MedWorm: Colposcopy

Regeneration of uterine cervix at 6 months after large loop excision of the transformation zone for cervical intraepithelial neoplasia

BJOG: An International Journal of Obstetrics and Gynaecology — Wed, 08 Feb 2012 05:00:00 +0100

Conclusions Cervical regeneration at 6 months after excision is dependent on the percentage of initial cervical volume excised and on the remaining cervical tissue immediately after conisation. The greater the cone and the less cervical tissue remaining, the less the degree of cervical regeneration achieved. (Source: BJOG: An International Journal of Obstetrics and Gynaecology)

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Pooled Analysis of a Self-Sampling HPV DNA Test as a Cervical Cancer Primary Screening Method

JNCI — Tue, 07 Feb 2012 05:00:00 +0100

Conclusions The sensitivity of Self-HPV testing compared favorably with that of LBC and was superior to the sensitivity of VIA. Self-HPV testing may complement current screening programs by increasing population coverage in settings that do not have easy access to comprehensive cytology-based screening. (Source: JNCI)

Agreement between colposcopic impression and histological diagnosis among human papillomavirus type 16‐positive women: a clinical trial using dynamic spectral imaging colposcopy

BJOG: An International Journal of Obstetrics and Gynaecology — Fri, 03 Feb 2012 05:00:00 +0100

Conclusions The sensitivity of DSI colposcopy for CIN2+ is higher in HPV16+ than in non‐16 hrHPV+ women. Furthermore, regardless of HPV16 status, the sensitivity of DSI for CIN2+ is higher than that of the colposcopist, probably because colposcopists tend to miss smaller cervical lesions. (Source: BJOG: An International Journal of Obstetrics and Gynaecology)

CAP/ASCCP Lower Anogenital Squamous Terminology Standardization Project

CAP Important Announcements and News — Tue, 31 Jan 2012 13:35:00 +0100

A joint collaboration with the American Society for Colposcopy and Cervical Pathology in an effort to harmonize terminology. (Source: CAP Important Announcements and News)

Schistosomiasis: an unusual finding of the cervix.

Obstetrics and Gynecology — Thu, 26 Jan 2012 20:31:26 +0100

CONCLUSION: : The differential diagnosis of female genital schistosomiasis should be considered for patients who have a history of residence in or travel to endemic areas, including asymptomatic patients and patients presenting a long time after exposure. PMID: 22270443 [PubMed - in process] (Source: Obstetrics and Gynecology)

Prediction of cervical intraepithelial neoplasia grade 2+ (CIN2+) using HPV DNA testing after a diagnosis of atypical squamous cells of undetermined significance (ASC-US) in Catalonia, Spain.

BMC Infectious Diseases — Thu, 26 Jan 2012 05:00:00 +0100

Conclusions: Triage of ASC-US with hrHPV testing showed a high sensitivity for the detection of CIN2+ and a high negative predictive value after 3 years of follow-up. The results of this study are in line with the current guidelines for triage of women with ASC-US in the target age range of 25-65. Non adherence to guidelines will lead to unnecessary medical interventions. Further investigation is needed to improve specificity of ASC-US triage. (Source: BMC Infectious Diseases)

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Adjunctive testing for cervical cancer screening in low resource settings

The Australian and New Zealand Journal of Obstetrics and Gynaecology — Wed, 25 Jan 2012 05:00:00 +0100

ConclusionsSequential testing combination of VIA and HPV, followed by colposcopy and directed biopsy for diagnosis, combines economic viability with high scientific fidelity. The high specificity and negative predictive value reduce referral and treatment rates, as well as number of visits required for diagnosis. HPV (P) followed by reflex Pap is a suitable option for high resource situations with access to liquid‐based cytology. (Source: The Australian and New Zealand Journal of Obstetrics and Gynaecology)

Diagnostic value of acetic acid comparing with conventional Pap smear in the detection of colposcopic biopsy-proved CIN

Journal of Cancer Research and Therapeutics — Thu, 19 Jan 2012 05:00:00 +0100

Conclusion: Since diagnostic values of VIA is comparable to Pap smear, and it performs well in detecting a high grade lesion, we conclude that VIA can be used as a screening modality for cervical cancer in low resource settings. (Source: Journal of Cancer Research and Therapeutics)

Use of electronic health record data to evaluate overuse of cervical cancer screening.

Journal of the American Medical Informatics Association — Thu, 19 Jan 2012 05:00:00 +0100

ConclusionSecondary analysis of EHR data can accurately measure the use of low-value services such as Pap testing performed sooner than recommended in women at low risk of cervical cancer. Similar application of our methodology could facilitate efforts to simultaneously improve quality and decrease costs, maximizing value in the US healthcare system. PMID: 22268215 [PubMed - as supplied by publisher] (Source: Journal of the American Medical Informatics Association)

Risk assessment and clinical impact of liquid-based cytology, oncogenic human papillomavirus (HPV) DNA and mRNA testing in primary cervical cancer screening (The FASE Study).

Gynecologic Oncology — Mon, 09 Jan 2012 05:00:00 +0100

CONCLUSIONS: These data corroborate the suitability of AHPV for the primary cervical cancer screening. PMID: 22233689 [PubMed - as supplied by publisher] (Source: Gynecologic Oncology)

A pilot study to test the differential validity of a genital injury severity scale, in development for use in forensic sexual assault examinations

Journal of Forensic Nursing — Fri, 06 Jan 2012 05:00:00 +0100

AbstractMethods of examining the sexual assault patient are not standardized and a definition of what constitutes significant genital injury after sexual assault (SA) remains controversial. This pilot study tests the empirical validity (initial differential validity) of a genital injury severity scale (GISS) under development by the authors with the hypothesis that women who report SA have more severe external genital injuries than those who engage in consensual intercourse (CI). In this observational, prospective study, an initially developed GISS is applied and the exam results of 59 CI volunteers and 185 SA patients are compared. All examinations were performed by experienced sexual assault forensic examiners (SAFE) using toluidine blue (TB) and colposcopy. The Independent Samples Media...

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Analysis of the effectiveness of visual inspection with acetic acid/Lugol’s iodine in one-time and annual follow-up screening in rural China

Archives of Gynecology and Obstetrics — Thu, 05 Jan 2012 17:06:19 +0100

Conclusion In a rural, low-resource setting in China, one-time VIA/VILI screening detected more than a half of CIN2 cases, most CIN3 cases and all the cervical cancer cases. Detection rates of CIN2 lesions significantly increased with a 1-year follow-up VIA/VILI screen. Therefore, if multiple cervical cancer screenings are not feasible logistically or financially, a one-time VIA/VILI may be the most efficient strategy to detect cervical cancer and most CIN3 lesions in women in low-resource settings. Content Type Journal ArticleCategory General GynecologyPages 1-6DOI 10.1007/s00404-011-2203-4Authors Rong Li, Department of Gynecological Oncology, Chongqing Cancer Institute/Hospital, 181 Hanyu Lane, Shapingba District, Chongqing, 400030 People’s Republic of ChinaAda...

Sociodemographic factors associated with cervical cancer screening and follow-up of abnormal results.

Canadian Family Physician Medecin de Famille Canadien — Sun, 01 Jan 2012 05:00:00 +0100

Conclusion Despite universal health coverage, cervical cancer screening rates are suboptimal among low-income women at greatest risk. Follow-up among women with inadequate or abnormal test results is often poor. Novel models of cervical cancer screening are needed to address these inadequacies. PMID: 22267636 [PubMed - in process] (Source: Canadian Family Physician Medecin de Famille Canadien)

Review of Screening Guidelines for Non-AIDS-Defining Malignancies: Evolving Issues in the Era of Highly Active Antiretroviral Therapy.

AIDS Reviews — Sun, 01 Jan 2012 05:00:00 +0100

Authors: Tyerman Z, Aboulafia DM Abstract HIV-associated morbidity and mortality have declined dramatically in the era of HAART. Through direct and indirect benefits of HAART, people with HIV/AIDS are living longer, developing less AIDS-defining cancers and more cancers commonly seen in the seronegative population. Herein, we review cancer screening strategies for people living with HIV and compare and contrast them with those of the general population. The most noticeable differences occur in anal and cervical cancer screening. Although anal cancer is uncommon in the general population, it is more prevalent in men who have sex with men and people at high risk for human papillomavirus infection, especially those infected with HIV. To address this, we recommend that a digital rectal...

Acceptability of self-collected human papillomavirus specimens as a primary screen for cervical cancer.

Pain Physician — Sat, 24 Dec 2011 11:06:14 +0100

Authors: Quincy BL, Turbow DJ, Dabinett LN Abstract The aim of this study was to compare the acceptability of self-collected vs clinician-collected human papillomavirus (HPV) tests. Utilising a cross-sectional approach, 250 non-pregnant, 25-60-year-old women from Leon, Nicaragua self-collected vaginal swabs and brushes for HPV and received a pelvic examination for liquid-based cytology and reflex HPV. Subjects underwent colposcopy, with biopsy if indicated, and completed questionnaires comparing their perceptions of HPV testing methods. Acceptability indices were significantly higher for self-collected brushes (M = 18.40, SD = 2.73) and swabs (M = 18.48, SD = 2.41) than clinician-collection (M = 17.56, SD = 2.92), p < 0.001. Multiple regression analyses revealed that age, educat...

Interventions for reducing anxiety in women undergoing colposcopy.

Cochrane Database of Systematic Reviews — Tue, 20 Dec 2011 01:00:04 +0100

CONCLUSIONS: Anxiety appears to be reduced by playing music during colposcopy. Although information leaflets did not reduce anxiety levels, they did increase knowledge levels and are therefore useful in obtaining clinical consent to the colposcopic procedure. Leaflets also contributed to improved patient quality of life by reducing psychosexual dysfunction. PMID: 22161395 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)

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Impact of media reporting of cervical cancer in a UK celebrity on a population-based cervical screening programme

Journal of Medical Screening — Mon, 19 Dec 2011 05:00:00 +0100

Conclusions Mass media reporting of cervical cancer in a UK celebrity was associated with a significant, but transient, increase in screening uptake and colposcopy referral and attendance. Mass media reporting can play a role in enhanced detection of abnormalities, but public health messages must be communicated effectively to minimize anxiety whilst maximizing case-finding and uptake among non-responders. (Source: Journal of Medical Screening)

Significance of HPV 16 and 18 viral load quantitation in women referred for colposcopy

Journal of Medical Virology — Wed, 14 Dec 2011 19:14:13 +0100

AbstractThe clinical utility of HPV 16 and 18 viral loads remains debated. The aim of this study was to assess the clinical significance of HPV 16 and 18 viral load and to determine a cut‐off for optimal prediction of grade 2 or higher cervical intraepithelial neoplasia among patients referred to colposcopy. A total of 186 cervico‐vaginal specimens harboring HPV 16 and/or 18 obtained at the time of colposcopy from patients without previous cervical neoplasia were tested for HPV 16 and 18 detection and quantitation using quantitative duplex real‐time PCR method. Grade 2 or higher cervical intraepithelial neoplasia was diagnosed in 87 (46.8%) cases. Only HPV 16 median viral load increased significantly with the lesion grade: 9.1 × 104 in normal cervix or grade 1 cervical intraepit...

