes for HPV DNA test. The total cost of using Pap smear and HPV DNA process for each woman in the population was 36.1$ and 174 $ respectively. The follow-up process for patients with suspicious cervical lesions needs to be included in the existing screening program. HPV DNA test is currently more expensive than Pap smear, it is suggested that we manage precancerous cervical lesions with this latter test.

The diagnostic value of parathyroid hormone washout after fine‐needle aspiration of suspicious cervical lesions in patients with hyperparathyroidism

We aimed to study the diagnostic value of parathyroid hormone (PTH) concentration in the needle washout of fine-needle aspiration (FNA) compared to cytology of suspicious lesions suggestive of culprit parathyroid glands in patients with recurrent or persistent primary hyperparathyroidism (PHPT). Retrospective review. Patients with recurrent or persistent PHPT, who were referred to one surgeon and underwent FNA of the culprit parathyroid lesion preoperatively, were included in this study. All patients underwent comprehensive neck ultrasound, and suspicious lesions underwent ultrasound-guided FNA by the same surgeon. The aspiration cytology was read by a single dedicated cytopathologist blinded to the PTH washout results. A positive cutoff value for PTH washout concentration was defined as superior to serum PTH level obtained at the same time. The final diagnosis after reoperative surgery was confirmed by the same cytopathologist. Twenty-four consecutive patients were included. The mean serum PTH and calcium were 111.5 ± 106.25 pg/mL (normal: 15-65 pg/mL) and 10.8 ± 0.5 mg/dL (normal: 8.6-10.2 pg/mL), respectively. Twenty-two patients (91.6%) had elevated PTH washout concentrations with a positive predictive value (PPV) of 100%. Cytopathology was successful in confirming parathyroid tissue only in seven patients (29%). An adenoma was identified in 19 patients (79.1%); however, five patients (20.8%) were found to have multiglandular disease. An elevated PTH washout concentration can help identify culprit parathyroid gland lesions with a high PPV in patients requiring reoperative parathyroid surgery. This diagnostic technique allows for targeted surgical approach in reoperative settings, especially in patients with negative preoperative sestamibi scans. 4.

Expression of p16 and Ki67 in cervical intraepithelial neoplasia and cervical carcinoma

Two hundred and seventy four patients with suspicious cervical lesions underwent pelvic examination and biopsy. Tissue biopsy results revealed 153 cases of cervical intraepithelial neoplasia(CIN)and 10 cases of cervical carcinoma. p16 and Ki67 were detected by immunohistochemistry method in tissue specimens. The positive rates of p16 were 9.0%, 69. 9%, 93. 8%, 95. 5% and 10/10 in normal cervical mucosa, CIN Ⅰ , CIN Ⅱ , CIN Ⅲ and cervical carcinoma, respectively; while those of Ki67 were 76. 6%,89. 2%, 91.7%, 95.5% and 10/10, respectively. The expressions of p16 and Ki67 were significantly associated with cervical lesions ( P ＜ 0. 01 ). The study suggests that p16 and Ki67 may be used as supplemental diagnostic markers for cervical lesions. Key words: Cervical intraepithelial neoplasia; Proteins

Cut‐off value for needle washout thyroglobulin in athyrotropic patients

The purpose of this study was to determine the appropriate cut-off value for fine needle aspiration-thyroglobulin (FNA-Tg) associated with postoperative recurrences and validate the diagnostic efficacy of FNA-Tg in patients after total thyroidectomy compared with concomitant cytology (C). Retrospective. We retrospectively evaluated the results of ultrasound-guided FNAs performed for suspicious cervical lesions of 40 patients (male:female = 10:30; mean age, 44.0 years) after total thyroidectomy (mean duration, 89.1 months), to acquire the material for Tg and C analysis. After collection of the cytologic sample, we rinsed the same needle with 1 mL of normal saline for Tg radioimmunoassay. Of 40 lesions (mean size, 0.89 cm; range, 0.3-3.5 cm), 21 were confirmed as recurrences and 19 were nonrecurrences. The rates of nondiagnostic sampling and sensitivity and specificity of FNA-C when diagnostic sampling was obtained were 40% (16/40), 100% (14/14), and 90.0% (9/10), respectively. According to receiver operating characteristic analysis, the optimal cut-off value of FNA-Tg was 4.1 ng/mL (sensitivity, 100% [21/21]; specificity, 100% [19/19], P < .05). Furthermore, in 16 inconclusive lesions due to nondiagnostic cytologic results, the FNA-Tg results coincided with a final diagnosis (seven recurrences and nine nonrecurrences). The cases with maximum diameters <1 cm showed a significantly increased rate of nondiagnostic cytologic results, and the FNA-Tg results were more helpful than lesions > or =1 cm in diagnosing a recurrence (P < .05). Measurement of FNA-Tg is helpful for distinguishing recurrent from nonrecurrent lesions in the majority of patients who were previously treated for well-differentiated papillary thyroid carcinoma.