How to optimize excisional procedures for the treatment of CIN? The role of colposcopy

Archives of Gynecology and Obstetrics — Tue, 13 Dec 2011 17:04:36 +0100

Conclusions Use of colposcopy, and particularly of DCV during excisional procedures for CIN, allows for smaller surgical specimen without jeopardizing the margins status. Content Type Journal ArticleCategory General GynecologyPages 1-8DOI 10.1007/s00404-011-2162-9Authors Céline Grisot, Department of Obstetrics and Gynaecology, Assistance Publique des Hôpitaux de Marseille (APHM), Hôpital Nord, Chemin des Bourrelly, 13015 Marseille, FranceJulien Mancini, University of Medicine of Marseille, Université de la Méditerranée, Aix-Marseille II, 27 boulevard Jean Moulin, 13385 Marseille Cedex 05, FranceSophie Giusiano, University of Medicine of Marseille, Université de la Méditerranée, Aix-Marseille II, 27 boulevard Jean Moulin, 13385 Marseille Cedex 05, FranceGille...

Factors associated with psychological distress following colposcopy among women with low‐grade abnormal cervical cytology: a prospective study within the Trial Of Management of Borderline and Other Low‐grade Abnormal smears (TOMBOLA)

Psycho-Oncology — Mon, 12 Dec 2011 05:00:00 +0100

ConclusionsSubstantial proportions of women experience psychological distress after colposcopy and related procedures, even when the colposcopy is normal. This is an important cost of cervical screening. Interventions to alleviate these adverse psychological effects are required. Copyright © 2011 John Wiley & Sons, Ltd. (Source: Psycho-Oncology)

Evaluation of patients with Behçet’s disease by cervical cytology and colposcopic examination

Archives of Gynecology and Obstetrics — Wed, 07 Dec 2011 10:52:22 +0100

Conclusion Patients with BD are more prone to having an abnormal cervical cytology and acetowhite and iodine-negative epithelium on colposcopic examination. However, these findings are mostly benign conditions. The complaint of dyspareunia should be considered during treatment of female patients with BD. Content Type Journal ArticleCategory General GynecologyPages 1-6DOI 10.1007/s00404-011-2158-5Authors Suna Özdemir, Department of Obstetrics and Gynecology, School of Medicine, Bezmialem Vakif University, 34093 Fatih, Istanbul, TurkeyMustafa Özdemir, Department of Dermatology, Bezmialem Vakif University School of Medicine, Istanbul, TurkeyÇetin Çelik, Department of Obstetrics and Gynecology, Meram School of Medicine, Selcuk University, Konya, TurkeyAli Balevi, De...

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Factors Associated with Time to Colposcopy After Abnormal Pap Testing in HIV-Infected Women

Journal of Women — Tue, 06 Dec 2011 04:10:14 +0100

Journal of Women's Health , Vol. 0, No. 0. (Source: Journal of Women)

Borderline nuclear change, high‐grade dyskaryosis not excluded: current concepts and impact on clinical practice

Cytopathology — Thu, 01 Dec 2011 05:00:00 +0100

Conclusions: The B/HG category was associated with a significantly higher incidence of CIN2+ compared with borderline cytology as a whole. This refining performance justifies its existence. Colposcopic appearances had a high PPV for detecting CIN2+. Therefore, colposcopy is recommended in patients with B/HG cytology and treatment should be offered if high‐grade colposcopic changes are seen. (Source: Cytopathology)

Optical coherence tomography compared with colposcopy for assessment of vaginal epithelial damage: a randomized controlled trial.

Obstetrics and Gynecology — Thu, 01 Dec 2011 05:00:00 +0100

CONCLUSION: : Optical coherence tomography detected epithelial disruption and thinning not identified by colposcopy. Vaginal epithelial thickness, a measure previously available only through biopsy, decreased after nonoxynol-9 use, a finding that may contribute to increased susceptibility to human immunodeficiency virus after frequent use. Optical coherence tomography shows promise for the noninvasive clinical assessment of vaginal epithelial damage. CLINICAL TRIAL REGISTRATION: : UMIN Clinical Trials Registry, www.umin.ac.jp/ctr/index.htm, R000006186. LEVEL OF EVIDENCE: : I. PMID: 22105265 [PubMed - in process] (Source: Obstetrics and Gynecology)

The clinical meaning of a cervical intraepithelial neoplasia grade 1 biopsy.

Obstetrics and Gynecology — Thu, 01 Dec 2011 05:00:00 +0100

CONCLUSION: : A CIN 1 diagnosis does not represent a significant risk factor for CIN 3 above the risk attributed to its molecular cause, genotype-specific HPV infection. LEVEL OF EVIDENCE: : II. PMID: 22105250 [PubMed - in process] (Source: Obstetrics and Gynecology)

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Factors predicting the outcome of conservatively treated adenocarcinoma in situ of the uterine cervix: An analysis of 166 cases.

Gynecologic Oncology — Thu, 01 Dec 2011 05:00:00 +0100

CONCLUSIONS: These results suggest that testing HR-HPV positive at any time point during FU is the most significant independent predictor of progressive disease, while showing free margins in cone has a significant protective effect against progression to AC. Furthermore, because 4.3% women with persistent, recurrent or progressive disease experienced a late (5th and 6th FU) diagnosis of HG-CGIN or microinvasive AC, a close surveillance should be scheduled for at least three years in conservatively treated AIS patients. PMID: 22188786 [PubMed - as supplied by publisher] (Source: Gynecologic Oncology)

Topical oxytocin reverses vaginal atrophy in postmenopausal women: a double-blind randomized pilot study

Menopause International — Wed, 30 Nov 2011 05:00:00 +0100

Conclusion Topical treatment with oxytocin appears to improve vaginal atrophy in postmenopausal women. A limitation of this pilot study is that it was based on a small study population hence the results should be regarded with caution. Larger studies are in progress to establish the possibility of using oxytocin as a clinical treatment for vaginal atrophy. (Source: Menopause International)

A New PCR-Based Mass Spectrometry System for High-Risk HPV, Part II: Clinical Trial.

American Journal of Clinical Pathology — Mon, 21 Nov 2011 13:31:09 +0100

Authors: Du H, Yi J, Wu R, Belinson SE, Qu X, Yang B, Wang C, Yi X, Belinson JL Abstract This was a population-based clinical trial of a polymerase chain reaction-based multiplex high-risk human papillomavirus (HR-HPV) assay using mass spectrometry (MassARRAY [Sequenom, San Diego, CA] matrix-assisted laser desorption/ionization time-of-flight mass spectrometry system [MALDI-TOF]). Participants were 10,000 women between the ages of 25 and 59 years in Guangdong Province, China (SHENCCAST II Study). All women collected a self-sample (tested with Cervista [Hologic, Marlborough, MA] and MALDI-TOF) followed by a clinician-collected cervical sample (for cytology, Hybrid Capture 2 [HC2; Qiagen, Gaithersburg, MD], Cervista, and MALDI-TOF). Patients with any abnormal result were asked to ret...

Colposcopy Workshop 2010 (Dana Sprute MD, MPH)

Family Medicine Digital Resources Library (FMDRL) Recently Uploaded — Thu, 10 Nov 2011 05:00:00 +0100

OBJECTIVES: Review cervical cancer screening criteria. Review Bethesda system of PAP description. Review common PAP abnormalities. Review role of HPV in evaluation of abnormal PAP Understand the role of colposcopy in evaluation of abnormal PAP. Understand the Reid's Colposcopic Index & its use in colposcopic evaluation. Be able to accurately describe colposcopic findings and determine presence & probable degree of cervical dysplasia; concepts reinforced with case-based discussion. (Source: Family Medicine Digital Resources Library (FMDRL) Recently Uploaded)

COMPARISON of Human Papillomavirus Testing and Cytology for Cervical Cancer Screening in a Primary Health Care Setting in the Democratic Republic of Congo.

Gynecologic Oncology — Fri, 04 Nov 2011 04:00:00 +0100

CONCLUSIONS: Among unscreened women, HC2 and HC2+4 had similar screening accuracy for cervical neoplasia, and both were more sensitive but less specific than Pap cytology. PMID: 22062546 [PubMed - as supplied by publisher] (Source: Gynecologic Oncology)

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High prevalence of HPV in non-cervical sites of women with abnormal cervical cytology

BMC Cancer — Wed, 02 Nov 2011 04:00:00 +0100

Conclusions: Women with abnormal smears have widespread infection with high-risk HPV at the cervical, anal and oro-pharyngeal mucosal sites and may represent a higher risk population for HPV disease in the future. (Source: BMC Cancer)

Single negative colposcopy: is it enough to rule out high-grade disease?

Journal of Medical Screening — Tue, 01 Nov 2011 04:00:00 +0100

We present data regarding 551 women who had colposcopy in Wales for a low-grade cytological abnormality and who were followed through Cervical Screening Wales for subsequent CIN. Of 436 women declared CIN free initially, 26 (6.0%) had high-grade CIN diagnosed on follow-up. We suggest that additional screening at an interval of less than three years should be offered to women with a negative colposcopy or a biopsy without CIN. (Source: Journal of Medical Screening)

Determinants of pre‐procedural state anxiety and negative affect in first‐time colposcopy patients: implications for intervention

European Journal of Cancer Care — Tue, 01 Nov 2011 04:00:00 +0100

KOLA S. & WALSH J.C. (2011) European Journal of Cancer CareDeterminants of pre‐procedural state anxiety and negative affect in first‐time colposcopy patients: implications for interventionWomen experience significant emotional distress in relation to further diagnostic evaluation of pre‐cancerous cell changes of the cervix. However, less is known about the specific variables that contribute to elevated state anxiety and negative affect prior to colposcopy. The study aims to identify psychosocial factors that predict distress in this patient group, which can help in the development of more sophisticated interventions to reduce psychological distress. Socio‐demographic variables, scores for state anxiety, negative affect, trait anxiety, fear of pain, coping style, pain‐related ...

Proposed Cervical Cancer Screening Guidelines

Health News from Medical News Today — Fri, 21 Oct 2011 08:00:00 +0100

The American Cancer Society (ACS), the American Society for Colposcopy and Cervical Pathology (ASCCP), and the American Society for Clinical Pathology (ASCP) have proposed new guidelines for the prevention and early detection of cervical cancer. The proposed guidelines, which are now posted for public comment, generally advise that women reduce the number of tests they get over their lifetime to better ensure that they receive the benefits of testing while minimizing the risks... (Source: Health News from Medical News Today)

Self‐sampling of vaginal fluid and high‐risk human papillomavirus testing in women aged 50 years or older not attending Papanicolaou smear screening

BJOG: An International Journal of Obstetrics and Gynaecology — Fri, 21 Oct 2011 04:00:00 +0100

Conclusions Self‐sampling of vaginal fluid in combination with high‐risk HPV testing appears to be an attractive method to improve screening coverage and decrease the prevalence of cervical cancer in women aged 50 years or older. (Source: BJOG: An International Journal of Obstetrics and Gynaecology)

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Health groups issue proposed cervical cancer screening guidelines

EurekAlert! - Medicine and Health — Wed, 19 Oct 2011 04:00:00 +0100

(American Cancer Society) The American Cancer Society, the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology have proposed new guidelines for the prevention and early detection of cervical cancer. (Source: EurekAlert! - Medicine and Health)

The Development and Implementation of an Electronic Departmental Note in a Colposcopy Clinic.

Computers, Informatics, Nursing : CIN — Wed, 19 Oct 2011 04:00:00 +0100

This study has demonstrated that practitioners in a colposcopy clinic successfully collaborated with information technology specialists and each other to develop and implement a clinical departmental information system. While certain challenges were encountered, nurses and physicians have bought into the system, recognize its potential for research and patient care, and are therefore committed to figuring out how to adapt to the changes in communication both within the clinic and with referring physicians. PMID: 22015979 [PubMed - as supplied by publisher] (Source: Computers, Informatics, Nursing : CIN)

Liquid-Based Cytology and Human Papillomavirus Testing to Screen for Cervical Cancer: A Systematic Review for the U.S. Preventive Services Task Force.

Annals of Internal Medicine — Mon, 17 Oct 2011 04:00:00 +0100

Conclusion: Evidence supports the use of LBC or conventional cytology for cervical cancer screening, but more complete evidence is needed before HPV-enhanced primary screening is widely adopted for women aged 30 years and older. Primary Funding Source: Agency for Healthcare Research and Quality. PMID: 22006930 [PubMed - as supplied by publisher] (Source: Annals of Internal Medicine)

Cytology Gives Guidance on Recurrent Cervical CancerCytology Gives Guidance on Recurrent Cervical Cancer

Medscape ObGyn and Womens Health Headlines — Thu, 06 Oct 2011 00:53:51 +0100

Cervical cancer survivors with an abnormal Pap test don't necessarily need colposcopy, researchers reported last month in Obstetrics and Gynecology. Reuters Health Information (Source: Medscape ObGyn and Womens Health Headlines)

[Correspondence] Premature conclusions on HPV-only testing – Authors' reply

The Lancet Oncology — Sat, 01 Oct 2011 04:00:00 +0100

We thank Jianyu Rao and colleagues for their comments, which permit us to clarify certain points. First, although more women tested positive for human papillomavirus (HPV) than had an abnormal Pap, 73% of the HPV-positive women had a concurrent normal Pap test and therefore did not undergo immediate colposcopy, as per guideline recommendations. In fact, 1063 more women were referred for colposcopy at enrolment on the basis of an abnormal Pap than a positive HPV test (4899 vs 3836, respectively; p<0·0001), which shows that guidelines help ensure that HPV testing does not lead to overtreatment. (Source: The Lancet Oncology)

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A guide for standardizing colposcopic observations for the evaluation of topical microbicide products in the pigtailed macaque model

Journal of Medical Primatology — Sat, 01 Oct 2011 04:00:00 +0100

(Source: Journal of Medical Primatology)

Cervical cancer screening among HIV‐infected women: An economic evaluation in a middle‐income country

International Journal of Cancer — Fri, 30 Sep 2011 04:00:00 +0100

This study evaluates the optimal cervical cancer screening strategy for HIV‐infected women in a middle‐income country. We developed a mathematical model which simulates the natural history of the HPV infection, as well as the HIV‐mediated immunosupression among women in Brazil. Our model was calibrated using data from the IPEC/FIOCRUZ Women's HIV‐infected cohort. The model compares the lifetime effects, costs, and cost‐effectiveness of strategies combining cytology, HPV DNA test, and colposcopy at different screening intervals for different CD4 count strata (27 strategies in total). We found that the strategy with the best cost‐effectiveness profile (cost‐effectiveness ratio – U$4,911/year of life saved [YLS] and probability of being cost‐effective – 86%) was HPV testin...

Automatic colposcopy video tissue classification using higher order entropy-based image registration

Computers in Biology and Medicine — Tue, 20 Sep 2011 06:05:30 +0100

Abstract: Colposcopy is a well-established method to detect and diagnose intraepithelial lesions and uterine cervical cancer in early stages. During the exam color and texture changes are induced by the application of a contrast agent (e.g.3–5% acetic acid solution or iodine). Our aim is to densely quantify the change in the acetowhite decay level for a sequence of images captured during a colposcopy exam to help the physician in his diagnosis providing new tools that overcome subjectivity and improve reproducibility. As the change in acetowhite decay level must be calculated from the same tissue point in all images, we present an elastic image registration scheme able to compensate patient, camera and tissue movement robustly in cervical images. The image registration is based on a nove...

Evaluation of HPV-16 and HPV-18 Genotyping for the Triage of Women With High-Risk HPV+ Cytology-Negative Results.

American Journal of Clinical Pathology — Fri, 16 Sep 2011 19:48:44 +0100

Authors: Wright TC, Stoler MH, Sharma A, Zhang G, Behrens C, Wright TL, Abstract The ATHENA (Addressing THE Need for Advanced HPV Diagnostics) HPV study evaluated the clinical usefulness of the cobas HPV Test (Roche Molecular Systems, Pleasanton, CA) for high-risk human papillomavirus (HR-HPV) testing (14 HR types) and individual HPV-16/HPV-18 genotyping in women undergoing routine cervical cytology screening in the United States. For the study, 47,208 women were recruited, including 32,260 women 30 years or older with negative cytology. All women with positive results for HR-HPV (n = 4,219) plus a subset of HR-HPV- women (n = 886) were referred for colposcopy and biopsy. The overall prevalence of HR-HPV was 6.7% and of HPV-16/HPV-18 was 1.5%. Cervical intraepithelial neoplasia gr...

What women want. Women's preferences for the management of low-grade abnormal cervical screening tests: a systematic review.

BJOG : An International Journal of Obstetrics and Gynaecology — Tue, 06 Sep 2011 04:00:00 +0100

Conclusions Even for low-grade abnormal cervical tests, women tend to prefer active management strategies. It may be a challenge to meet their expectations of optimal follow-up when HPV testing is used in primary screening. PMID: 21895959 [PubMed - as supplied by publisher] (Source: BJOG : An International Journal of Obstetrics and Gynaecology)

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Can visual cervical screening be sustained in routine health services? Experience from Mali, Africa.

BJOG : An International Journal of Obstetrics and Gynaecology — Tue, 06 Sep 2011 04:00:00 +0100

Conclusion Visual screening and treatment services are sustainable and effective in improving cervical cancer control provision by health services in Bamako, Mali. It is essential to organise and sustain several point-of-care services in order to extend cervical cancer prevention in low-income African countries. PMID: 21895956 [PubMed - as supplied by publisher] (Source: BJOG : An International Journal of Obstetrics and Gynaecology)

Regeneration of cervix after excisional treatment for cervical intraepithelial neoplasia: a study of collagen distribution.

BJOG : An International Journal of Obstetrics and Gynaecology — Tue, 06 Sep 2011 04:00:00 +0100

Conclusion There is no overall change in collagen distribution during regeneration following excisional treatment for CIN. PMID: 21895948 [PubMed - as supplied by publisher] (Source: BJOG : An International Journal of Obstetrics and Gynaecology)

Can visual cervical screening be sustained in routine health services? Experience from Mali, Africa

BJOG: An International Journal of Obstetrics and Gynaecology — Mon, 05 Sep 2011 23:00:00 +0100

Conclusion Visual screening and treatment services are sustainable and effective in improving cervical cancer control provision by health services in Bamako, Mali. It is essential to organise and sustain several point‐of‐care services in order to extend cervical cancer prevention in low‐income African countries. (Source: BJOG: An International Journal of Obstetrics and Gynaecology)

What women want. Women’s preferences for the management of low‐grade abnormal cervical screening tests: a systematic review

BJOG: An International Journal of Obstetrics and Gynaecology — Mon, 05 Sep 2011 23:00:00 +0100

Conclusions Even for low‐grade abnormal cervical tests, women tend to prefer active management strategies. It may be a challenge to meet their expectations of optimal follow‐up when HPV testing is used in primary screening. (Source: BJOG: An International Journal of Obstetrics and Gynaecology)

Regeneration of cervix after excisional treatment for cervical intraepithelial neoplasia: a study of collagen distribution

BJOG: An International Journal of Obstetrics and Gynaecology — Mon, 05 Sep 2011 23:00:00 +0100

Conclusion There is no overall change in collagen distribution during regeneration following excisional treatment for CIN. (Source: BJOG: An International Journal of Obstetrics and Gynaecology)

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Micronuclei as biomarkers for evaluating the risk of malignant transformation in the uterine cervix.

Genetics and Molecular Research — Mon, 29 Aug 2011 13:48:03 +0100

Authors: Aires GM, Meireles JR, Oliveira PC, Oliveira JL, Araújo EL, Pires BC, Cruz ES, Jesus NF, Pereira CA, Cerqueira EM Abstract We evaluated micronucleus and apoptosis occurrence among women with normal smears and women with different kinds of cervical abnormalities, i.e., inflammatory processes and low- and high-grade squamous intraepithelial lesions (N = 12, N = 10 and N = 27, respectively). The sample included 59 women who were seen at a public medical service for cervical cancer prevention in Feira de Santana, Bahia, Brazil. The diagnosis was established by means of cytological, colposcopic, and histopathological examination. Cytogenetic analysis was performed on 2000 cells from each woman and included assessment of micronuclei and nuclear degenerative abnormalities indica...

Cervicovaginal cytology in the detection of recurrence after cervical cancer treatment.

Obstetrics and Gynecology — Sun, 28 Aug 2011 00:20:09 +0100

CONCLUSION: : A third of cervical cancer survivors will have abnormal cytology during follow-up, but in the absence of a visible lesion, those with ASC-US or LSIL can be followed without colposcopy unless abnormalities persist. Women with ASC-H, HSIL, and similar abnormalities deserve colposcopy. LEVEL OF EVIDENCE: : II. PMID: 21860282 [PubMed - in process] (Source: Obstetrics and Gynecology)

Validation of histological diagnoses in a national cervical screening register.

Acta Oncologica — Sat, 27 Aug 2011 23:00:00 +0100

Conclusions. The data in the screening register has high coverage and is thus useful for statistical and evaluation purposes. However, in order to improve the accuracy of diagnostic information, there are grounds to consider data retrieval through systematic linkage to other health care registers. PMID: 21871004 [PubMed - as supplied by publisher] (Source: Acta Oncologica)

HPV Test Better Than Cytology For Screening For Cervical Cancer

Health News from Medical News Today — Tue, 23 Aug 2011 03:00:00 +0100

A study published online first in The Lancelot Oncology recommends that HPV (Human papillomavirus) testing should become the primary screening tool to rule out cervical cancer, with cytology reserved for triage of women who test positive for HPV, deciding which women need immediate colposcopy. Testing for the two most dangerous strains of HPV - HPV16 and HPV18 - identifies more high-grade pre-cancerous lesions that can lead to cervical cancer, than using solely cytology for current cervical cancer screening... (Source: Health News from Medical News Today)

Outcomes of pregnant patients with Pap smears classified as atypical glandular cells

Cytopathology — Tue, 16 Aug 2011 23:00:00 +0100

Conclusions: Conservative management of women with AGC in pregnancy is safe where invasive cancer is excluded. As histological verification of glandular pre‐cancerous lesions by punch biopsy is not reliable and the postpartum regression rate cannot be determined precisely, conization should be performed in all cases with AGC‐FN or AIS. Triage of persistent AGC‐NOS with HPV testing is useful in distinguishing significant underlying lesions. (Source: Cytopathology)

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CD4+ T-cell response against human papillomavirus type 16 E6 protein is associated with a favorable clinical trend

Cancer Immunology, Immunotherapy — Sat, 13 Aug 2011 06:12:25 +0100

Abstract The association between the CD8+ T-cell responses to human papillomavirus type 16 (HPV-16) E6 protein and a favorable clinical trend has been demonstrated previously. The roles of human papillomavirus (HPV)-specific CD4+ T-cell responses and of regulatory T-cells (Tregs) were examined. Subjects with a recent history of abnormal Papanicolaou smear were eligible, and colposcopy-guided biopsy was performed at enrollment. Interferon-γ enzyme-linked immunospot assay and fluorescent-activated cell sorter analysis to measure the frequencies of Tregs were performed. Subjects with histological diagnoses of cervical intraepithelial neoplasia 1, 2, or 3 were considered to have short-term persistence of cervical abnormality and were called “persistors” (n = 51) ...