Cervical Signet-Ring Cell Carcinoma Presenting as a Synchronous Primary Carcinoma with Uterine Adenocarcinoma

Synchronous primary gynecologic tumors are relatively uncommon with the diagnosis often made following initial surgery. A multiparous female in her 50s with postmenopausal bleeding was referred to our institution with a biopsy-proven diagnosis of endometrial cancer. Preoperative physical exam revealed a suspicious cervical lesion and upon biopsy she was found to have a signet-ring cell carcinoma of the cervix. Secondary to morbid obesity, the patient was not a candidate for a radical hysterectomy and was treated with curative radiation for stage IB 1 cervical carcinoma and clinical stage I endometrial carcinoma. Cervical signet-ring cell carcinoma is an extremely rare pathologic diagnosis. The preoperative discovery of synchronous primary gynecological tumors necessitates individualized planning and treatment.

Preoperative Diagnosis of Suspicious Parathyroid Adenomas by RT-PCR Using mRNA Extracted from Leftover Cells in a Needle Used for Ultrasonically Guided Fine Needle Aspiration Cytology

To determine the usefulness of reverse transcriptase-polymerase chain reaction (RT-PCR) detection of parathormone (PTH) gene mRNA in needle aspirates to confirm the parathyroid nature of suspicious cervical lesions in patients with hyperparathyroidism. Ultrasound-guided fine needle aspiration cytology (FNAC) was performed on 12 patients with suspected parathyroid adenomas. The aspirates were subjected to cytologic and chromogranin A examination. Messenger RNA was isolated from left-over cells within the needle, and RT-PCR was used to amplify mRNA encoding PTH. The 12 aspirates were positive by PTH RT-PCR, and molecular diagnosis was confirmed by histologic examination. The lower sensitivity of cytologic and immunocytochemical methods was demonstrated, respectively, by 67% and 50% of positive results. Sensitivity assays demonstrated that with our system, PTH RT-PCR products are obtained from as few as 10 pg of parathyroid mRNA. The present study showed that RT-PCR-based analysis of PTH gene transcripts in aspirates, obtained by US-guided FNAC of cervical lesions suspicious for parathyroid adenoma, is a feasible, sensitive and specific method for preoperative diagnosis of parathyroid adenomas.

Cervical coring versus noncoring technique in supracervical laparoscopic hysterectomy

We questioned whether cervical coring is necessary in laparoscopic supracervical hysterectomy. More than 250 laparoscopic supracervical hysterectomies have been done with transvaginal resection of the endocervical canal at our hospital since October 1992, and 35 cases without transvaginal resection of endocervical canal in 1995 and 1996. Women with suspicious cervical lesions and abnormal Papanicolaou smears were excluded from the noncoring technique. The purpose of coring the cervix is to prevent cancer in the remaining cervix, but the occurrence rate is the same as with an intact cervix. After comparing operating times, length of hospital stay, blood loss, and technique in both groups, we concluded that noncoring technique has many advantages over coring.