Human papillomavirus genotype detection and viral load in paired genital and urine samples from both females and males

Journal of Medical Virology — Thu, 11 Aug 2011 18:51:59 +0100

AbstractThe ability to detect type‐specific high risk HPV (HR‐HPV) infections in samples from females and males is important for monitoring the epidemiology of HPV and the impact of vaccination. Type‐specific detection concordance between paired urine and genital samples from females (n = 264) undergoing routine colposcopy and males (n = 88) attending a genito‐urinary medicine clinic was evaluated using an in‐house genotyping assay. The overall inter‐rater agreement (κ) was 0.781 for female pairs and 0.346 for male pairs. Female urine had sensitivity for detection of HPV16/18 and HR‐HPV of 75% and 84%, respectively, while male urine had sensitivities of 13% and 28%, respectively. Genital samples had a higher HPV DNA copy number than urine although a small proportion ...

Cofactors in human papillomavirus infection and cervical carcinogenesis

Archives of Gynecology and Obstetrics — Wed, 10 Aug 2011 15:40:16 +0100

Conclusion Information gathered from this study could be used to prioritize limited screening and treatment services to woman who have specific characteristics that may put them at an increased risk of HPV infection. Additionally, by identifying which women have a higher risk of cervical cancer; it may be possible to reduce the number of unnecessary colposcopies. Content Type Journal ArticlePages 1-6DOI 10.1007/s00404-011-2034-3Authors Hakan Yetimalar, Department of Obstetrics and Gynecology Clinic III, Izmir Ataturk Training and Research Hospital, Izmir, TurkeyBurcu Kasap, Department of Obstetrics and Gynecology Clinic III, Izmir Ataturk Training and Research Hospital, Izmir, TurkeyKulal Cukurova, Department of Obstetrics and Gynecology Clinic III, Izmir Ataturk Tr...

Role of high-risk human papillomavirus (HPV) mRNA testing in the prediction of residual disease after conisation for high-grade cervical intraepithelial neoplasia.

Gynecologic Oncology — Tue, 09 Aug 2011 23:00:00 +0100

CONCLUSION: Detection of E6/E7 mRNA transcripts by PreTect HPV Proofer does not seem suitable for short-term follow-up to detect residual CIN2+ after conisation. PMID: 21839500 [PubMed - as supplied by publisher] (Source: Gynecologic Oncology)

HPV molecular assays: Defining analytical and clinical performance characteristics for cervical cytology specimens.

Gynecologic Oncology — Tue, 09 Aug 2011 23:00:00 +0100

CONCLUSION: The performance characteristics of 3 leading PCR-based HPV assays revealed qPCR to be sensitive and specific for HPV detection and quantification. Parallel PCR testing using the 3 primers and direct sequencing offered the greatest clinical sensitivity and breadth of detection for known HPV types. PMID: 21839499 [PubMed - as supplied by publisher] (Source: Gynecologic Oncology)

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Long‐term risk of recurrent cervical HPV infection and precancer and cancer following excisional treatment

International Journal of Cancer — Thu, 04 Aug 2011 23:00:00 +0100

AbstractRisk of recurrent CIN2+ (including cervical intraepithelial neoplasia grade 2 [CIN2], CIN3, carcinoma and in situ, adenocarcinoma in situ or cancer) remains elevated for years following treatment. The role of long‐term post‐treatment HPV presence on subsequent risk of CIN2+ was evaluated in the 10,049‐women Guanacaste cohort. 681 women were referred to colposcopy because of high‐grade cytology, positive cervicography and/or suspicion of cancer based on visual assessment; 486 were judged to require treatment. After excluding women with <12 months of follow‐up (N=88), prior cancer or hysterectomy (n=37) or other reasons (N=14), 347 were included in the analysis. Infections were categorized as persistent if present at both pre‐ and post‐treatment visits and new if det...

Long‐term risk of recurrent cervical human papillomavirus infection and precancer and cancer following excisional treatment

International Journal of Cancer — Thu, 04 Aug 2011 23:00:00 +0100

AbstractRisk of recurrent CIN2+ (including cervical intraepithelial neoplasia grade 2 [CIN2], CIN3, carcinoma and in situ, adenocarcinoma in situ or cancer) remains elevated for years following treatment. The role of long‐term post‐treatment human papillomavirus (HPV) presence on subsequent risk of CIN2+ was evaluated in the 10,049‐women Guanacaste cohort. Six hundred eighty‐one women were referred to colposcopy because of high‐grade cytology, positive cervicography and/or suspicion of cancer based on visual assessment; 486 were judged to require treatment. After excluding women with <12 months of follow‐up (N = 88), prior cancer or hysterectomy (N = 37) or other reasons (N = 14), 347 were included in the analysis. Infections were categorized as persistent if present at both...

Colposcopy and cervical pathology: Answers to multiple choice questions for Vol. 25, No. 5

Best Practice and Research. Clinical Obstetrics and Gynaecology — Tue, 02 Aug 2011 04:00:00 +0100

1.(a) F(b) F(c) T(d) F(e) F Papillomaviruses are species-specific, so HPV only infects humans; rabbits may be infected by a type of papillomavirus called cottontail rabbit papillomavirus. The relevance of this is that laboratory animals such as rodents cannot be infected with HPV for research purposes. Multiple types of HPV (over 200) are thought to be in existence. The definition of a new HPV type depends on a difference in the DNA sequence of a particular HPV gene of at least 10%. Acquisition of HPV in women is common with the onset of sexual intercourse. Cross-sectional prevalence studies in student-age women (late teens, early twenties) have shown rates exceeding 50%. Most of these infections are transient, and will be cleared by immunological mechanisms. There is no evidence that gen...

Value of P16 expression in the triage of liquid-based cervical cytology with atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesions.

Chinese Medical Journal — Mon, 01 Aug 2011 04:00:00 +0100

CONCLUSION: P16 immunostaining had significantly higher specificity and accuracy than HR-HPV DNA test for predicting for high-grade CIN and cervical cancer in ASCUS and LSIL and can be used for the triage of women with ASCUS/LSIL cytological abnormality. PMID: 21933584 [PubMed - in process] (Source: Chinese Medical Journal)

Behavioral and biological risks of women seeking HIV test in an anonymous testing center.

Braz J Infect Dis — Sun, 31 Jul 2011 23:00:00 +0100

CONCLUSION: Women who seek care in centers for anonymous testing have high biological risk, which is neither proportional nor concurrent to behavioral risk. The low concordance found between these risks suggests the need for routine gynecological investigation (clinical and microbiological) for all women. PMID: 21861007 [PubMed - in process] (Source: Braz J Infect Dis)

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Colposcopy and Cervical Pathology: Multiple Choice Questions For Vol. 25, No. 5

Best Practice and Research. Clinical Obstetrics and Gynaecology — Thu, 28 Jul 2011 23:00:00 +0100

The following statement(s) is/are true about human papillomavirus (HPV) infection: (Source: Best Practice and Research. Clinical Obstetrics and Gynaecology)

Recent advances in optical imaging for cervical cancer detection

Archives of Gynecology and Obstetrics — Thu, 28 Jul 2011 15:58:37 +0100

Abstract Cervical cancer is one of the most common and lethal gynecological malignancies in both developing and developed countries, and therefore, there is a considerable interest in early diagnosis and treatment of precancerous lesions. Although the current standard care mainly based on cytology and colposcopy has reduced rates of cervical cancer morbidity and mortality, many lesions are still missed or overcalled and referred for unnecessary biopsies. Optical imaging technologies, spectroscopy approaches and high-resolution imaging methods are anticipated to improve the conventional cervical cancer screening providing in vivo diagnosis with high sensitivity and specificity. Their concept is that morphologic and biochemical properties of the cervical tissue are altered i...

The effect of “breathable” panty liners on the female lower genital tract

International Journal of Gynaecology and Obstetrics — Thu, 28 Jul 2011 04:00:00 +0100

Conclusion: After 75days of BPL use, there was no significant increase in vulvovaginal candidiasis, bacterial vaginosis, vulvovaginal irritation, or vulvovaginal inflammation. (Source: International Journal of Gynaecology and Obstetrics)

Evaluation of visual inspection with acetic acid as a feasible screening test for cervical neoplasia

Journal of Obstetrics and Gynaecology Research — Tue, 26 Jul 2011 23:00:00 +0100

Conclusion: The results of this study indicate that VIA may be a useful and feasible alternative screening test for cervical precancerous and cancerous lesions. (Source: Journal of Obstetrics and Gynaecology Research)

Birth outcomes following treatment for precancerous changes to the cervix: a population‐based record linkage study

BJOG: An International Journal of Obstetrics and Gynaecology — Tue, 26 Jul 2011 23:00:00 +0100

Conclusion Women who were referred for colposcopy had an increased risk of preterm births regardless of whether or not they received treatment to the cervix. This increased risk could be the result of common risk factors for abnormal smears and preterm birth. (Source: BJOG: An International Journal of Obstetrics and Gynaecology)

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Pregnancy incidence and outcome among patients with cervical intraepithelial neoplasia: a retrospective cohort study

BJOG: An International Journal of Obstetrics and Gynaecology — Tue, 26 Jul 2011 23:00:00 +0100

Conclusions No clear evidence emerged of adverse effects resulting from the CIN treatment itself, because the women treated had more pregnancies and more children than their reference population. TOPs and extrauterine pregnancies were more common among the treated women already before the CIN treatment. (Source: BJOG: An International Journal of Obstetrics and Gynaecology)

The ATHENA human papillomavirus study: design, methods, and baseline results

American Journal of Obstetrics and Gynecology — Mon, 25 Jul 2011 04:00:00 +0100

Conclusion: The Addressing the Need for Advanced HPV Diagnostics study provides important estimates of the prevalence of cytologic abnormalities, hrHPV positivity, and CIN2 or greater in a US screening population. (Source: American Journal of Obstetrics and Gynecology)

Development of a pigtail macaque model of sexually transmitted infection/HIV coinfection using Chlamydia trachomatis, Trichomonas vaginalis, and SHIVSF162P3

Journal of Medical Primatology — Sat, 23 Jul 2011 22:11:18 +0100

Conclusions These pilot studies demonstrate the first successful STI‐SHIV triple infection of pigtail macaques, with clinical presentation of genital STI symptoms similar to those observed in humans. (Source: Journal of Medical Primatology)

Comparison of ThinPrep and SurePath liquid‐based cytology and subsequent human papillomavirus DNA testing in China

Cancer Cytopathology — Mon, 18 Jul 2011 23:00:00 +0100

CONCLUSIONS:Both methods yielded similar validity in detecting significant cervical lesions. However, SurePath samples yielded higher rates of satisfactory LBC slides and sufficient residual volume for HC2. Cancer (Cancer Cytopathol) 2011;. © 2011 American Cancer Society. (Source: Cancer Cytopathology)

Chlamydia trachomatis infection and risk of cervical intraepithelial neoplasia

Sexually Transmitted Infections — Mon, 18 Jul 2011 23:00:00 +0100

Conclusion Further studies based on larger cohorts with longitudinal follow-up in relation to the C trachomatis acquisition and a thorough evaluation of temporal relationships of infections with hrHPV types, C trachomatis and cervical neoplasia are needed to demonstrate whether and how in some situations C trachomatis sets the stage for cervical carcinogenesis. Trial registration NCT00092521 and NCT00092534. (Source: Sexually Transmitted Infections)

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Subsequent risks for cervical precancer and cancer in women with low-grade squamous intraepithelial lesions unconfirmed by colposcopy-directed biopsy: results from a multicenter, prospective, cohort study

International Journal of Clinical Oncology — Tue, 12 Jul 2011 06:12:07 +0100

Conclusion In women with biopsy-negative LSILs, the risk of CIN3+ diagnosed within 2 years was low; furthermore, approximately 70% underwent cytologic regression within 12 months, regardless of HPV testing results. Biopsy-negative LSILs may represent regressing lesions rather than lesions missed by colposcopy. Content Type Journal ArticlePages 1-7DOI 10.1007/s10147-011-0280-9Authors Koji Matsumoto, Department of Obstetrics and Gynecology, Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, 305-8575 JapanYasuo Hirai, Departments of Gynecology and Cytopathology, Cancer Institute Hospital, Japanese Foundation of Cancer Research, Tokyo, 135-8550 JapanReiko Furuta, Department of Pathology, Cancer Institute, Japanese Foundation o...

Prior knowledge of HPV status improves detection of CIN2+ by cytology screening

American Journal of Obstetrics and Gynecology — Mon, 11 Jul 2011 04:00:00 +0100

Conclusion: Guided cytological screening performed with prior knowledge of HPV status results in an improved detection of CIN2 or higher-grade lesions. (Source: American Journal of Obstetrics and Gynecology)

Use of high‐risk human papillomavirus testing in patients with low‐grade squamous intraepithelial lesions

Cancer Cytopathology — Mon, 04 Jul 2011 23:00:00 +0100

CONCLUSIONSUsing 1 RLU/CO as the cutoff value, HR HPV testing was found to be highly sensitive for detecting CIN 2+ lesions in women with LSIL. The colposcopy rate was significantly lower in women aged ≥ 30 years compared with women aged < 30 years. Triaging with HR HPV testing may be indicated in women aged ≥ 30 years with LSIL cytology, but not in women aged < 30 years. Cancer (Cancer Cytopathol) 2011;. © 2011 American Cancer Society. (Source: Cancer Cytopathology)

[Performance by cytology and hybrid capture II in screening for high-grade squamous intraepithelial lesions in women with HIV].

Cadernos de Saude Publica — Thu, 30 Jun 2011 23:00:00 +0100

This study estimated and compared the performance of cytology and hybrid capture II in screening for precursor lesions of cervical cancer among HIV-infected women. The study population consisted of women from the open prospective cohort at the Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation (IPEC/Fiocruz). Colposcopy and histology were considered jointly in defining the gold standard. Cytology showed 31.8% sensitivity and 95.5% specificity, while hybrid capture II showed higher sensitivity (100%) and lower specificity (52%). The positive likelihood ratio was 7.1 for cytology and 2.1 for hybrid capture II, while the negative likelihood ratio was 0.7 for cytology and 0.0 for hybrid capture II. PMID: 21808813 [PubMed - in process] (Source: Cadernos de Saude Publica)

Evaluation of CINtec PLUS® testing as an adjunctive test in ASC‐US diagnosed SurePath® preparations

Diagnostic Cytopathology — Sun, 26 Jun 2011 23:00:00 +0100

AbstractThe CINtec PLUS® system is an immunohistochemical cocktail composed of antibodies against p16INK4a (surrogate of HPV infection) and Ki‐67 (proliferation marker) meant to improve the sensitivity and specificity for detecting high‐grade dysplasia (HGD). In the presence of dysplasia, a red chromogen marks Ki‐67 expression in the nucleus and a brown chromogen marks cytoplasmic p16INK4a expression. Only cells showing dual staining are interpreted as positive. This retrospective study examined the performance of CINtec PLUS testing when performed on ASC‐US diagnosed samples. Comparison was made to high‐risk HPV DNA test results and colposcopic biopsy results. Technical considerations in the interpretation of this immunohistochemical stain are additionally discussed. CINtec PLU...

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Triage of cervical cytological diagnoses of atypical squamous cells by DNA methylation of paired boxed gene 1 (PAX1)

Diagnostic Cytopathology — Sun, 26 Jun 2011 23:00:00 +0100

This study tested the efficacy of PAX1 methylation analysis in the triage of cervical ASCUS and ASC‐H and compared its performance with Hybrid Capture 2 (HC2) HPV test. A hospital‐based case–control study was conducted. Cervical scrapings from patients with ASCUS or ASC‐H were used for the quantitative methylation analysis of PAX1 methylation by MethyLight and HPV testing by HC2. Patients with ASC‐H or ASCUS with repeated abnormal smears underwent colposcopic biopsy and subsequent therapies. Diagnoses were made by histopathology at a follow‐up of 2 years. The efficacies of detecting high‐grade lesions were compared. Fifty‐eight cervical scrapings with cytological diagnosis of ASCUS (n = 41) and ASC‐H (n = 17) were analyzed. One of the 41 (2.4%) ASCUS patients and seven of...

Effects of intravaginal estriol and pelvic floor rehabilitation on urogenital aging in postmenopausal women

Archives of Gynecology and Obstetrics — Sat, 25 Jun 2011 15:51:24 +0100

Conclusions Our results showed that combination therapy with estriol plus pelvic floor rehabilitation was effective and should be considered as a first-line treatment for symptoms of urogenital aging in postmenopausal women. Content Type Journal ArticlePages 1-7DOI 10.1007/s00404-011-1955-1Authors Giampiero Capobianco, Urogynecology Unit, Gynecologic and Obstetric Clinic, University of Sassari, Viale San Pietro 12, 07100 Sassari, ItalyErmes Donolo, Urogynecology Unit, Gynecologic and Obstetric Clinic, University of Sassari, Viale San Pietro 12, 07100 Sassari, ItalyGianna Borghero, Urogynecology Unit, Gynecologic and Obstetric Clinic, University of Sassari, Viale San Pietro 12, 07100 Sassari, ItalyFrancesco Dessole, Urogynecology Unit, Gynecologic and Obstetric Clinic...

Microinvasive squamous carcinoma (FIGO stage IA1) of the cervix: are there colposcopic criteria for the diagnosis?

American Journal of Obstetrics and Gynecology — Thu, 16 Jun 2011 04:00:00 +0100

Conclusion: The sensitivity of colposcopy in the diagnosis of microinvasive carcinoma of the cervix was low. Colposcopy plays an important role in directing the biopsy to the most suspicious area. The definitive diagnosis of microinvasive squamous carcinoma is established only by histologic study. (Source: American Journal of Obstetrics and Gynecology)

CIN Risk Low in HPV+ Women With Normal Colposcopy ResultsCIN Risk Low in HPV+ Women With Normal Colposcopy Results

Medscape ObGyn and Womens Health Headlines — Tue, 14 Jun 2011 10:48:18 +0100

When women with human papilloma virus (HPV) have low-grade cytology findings but a normal colposcopy, they can be followed at routine intervals, a UK team has shown. Reuters Health Information (Source: Medscape ObGyn and Womens Health Headlines)

Cervical cancer: when should the UK switch to HPV testing?

Guardian Unlimited Science — Mon, 13 Jun 2011 11:37:56 +0100

The NHS currently offers one of the best screening programmes in the world, but newer methods with potentially higher success rates are now available. So when should Britain make the switch?Débora Miranda welcomes your help and feedback in her research. She can be contacted on Twitter @debmir and via email on cancerscreeningproject@gmail.comThe more I investigate the different ways to prevent cervical cancer, the better I understand why the general public – and those who've been sending me their feedback – are confused about the disease. We've seen how HPV (human papilloma virus) vaccination can be affected by costs, the diseases it would prevent and the culture where it is adopted. We've also seen that the age women begin cervical screening depends on the in which country they live. ...

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Colposcopy in special circumstances: Pregnancy, immunocompromise, including HIV and transplants, adolescence and menopause

Best Practice and Research. Clinical Obstetrics and Gynaecology — Sun, 12 Jun 2011 23:00:00 +0100

The true value of colposcopy in pregnancy is under debate; the examination may be more difficult depending on the gestation at which a woman presents. Cervical intraepithelial neoplasia does not have an accelerated progression during pregnancy, and treatment is usually deferred until postpartum. The prevalence of cervical intraepithelial neoplasia is greater in women with immune compromise. Those with human immunodeficiency have a higher prevalence, more persistence and less regression of human papillomavirus-related infections. Cervical cancer remains an AIDS-defining illness. Women who have had renal transplants also have a higher risk of developing cervical intraepithelial neoplasia. By contrast, other chronic illnesses that require immunosuppressant therapy do not seem to show this add...

The role of individually targeted information to reduce anxiety before colposcopy: a randomised controlled trial

BJOG: An International Journal of Obstetrics and Gynaecology — Fri, 10 Jun 2011 20:36:08 +0100

Conclusions Anxiety levels before primary colposcopy are surprisingly high, and are not reduced following individually targeted information given before colposcopy. (Source: BJOG: An International Journal of Obstetrics and Gynaecology)

Coexistence of early microinvasive endometrioid adenocarcinoma and CIN3 in the uterine cervix in a 32-year-old Japanese woman

Diagnostic Pathology — Thu, 09 Jun 2011 23:00:00 +0100

In conclusion, the author reported a rare case of simultaneous EMEA and CIN 3 with extensive immunohistochemical findings. (Source: Diagnostic Pathology)

CIN risk low in HPV+ women with normal colposcopy results

Modern Medicine — Thu, 09 Jun 2011 23:00:00 +0100

NEW YORK (Reuters Health) - When women with human papilloma virus (HPV) have low-grade cytology findings but a normal colposcopy, they can be followed at routine intervals, a UK team has shown. (Source: Modern Medicine)

Value of HPV-DNA test in women with cytological diagnosis of atypical glandular cells (AGC)

European Journal of Obstetrics, Gynecology, and Reproductive Biology — Mon, 06 Jun 2011 04:00:00 +0100

Conclusions: HPV testing at the time of colposcopy for patients with AGC in whom no colposcopic abnormality is found may be a powerful ancillary tool for identifying women at a high risk of underlying significant cervical lesions. (Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology)

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Preface: Issue 25.5

Best Practice and Research. Clinical Obstetrics and Gynaecology — Sun, 05 Jun 2011 23:00:00 +0100

Cervical cancer is arguably the most preventable and treatable form of cancer due, in large part, to its long detectable precancerous phase. Colposcopy and the improved understanding of cervical pathology has played a major role in the early detection and management of cervical cancer, there by reducing incidence of and mortality from invasive cervical disease. (Source: Best Practice and Research. Clinical Obstetrics and Gynaecology)

Objective perspective in colposcopy

Best Practice and Research. Clinical Obstetrics and Gynaecology — Sun, 05 Jun 2011 23:00:00 +0100

Colposcopy is a widely used diagnostic procedure, primarily in the assessment of women with abnormal cervical cytology. It is used by appropriately trained individuals using techniques that allow a full assessment of the abnormality and plan for further investigation or treatment. Certain key features are specifically looked for, and a colposcopic impression formed. Using a systematic approach to the colposcopic assessment can improve the diagnostic accuracy. In this chapter, we review various factors and meta-analyses in relation to the diagnostic performance of colposcopy. Newer technologies are being developed that will assist the clinician in assessing the colposcopic changes. Quality assurance of the training and practise of colposcopy is important to maintain appropriate management f...

Women’s preferences regarding options for management of atypical, borderline or low‐grade cervical cytological abnormalities: a review of the evidence

Cytopathology — Tue, 31 May 2011 23:00:00 +0100

Conclusion: Consideration of patient preferences in the management of low‐grade cytology is important for designing screening protocols. The reviewed studies indicate that potentially different conclusions may be drawn depending on the elicitation methodology and selection of participants in the research. (Source: Cytopathology)

Risk of significant gynaecological pathology in women with ?glandular neoplasia on cervical cytology

Cytopathology — Tue, 31 May 2011 23:00:00 +0100

Conclusion: At least CIN2 was found in 81.5% in women referred with cervical cytology reporting ?glandular neoplasia. A thorough evaluation of the whole genital tract is needed if colposcopy is negative. (Source: Cytopathology)

New technologies and advances in colposcopic assessment

Best Practice and Research. Clinical Obstetrics and Gynaecology — Tue, 31 May 2011 23:00:00 +0100

To have a good grasp of clinical colposcopy, it is necessary to understand the histopathologic structure of the normal and dysplastic cervical epithelium. Previous meta-analyses had indicated high overall sensitivity of colposcopy in detecting dysplastic lesions, but recent studies have suggested that the technique has much lower sensitivity in detecting high-grade intraepithelial neoplasia. The best practice in colposcopy relies on accurately taking a biopsy from the correct (i.e. most morphological abnormal) site, and by taking more than one biopsy, the sensitivity for detection of high-grade cervical intraepithelial neoplasia can be increased. Cytological screening programmes of proven and maintained high quality will enhance the predictive colposcopic accuracy for high-grade cervical i...