Transvaginal sonography in patients with pathological cervical exfoliative cytology or histologically verified cervical carcinoma

Objective: The aim of the study was to evaluate whether detection of cervical carcinoma or cervical dysplasia is possible with the use of transvaginal sonography (TVS). Method: TVS was performed in 215 patients with pathological cervical cytology (PAP III-V), suspicious clinical findings or histologically verified carcinoma of the cervix. Results: Cone biopsy in 54 patients with suspicious cytology and normal cervical features revealed 26 cases of cervical intra-epithelial neoplasia (CIN) 0-II and 19 cases of carcinoma in situ. Sonography failed to detect cervical carcinoma in only nine cases (stages Ia, Ib and IIa). False-positive results of TVS were associated in no cases with CIN 0. In 161 cases with suspicious cervical lesions, 133 invasive cancers and 23 carcinomas in situ were detected. The most striking cytological finding was that 92% of patients with PAP III/IIID and abnormal sonographic signs, and 7% with normal sonographic results and suspicious PAP, had cancer of the cervix uteri. Conclusion: We conclude that TVS could be usefully applied to the routine pretreatment evaluation of patients with cervical carcinoma.

Diagnosis of parathyroid adenomas: efficacy of measuring parathormone levels in needle aspirates of cervical masses.

The purpose of this study was to assess the value of measuring parathormone levels in percutaneous needle aspirates of suspicious cervical lesions in patients with hyperparathyroidism to confirm whether the lesion represents abnormal parathyroid tissue. The study group consisted of 66 patients with hyperparathyroidism in whom 80 cervical lesions were aspirated and levels of parathormone in the aspirates were measured. CT guidance was used for two patients and sonographic guidance for the remainder. The lesions selected for aspiration were demonstrated on either sonography or CT and had either an unusual position (separate from the thyroid gland or were intrathyroidal) or configuration (irregular shape or atypical heterogeneous sonographic texture). In 15 patients, an indeterminate, posteriorly located intrathyroidal mass was detected and felt most likely to represent a thyroid nodule by sonographic criteria. These masses were aspirated to rule out atypical parathyroid adenomas. In patients who had been previously explored for hyperparathyroidism and presented with persistent or recurrent hypercalcemia, all indeterminate, cervical, potentially parathyroid masses were aspirated for parathormone determination. The level of parathormone in each aspirate was measured by using an immunoradiometric assay. Levels of parathormone were increased in the aspirates in 37 of the 45 patients in whom sonography showed classic lesions suggestive of parathyroid adenoma. This included the 25 patients who had previously undergone exploratory surgery. At surgery, all 37 had parathyroid adenomas in the indicated locations, for a specificity of 100%. In six patients, the results of the aspiration were false-negative. Parathyroid adenomas were suspected on sonograms and confirmed at surgery, but no parathormone was detected in the aspirate. Results of aspiration of indeterminate lesions were true-negative in two patients who had both characteristic and indeterminate lesions on sonography and in the 15 patients who had indeterminate lesions that were felt to be of thyroid origin. Aspirates contained no parathormone, and surgical findings confirmed the lesions were not of parathyroid origin. Our results show that increased levels of parathormone in percutaneous needle aspirates of cervical masses in patients with hyperparathyroidism confirm the mass is a parathyroid adenoma. Although absence or low levels of parathormone in the aspirates usually excludes a parathyroid adenoma, this is not absolute as sometimes the needle may miss the mass, rendering the parathormone value invalid (false-negative).

Cytology and colposcopy in the diagnosis of cervical neoplasia

A total of 98 patients were referred to the Cervical Dysplasia Clinic for colposcopic evaluation. These included 52 patients with abnormal cytology and 46 with a grossly suspicious cervical lesion but negative cytology. None of the patients in the latter group showed any lesion on colposcopic examination. Of the 52 patients with abnormal cytology, cervical neoplasia was present in 47. The accuracy of cytology and colposcopy in predicting the degree of cervical neoplasia was 78.8 and 87.2%, respectively. The histology of the directed biopsy and that of the cone biopsy were within one histological grade of agreement in 88.5% of cases. The results also indicate that only 17.3% of the patients would require a cone biopsy for definitive diagnosis. It is concluded that colposcopy is a valuable adjunct to cytology in the diagnosis of cervical neoplasia, and the necessity for conization to establish a diagnosis can be markedly decreased.