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Incidence of cervical intraepithelial neoplasia grade 2 or worse in colposcopy‐negative/human papillomavirus‐positive women with low‐grade cytological abnormalities

BJOG: An International Journal of Obstetrics and Gynaecology — Mon, 30 May 2011 23:00:00 +0100

Conclusions The rate of subsequent high‐grade CIN among colposcopically negative triaged women was sufficiently low to justify return to routine recall. (Source: BJOG: An International Journal of Obstetrics and Gynaecology)

Improved sensitivity of vaginal self‐collection and high‐risk human papillomavirus testing

International Journal of Cancer — Mon, 30 May 2011 23:00:00 +0100

Conclusion:A self‐collected sample using a PCR based assay with the capability of very high throughput has similar sensitivity as a direct endocervical specimen obtained by a physician. Large population based screening “events” in low resource settings could be achieved by promoting self‐collection and centralized high‐throughput, low‐cost testing by PCR‐based MALDI‐TOF. (Source: International Journal of Cancer)

Building capacity for cervical cancer screening in outpatient HIV clinics in the Nyanza province of western Kenya

International Journal of Gynaecology and Obstetrics — Sun, 29 May 2011 23:00:00 +0100

Conclusion: Cervical cancer screening and prevention are feasible, acceptable, and effective within HIV care and treatment clinics. Screening test performance characteristics need to be defined for an HIV-positive population to determine the cost/benefit ratio of lower cost strategies that will ultimately be necessary to provide universal access to cervical cancer screening in low-resource settings. (Source: International Journal of Gynaecology and Obstetrics)

A pilot analytic study of a research-level, lower-cost human papillomavirus 16, 18, and 45 test.

Journal of Virological Methods — Thu, 26 May 2011 23:00:00 +0100

Authors: Yang HP, Walmer DK, Merisier D, Gage JC, Bell L, Rangwala S, Shrestha N, Kobayashi L, Eder PS, Castle PE The analytic performance of a low-cost, research-stage DNA test for the most carcinogenic human papillomavirus (HPV) genotypes (HPV16, HPV18, and HPV45) in aggregate was evaluated among carcinogenic HPV-positive women, which might be used to decide who needs immediate colposcopy in low-resource settings ("triage test"). We found that HPV16/18/45 test agreed well with two DNA tests, a GP5+/6+ genotyping assay (Kappa=0.77) and a quantitative PCR assay (at a cutpoint of 5000 viral copies) (Kappa=0.87). DNA sequencing on a subset of 16 HPV16/18/45 positive and 16 HPV16/18/45 negative verified the analytic specificity of the research test. It is concluded that the HPV16/18/45 as...

Male circumcision is associated with a lower prevalence of human papillomavirus‐associated penile lesions among Kenyan men

International Journal of Cancer — Wed, 25 May 2011 23:00:00 +0100

This study suggests that circumcision reduces the prevalence of HPV‐associated flat lesions and may ultimately reduce male to female HPV transmission. © 2011 Wiley‐Liss, Inc. (Source: International Journal of Cancer)

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Switch from cytology‐based to HPV‐based cervical screening: Implications for colposcopy

International Journal of Cancer — Sun, 22 May 2011 23:00:00 +0100

ConclusionsThe major concern with switching from cytology to more sensitive HPV screening is management of the many HPV‐positive women, including those with still non‐visible ≥CIN2 lesions. Our data support the need for a non‐visual diagnostic method to guide management and treatment of HPV‐positive women. (Source: International Journal of Cancer)

Switch from cytology‐based to human papillomavirus test‐based cervical screening: Implications for colposcopy

International Journal of Cancer — Sun, 22 May 2011 23:00:00 +0100

The objective of our study is to evaluate the clinical implications of a switch to HPV test‐based screening on performance and workload of colposcopy. Women in the population‐based, 7‐year Guanacaste cohort study were screened at enrollment using cytology. We also took another specimen for HPV DNA testing and collected magnified cervical photographic images (cervigrams). A final case diagnosis (≥cervical intraepithelial neoplasia [CIN] grade 3, CIN2, <CIN2) was assigned at exit. Using the cervigram as a surrogate of colposcopy impression, we evaluated the impact of changing screening method from cytology to carcinogenic HPV testing on the distribution of enrollment colposcopic impression and on the predictive values of positive and negative colposcopic impressions for the cumula...

A pilot study to investigate the treatment of cervical human papillomavirus infection with zinc-citrate compound (CIZAR®).

Gynecologic Oncology — Fri, 20 May 2011 23:00:00 +0100

CONCLUSION: The results of this study showed for the first time that treatment with intra-vaginal infusion of a zinc-citrate compound (CIZAR®) can result in elimination of HR-HPV infection from the uterine cervix. PMID: 21605892 [PubMed - as supplied by publisher] (Source: Gynecologic Oncology)

Follow-up outcomes for a large cohort of US women with negative imaged liquid-based cytology findings and positive high risk human papillomavirus test results.

Gynecologic Oncology — Thu, 19 May 2011 23:00:00 +0100

CONCLUSION: This is the largest study documenting follow-up on US cytology-negative hrHPV-positive patients screened with now widely utilized FDA-cleared methods of ciLBC and hrHPV testing. Of 869 patients followed for an average of almost 2years, 20 cases of high grade intraepithelial neoplasia (2.3%) and one case of endocervical adenocarcinoma were detected. 90.5%(190/210) of intraepithelial neoplasias detected during follow-up were CIN1. PMID: 21601911 [PubMed - as supplied by publisher] (Source: Gynecologic Oncology)

Voiding Dysfunction: Another Etiology of Vulvovaginitis in Young Girls

Journal of Pediatric and Adolescent Gynecology — Thu, 19 May 2011 23:00:00 +0100

Conclusion: VD is an important cause when considering the etiology of PVV. (Source: Journal of Pediatric and Adolescent Gynecology)

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Management options for cervical intraepithelial neoplasia

Best Practice and Research. Clinical Obstetrics and Gynaecology — Thu, 19 May 2011 23:00:00 +0100

Management of cervical intraepithelial neoplasia (CIN) needs to protect women at risk from developing cervical cancer and to avoid over-treatment as well as obstetrical complications in women undergoing invasive treatment. Strong evidence shows that CIN3 is a true precursor and must be treated, whereas CIN1 lesions do not benefit from immediate surgery and should be followed conservatively. Although the clinical course of CIN2 differs from CIN3, it should be treated the same way for legal reasons. Colposcopy plays a central role in selection of patients and treatments. Treatment of CIN2 and 3 should be excisional. Large loop excision of the transformation zone, high-frequency-needle or laser conisation are equally good, whereas cold-knife conisation is associated with an excess risk for su...

Colposcopy: A follow-up to abnormal Pap test results

MayoClinic.com Full Feed — Sat, 14 May 2011 05:00:00 +0100

Colposcopy — Overview covers definition, risks, results of this procedure to examine cervical cells. (Source: MayoClinic.com Full Feed)

Vesicovaginal fistula following large‐loop excision of the transformation zone in a chronic systemic glucocorticoid user

Journal of Obstetrics and Gynaecology Research — Mon, 02 May 2011 23:00:00 +0100

AbstractA 42‐year‐old woman with a history of a large‐loop excision of transformation zone for cervical intraepithelial neoplasia III four years previously visited our outpatient department for cervical intraepithelial neoplasia I that newly detected by colposcopy‐directed punch biopsy. Her other medical conditions include systemic lupus erythematosus on daily prednisolone 15 mg during 19 years. After second large‐loop excision of transformation zone, delayed vesicovaginal fistula was confirmed by indigo carmine leakage test, computed tomography scan, and cystoscopy. Fistula was primarily repaired with indwelling double‐J catheters with anchoring omentum on suture site. (Source: Journal of Obstetrics and Gynaecology Research)

Human papilloma virus infection in female kidney transplant recipients.

Saudi Journal of Kidney Diseases and Transplantation — Sat, 30 Apr 2011 23:00:00 +0100

The objective of this study was to evaluate the incidence of genital human papilloma virus (HPV) infection and cervical intra-epithelial lesions in transplanted patients. Cervical Papanicolaou (Pap) smear/HPV test and colposcopic examinations were performed in 58 patients who were candidates for renal transplant surgery; these tests were repeated one year later. Their age range was 26-53 years (mean, 37.2 years). Hypertension was the most common cause of renal insufficiency (34.4%), while in 41.4% of the patients, the causative pathology was unknown. In 24.1% of the patients, there was no history of dialysis, i.e. they had pre-emptive transplantation. The mean duration of marriage (years since first intercourse) was 16.2 years (range, 1-35). Coitus interruptus was the most common contracep...

Male urethral pap smears and peniscopy examination and polymerase chain reaction human papillomavirus correlation

Diagnostic Cytopathology — Sat, 30 Apr 2011 01:58:58 +0100

AbstractThe aims of this study were to determine HPV in a male population and its correlation with penile gross inspection and urethral pap smears. Fifty male volunteers were included in the study; all of them were sexual partners of women with evidence of HPV‐related cervical diseases. Urethral Pap smear features and polymerase chain reaction (PCR; HPV detection) of urethral samples were correlated. Statistical analyses were conducted to identify variables associated with high and low‐risk HPV types. Mean age of participants was 33.14 ± 1.52 (range, 23–50 years), and the mean age for those with high risk HPV was 32.12 ± 6.66 and 34.08 ± 6.58 for subjects with low‐risk HPV (P = 0.820). Penile gross inspection revealed 19 (38%) cases with no lesions, papules in balanoprepusial fu...

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Vaginal Inflammatory Status in Pregnant Women with Normal and Pathogenic Microbiota in Lower Genital Tract

Advances in Pharmacological Sciences — Tue, 26 Apr 2011 14:23:42 +0100

Conclusion. The VIS is influenced by vaginal microbiota and depends on the state of pregnancy and also, on gestational age. The pronounced leukocyte increase in asymptomatic patients in the absence of lower genital tract infection during the third trimester of pregnancy should be highlighted. (Source: Advances in Pharmacological Sciences)

A Population-Based Clinical Trial Comparing Endocervical High-Risk HPV Testing Using Hybrid Capture 2 and Cervista From the SHENCCAST II Study.

American Journal of Clinical Pathology — Wed, 20 Apr 2011 13:45:23 +0100

Authors: Belinson JL, Wu R, Belinson SE, Qu X, Yang B, Du H, Wu R, Wang C, Zhang L, Zhou Y, Liu Y, Pretorius RG Our objective was to directly compare the accuracy of the high-risk human papillomavirus (HPV) assays, Hybrid Capture 2 (hc2; Qiagen, Gaithersburg, MD) and Cervista (Hologic, Bedford, MA), in diagnosing cervical intraepithelial neoplasia (CIN) 3 or worse (cancer). A population-based, cross-sectional study (The Shenzhen Cervical Cancer Screening Trial II) was conducted in Guangdong Province in China. Three high-risk HPV assays, self and direct cervical sampling and cytology, were studied. Abnormal results on any of 6 study tests (33%) resulted in referral to colposcopy. At colposcopy, every patient had at least 5 cervical biopsy specimens obtained. For 8,556 women between the ...

Women's experience of colposcopy: a qualitative investigation

BMC Women's Health - Latest articles — Tue, 12 Apr 2011 23:00:00 +0100

Conclusions: Service changes in information provision and increased respect for dignity seem to have improved the experience that women have of colposcopy, however, this does not appear to have translated into decreased anxiety. Women still have strong emotional reactions to being referred for, and attending, colposcopy appointments. Staff taking time to explain the diagnosis fully, and discuss their preferences about aspects of their consultation, can alleviate their anxiety. (Source: BMC Women's Health - Latest articles)

Experience with high‐risk human papillomavirus testing on vaginal brush‐based self‐samples of non‐attendees of the cervical screening program

International Journal of Cancer — Sun, 10 Apr 2011 23:00:00 +0100

In conclusion, offering hrHPV testing on self‐sampled vaginal material with a brush device to non‐attendees significantly increases the attendance to the regular screening program, yields hrHPV test results that are in very good concordance with those of physician‐taken scrapes in women with CIN2+/CIN3+, and is effective in detecting CIN2+/CIN3+. (Source: International Journal of Cancer)

Effect of Patient Education on Postcolposcopy Follow-Up

Clinical Nursing Research — Wed, 06 Apr 2011 23:00:00 +0100

The purpose of this study was to investigate the effects of patient education on human papillomavirus (HPV) infection and abnormal Pap smears for women scheduled for colposcopy and their compliance to treatment recommendations. A convenience sample of 60 women was included in the study. The experimental group included 30 women scheduled for colposcopy who received education prior to procedure. Thirty patients in the control group were women referred for colposcopy the year before the study. Both groups were similar in age, ethnicity, insurance status, and histological findings. Recall rates were analyzed between the two groups and results demonstrated a statistical difference in the return rate of the experimental group. Patient education increased compliance to treatment recommendations p...

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Assessment of clinical and analytical performance characteristics of an HPV genotyping test

Diagnostic Cytopathology — Tue, 05 Apr 2011 23:00:00 +0100

AbstractHuman papillomavirus (HPV), the known cause of cervical cancer, is found in essentially all cervical cancer specimens. Infection with high‐risk HPV genotypes carries the greatest risk of viral persistence and the potential to develop precancerous lesions or cervical cancer. Identifying women infected with HPV 16 and/or 18, the two genotypes most commonly found in cervical cancer, helps further stratify women for either immediate referral to colposcopy or repeat cytological and HPV DNA testing in 12 months. Genotyping additional, less carcinogenic HPV types may be of limited clinical utility. Detection of multiple individual genotypes may capture a greater percentage of those with the potential to develop cervical disease. However, the advantage of individual detection must be wei...

mtm's P16/Ki-67 Dual Immuno-Staining Identifies High-Grade Cervical Disease In ASC-US And LSIL With High Sensitivity And Specificity

Health News from Medical News Today — Wed, 30 Mar 2011 17:00:00 +0100

mtm laboratories, a privately held diagnostics company developing, manufacturing and globally commercializing in vitro diagnostics for cervical cancer early detection and diagnosis, today announced the publication of a new paper showing that dual staining for p16 and Ki-67 can pinpoint the underlying high-grade cervical disease with a high degree of sensitivity and specificity in women with ASC-US or LSIL cytology results. These are a group of patients currently poorly served by existing screening technologies, with too many referred for unnecessary colposcopy... (Source: Health News from Medical News Today)

Mucosal integrity and inflammatory markers in the female lower genital tract as potential screening tools for vaginal microbicides

Contraception — Wed, 30 Mar 2011 04:00:00 +0100

Conclusions: Gynol II and HEC may modulate inflammatory markers in the vagina and endometrium. How these changes relate to infection susceptibility warrants further study. (Source: Contraception)

Should patients with cytologic high-grade intraepithelial lesions of the cervix be treated without colposcopic-guided biopsy?

American Journal of Obstetrics and Gynecology — Sun, 27 Mar 2011 23:00:00 +0100

Zuchna et al report underestimation of the severity of cervical intraepithelial neoplasia (CIN) in 47% of cases after colposcopic-guided biopsies in patients with suspected high-grade squamous intraepithelial lesions (H-SIL) of the cervix. On the basis of this low correlation between the histology at biopsy vs the histology in the cone specimen the authors conclude that H-SIL cytology can be treated without previous biopsy. We question these findings and the conclusion. (Source: American Journal of Obstetrics and Gynecology)

Safety and Immunogenicity of a Human Papillomavirus Peptide Vaccine (CIGB-228) in Women with High-Grade Cervical Intraepithelial Neoplasia: First-in-Human, Proof-of-Concept Trial

Clinical and Developmental Immunology — Thu, 24 Mar 2011 14:57:08 +0100

Conclusion. CIGB-228 vaccination was well tolerated and capable to induce IFNγ-associated T-cell response in women with high-grade CIN. In several patients, lesion regression and HPV clearance were observed. (Source: Clinical and Developmental Immunology)

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Histological recurrence and depth of loop treatment of the cervix in women of reproductive age: incomplete excision versus adverse pregnancy outcome

BJOG: An International Journal of Obstetrics and Gynaecology — Wed, 23 Mar 2011 20:17:08 +0100

Conclusion In women of reproductive age requiring treatment for HGCIN, colposcopists performing loop excision should aim for <10 mm depth. This provides adequate treatment for HGCIN and minimises the potential risk of adverse outcomes in future pregnancies. (Source: BJOG: An International Journal of Obstetrics and Gynaecology)

Histological recurrence and depth of loop treatment of the cervix in women of reproductive age: incomplete excision versus adverse pregnancy outcome.

BJOG : An International Journal of Obstetrics and Gynaecology — Wed, 23 Mar 2011 00:00:00 +0100

Conclusion In women of reproductive age requiring treatment for HGCIN, colposcopists performing loop excision should aim for <10 mm depth. This provides adequate treatment for HGCIN and minimises the potential risk of adverse outcomes in future pregnancies. PMID: 21429068 [PubMed - as supplied by publisher] (Source: BJOG : An International Journal of Obstetrics and Gynaecology)

The value of repeated cytology at the time of first colposcopy: a retrospective analysis of 1,087 cases.

American Journal of Clinical Pathology — Mon, 21 Mar 2011 22:15:29 +0100

Authors: Hall JM, Han JJ, Fadare O Papanicolaou tests are often repeated just before the procedure for women who have been referred for colposcopy. The validity and clinical usefulness of this practice, however, is unclear. We retrospectively assessed the value of repeated cytology in a cohort of 1,087 consecutive patients who underwent repeated Papanicolaou testing at first colposcopy. The repeated cytology was considered clinically useful if the results could conceivably have influenced the physician's decision about more invasive diagnostic/therapeutic evaluation based on contemporary practice guidelines. Repeated cytology provided potentially clinically useful information in only a small proportion (3.6%) of the cases analyzed overall, including 41% (26/63) and 1.8% of the high- an...

Diagnostic and prognostic validity of the human papillomavirus E6/E7 mRNA test in cervical cytological samples of HC2-positive patients

Cancer Causes and Control — Fri, 18 Mar 2011 16:47:45 +0100

Abstract The study aimed to assess the clinical utility in identifying CIN2 or worse (CIN2+), of the Pretect HPV-Proofer test for E6/E7 mRNA detection in Hybrid Capture 2 (HC2)-positive patients, who underwent colposcopy. In particular, the study analyzed the mRNA test performance as the third test in a subgroup of HC2+ patients with less severe than high-grade squamous intraepithelial lesions (HSIL−). We analyzed 464 cervico-vaginal samples by liquid-based cytology (LBC) and PreTect HPV-Proofer. Moreover 231 patients also had a biopsy at baseline and 75, with HSIL−, were followed up within 2 years by LBC, colposcopy, and histology when indicated. The highest sensitivity for CIN2+ belonged to the mRNA compared to LBC, at the HSIL+ threshold (72% vs. 58%), whereas ...

Triaging Pap cytology negative, HPV positive cervical cancer screening results with p16/Ki-67 Dual-stained cytology.

Gynecologic Oncology — Thu, 17 Mar 2011 00:00:00 +0100

CONCLUSIONS: Triaging Pap negative/HPV positive screening test results with p16/Ki-67 Dual-stained cytology may identify women with a high probability of underlying CIN2+ and may efficiently complement HPV-based screening programs to prevent cervical cancer. PMID: 21420158 [PubMed - as supplied by publisher] (Source: Gynecologic Oncology)

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Association between genital intraepithelial lesions and anal squamous intraepithelial lesions in HIV-negative women

American Journal of Obstetrics and Gynecology — Thu, 17 Mar 2011 00:00:00 +0100

Conclusion: There seems to be a strong association between ASIL and multicentric GSIL. Another factor related to ASIL was the practice of unprotected anal intercourse. (Source: American Journal of Obstetrics and Gynecology)

Outcome of cervical intraepithelial neoplasia 2 diagnosed by punch biopsy in 131 women

Journal of Obstetrics and Gynaecology Research — Sun, 13 Mar 2011 00:00:00 +0100

Conclusion: Our data showed that a significant number of women (28%) with biopsy‐diagnosed CIN 2 had CIN 1 or no dysplasia on subsequent excisional biopsy. The recurrence risk of high grade dysplasia in CIN 2 is low (1.5%). However, due to the high number of patients (72%) with high grade dysplasia at treatment biopsy, caution needs to be exercised when a conservative approach is adopted in the management of CIN 2. (Source: Journal of Obstetrics and Gynaecology Research)

Prevalence of HPV infection and cervical intraepithelial neoplasia and attitudes towards HPV vaccination among Chinese women aged 18–25 in Jiangsu Province

Chinese Journal of Cancer Research — Sat, 12 Mar 2011 06:52:19 +0100

Conclusion Our study indicates cervical disease burden is relatively high among sampled Chinese women aged 18–25. Appropriate educational interventions for female adolescents and strategies to subsidize vaccine costs are definitely needed to ensure the effectiveness of vaccination campaigns in China. Content Type Journal ArticlePages 25-32DOI 10.1007/s11670-011-0025-3Authors Shang-ying Hu, Department of Epidemiology & Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences; School of Basic Medicine, Peking Union Medical College, Beijing, 100730 ChinaYing Hong, Department of Gynecology and Obstetrics, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, 210008 ChinaFang-hui Zhao, Department of Cancer Epidemiolo...

Evaluation of 14 triage strategies for HPV DNA positive women in population‐based cervical screening

International Journal of Cancer — Fri, 11 Mar 2011 00:00:00 +0100

AbstractHigh‐risk human papillomavirus (hrHPV) testing has a higher sensitivity but lower specificity than cytology for detection of high‐grade intraepithelial neoplasia (CIN). To avoid over‐referral to colposcopy and overtreatment, hrHPV‐positive women require triage testing and/or follow‐up. 25,658 women (30‐60 years) enrolled in a population‐based cohort study had an adequate baseline Pap smear and hrHPV test. The end‐point was cumulative two‐year risk of CIN grade 3 or worse (CIN3+). In a post‐hoc analysis, fourteen triage/follow‐up strategies for hrHPV‐positive women (n=1303) were evaluated for colposcopy referral rate, positive (PPV) and negative predictive value (NPV). Five strategies involved triage testing without a repeat test and nine strategies involved ...

Evaluation of 14 triage strategies for HPV DNA‐positive women in population‐based cervical screening

International Journal of Cancer — Fri, 11 Mar 2011 00:00:00 +0100

AbstractHigh‐risk human papillomavirus (hrHPV) testing has a higher sensitivity but lower specificity than cytology for detection of high‐grade intraepithelial neoplasia (CIN). To avoid over‐referral to colposcopy and overtreatment, hrHPV‐positive women require triage testing and/or followup. A total of 25,658 women (30–60 years) enrolled in a population‐based cohort study had an adequate baseline Pap smear and hrHPV test. The end‐point was cumulative two‐year risk of CIN grade 3 or worse (CIN3+). In a post‐hoc analysis, fourteen triage/followup strategies for hrHPV‐positive women (n = 1,303) were evaluated for colposcopy referral rate, positive (PPV) and negative predictive value (NPV). Five strategies involved triage testing without a repeat test and nine strategies i...

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Domain-Specific Image Analysis for Cervical Neoplasia Detection Based on Conditional Random Fields

IEE Transactions on Medical Imaging — Tue, 01 Mar 2011 00:00:00 +0100

This paper presents a domain-specific automated image analysis framework for the detection of pre-cancerous and cancerous lesions of the uterine cervix. Our proposed framework departs from previous methods in that we include domain-specific diagnostic features in a probabilistic manner using conditional random fields. Likewise, we provide a novel window-based performance assessment scheme for 2D image analysis which addresses the intrinsic problem of image misalignment. Image regions corresponding to different tissue types are indentified for the extraction of domain-specific anatomical features. The unique optical properties of each tissue type and the diagnostic relationships between neighboring regions are incorporated in the proposed conditional random field model. The validity of our ...

Human Papillomavirus Testing in the Prevention of Cervical Cancer

JNCI — Tue, 01 Mar 2011 00:00:00 +0100

Strong evidence now supports the adoption of cervical cancer prevention strategies that explicitly focus on persistent infection with the causal agent, human papillomavirus (HPV). To inform an evidence-based transition to a new public health approach for cervical cancer screening, we summarize the natural history and cervical carcinogenicity of HPV and discuss the promise and uncertainties of currently available screening methods. New HPV infections acquired at any age are virtually always benign, but persistent infections with one of approximately 12 carcinogenic HPV types explain virtually all cases of cervical cancer. In the absence of an overtly persistent HPV infection, the risk of cervical cancer is extremely low. Thus, HPV test results predict the risk of cervical cancer and its pre...

High-Risk Human Papillomavirus Testing in Women With ASC-US Cytology: Results From the ATHENA HPV Study.

American Journal of Clinical Pathology — Tue, 01 Mar 2011 00:00:00 +0100

This study evaluated the clinical performance of the cobas 4800 HPV Test (Roche Molecular Systems, Pleasanton, CA) for high-risk human papillomavirus (HR-HPV) testing with individual HPV-16/HPV-18 genotyping in women 21 years or older with atypical squamous cells of undetermined significance (ASC-US). Women (N = 47,208) were recruited in the United States during routine screening, and liquid-based cytology and HPV testing were performed. The ASC-US prevalence was 4.1% (1,923/47,208), and 1,578 women underwent colposcopy with valid results. The cobas 4800 HPV Test demonstrated performance comparable to the Hybrid Capture 2 test (QIAGEN, Gaithersburg, MD) for the detection of cervical intraepithelial neoplasia (CIN) grade 2 or worse and grade 3 or worse. HPV-16/HPV-18+ women had a greater ab...

Follow-up Findings in Young Females With High-Grade Squamous Intraepithelial Lesion Papanicolaou Test Results.

Archives of Pathology and Laboratory Medicine — Tue, 01 Mar 2011 00:00:00 +0100

Conclusions.?Histopathologic CIN 2/3 was documented in 148 of 335 (44%) of biopsied young females with HSIL Pap results, likely reflecting both the reported high likelihood of HSIL regression in younger females and the challenge of colposcopic sampling of relatively short-lived smaller CIN 2/3 lesions. Although no cases of invasive carcinoma were identified in this study, updated guidelines pose new risks for maturing females with undetected cervical precancer. PMID: 21366461 [PubMed - in process] (Source: Archives of Pathology and Laboratory Medicine)

Optical coherence tomography for the diagnosis of cervical intraepithelial neoplasia

Lasers in Surgery and Medicine — Tue, 01 Mar 2011 00:00:00 +0100

ConclusionOCT is highly sensitive in identifying pre‐invasive and invasive cancer of the uterine cervix. Improvements in resolution and the development of new light sources and optics may improve the specificity as well as the differentiation of cervical dysplasia. The interobserver agreement was substantial. Lasers Surg. Med. 43:206–212, 2011. © 2011 Wiley‐Liss, Inc. (Source: Lasers in Surgery and Medicine)

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Non-uptake of colposcopy in a resource-poor setting

International Journal of Gynaecology and Obstetrics — Thu, 24 Feb 2011 00:00:00 +0100

Conclusion: The rate of refusal of colposcopy in southeast Nigeria was high, indicating an urgent need for appropriate remedial measures instituted through intensive education of women regarding cervical cancer and its prevention. Targeted counseling should be initiated early as part of prescreening counseling. (Source: International Journal of Gynaecology and Obstetrics)

[Should CIN 2 and 3 be treated the same way?]

Gynecologie, Obstetrique et Fertilite — Tue, 15 Feb 2011 00:00:00 +0100

Authors: Carcopino X, Muszynski C, Mergui JL, Gondry J, Boubli L Although spontaneous regression of cervical intraepithelial neoplasia type 2 (CIN 2) occurs in 40% of cases over a 2 years period, such diagnosis commonly requires the use of excisional techniques exposing to genuine obstetrical and neonatal morbidity as well as the risk of unsatisfactory post-treatment colposcopy. Recent advances in knowledge about CIN 2 natural history and morbidity of conservative therapies brings out the need to optimize therapeutics indications and to reconsider the use of ablative techniques. In order to allow for the lack of histological analysis and final diagnosis, it is therefore crucial not to misdiagnose microinvasive cervical disease. The use of factors significantly related to the risk of mi...

European guidelines for quality assurance in cervical histopathology.

Acta Oncologica — Fri, 11 Feb 2011 00:00:00 +0100

Authors: Bulten J, Horvat R, Jordan J, Herbert A, Wiener H, Arbyn M Abstract The current paper presents Chapter 5 of the second edition of the European Guidelines for Quality Assurance in Cervical Cancer Screening, which deals with the histopathological diagnosis of lesions of the uterine cervix. It completes a series of publications in journals containing the contents of other parts of the European Guidelines. Histopathology provides the final diagnosis on the basis of which treatment is planned, and serves as the gold standard for quality control of cytology and colposcopy. It is also the source of the diagnostic data stored at the cancer registry and used for evaluation of screening programmes. It is therefore important that histopathology standards are monitored and based on agreed...

Lack of HPV 16 and 18 detection in serum of colposcopy clinic patients

Journal of Clinical Virology — Wed, 09 Feb 2011 00:00:00 +0100

Conclusions: In this colposcopy clinic population with a range of clinical characteristics and established HPV cofactors, HPV DNA was undetectable in their serum. Our findings suggest that serum HPV DNA detection is not a cervical cancer screening tool. (Source: Journal of Clinical Virology)

Post-coital bleeding in young women: the role of genitourinary medicine

International Journal of STD and AIDS — Fri, 04 Feb 2011 00:00:00 +0100

The objectives of this questionnaire study were to ascertain whether GU medicine practitioners agreed with these recommendations and to assess which skills were considered necessary regarding the diagnosis and management of cervical pathology in departments of GU medicine and sexual health and also, therefore, in training in the specialty. The majority of respondents considered it important to check for cervical infection in determining the cause of PCB, but few GU medicine practitioners now perform colposcopy and many consider themselves insufficiently trained to assess the cervix in more detail. Since the colposcope is the optimal tool for examining the anogenital tract, we suggest that colposcopy, in its broadest sense, should be reconsidered as an essential part of GU medicine training...

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Comparison of visual inspection with acetic acid (VIA) and cervical cytology to detect high grade cervical neoplasia among HIV‐infected women in India

International Journal of Cancer — Thu, 03 Feb 2011 00:00:00 +0100

AbstractHIV‐infected women in India and other developing country settings are living longer on antiretroviral therapy, yet their risk for HPV‐induced cervical cancer remains unabated due to lack of cost effective and accurate secondary prevention methods. Visual inspection after application of dilute acetic acid on the cervix (VIA) has not been adequately studied against the current standard: conventional cervical cytology (Pap smears) among HIV‐infected women. We evaluated 303 non‐pregnant HIV‐infected women in Pune, India by simultaneous and independent screening with VIA and cervical cytology, with disease ascertainment by colposcopy and histopathology. At the CIN2+ disease threshold, the sensitivity, specificity, positive and negative predictive value estimates of VIA were 80...

Comparison of visual inspection with acetic acid and cervical cytology to detect high‐grade cervical neoplasia among HIV‐infected women in India

International Journal of Cancer — Thu, 03 Feb 2011 00:00:00 +0100

AbstractHuman immunodeficiency virus (HIV)‐infected women in India and other developing country settings are living longer on antiretroviral therapy, yet their risk for human papillomavirus (HPV)‐induced cervical cancer remains unabated because of lack of cost‐effective and accurate secondary prevention methods. Visual inspection after application of dilute acetic acid on the cervix (VIA) has not been adequately studied against the current standard: conventional cervical cytology (Pap smears) among HIV‐infected women. We evaluated 303 nonpregnant HIV‐infected women in Pune, India, by simultaneous and independent screening with VIA and cervical cytology with disease ascertainment by colposcopy and histopathology. At the cervical intraepithelial neoplasia (CIN2+) disease threshold,...

Regression of high-grade cervical intraepithelial neoplasia with TG4001 targeted immunotherapy

American Journal of Obstetrics and Gynecology — Tue, 01 Feb 2011 00:00:00 +0100

Conclusion: These promising data warrant further development of TG4001 in CIN 2/3 treatment. (Source: American Journal of Obstetrics and Gynecology)

No long-term psychosocial effects of delayed versus immediate cervical treatment

MedWire News - Ob/Gyn — Mon, 31 Jan 2011 18:44:21 +0100

There are no short- or long-term psychosocial effects on women who are treated with punch biopsies and subsequent selective recall as opposed to immediate large loop excision during colposcopy, study results show. (Source: MedWire News - Ob/Gyn)

Large loop excision of transformation zone procedures used in the management of cytological abnormalities of the cervix

The Australian and New Zealand Journal of Obstetrics and Gynaecology — Mon, 31 Jan 2011 00:00:00 +0100

Conclusions: The 2005 NHMRC guidelines should result in 33.9% fewer LLETZ procedures being performed in the younger age group. This has benefits for their future fertility needs. STI screening would be beneficial in this group when seen at colposcopy clinics, as they have significant rates of prior or current infection. (Source: The Australian and New Zealand Journal of Obstetrics and Gynaecology)

Accuracy of visual inspection with acetic acid for cervical cancer screening

International Journal of Gynaecology and Obstetrics — Tue, 25 Jan 2011 00:00:00 +0100

Conclusion: Screening for precancerous and cancerous cervical lesions using VIA is a simple, low-cost, and efficient alternative to cytologic testing in low-resource areas. (Source: International Journal of Gynaecology and Obstetrics)

Dynamic spectral imaging colposcopy: higher sensitivity for detection of premalignant cervical lesions.

BJOG : An International Journal of Obstetrics and Gynaecology — Thu, 20 Jan 2011 11:31:48 +0100

Conclusions DSI colposcopy has a significantly higher sensitivity to detect cervical lesions than conventional colposcopy. If the colour-coded map is combined with conventional colposcopic examination, the sensitivity increases further. PMID: 21176085 [PubMed - as supplied by publisher] (Source: BJOG : An International Journal of Obstetrics and Gynaecology)

A case of usual (basaloid)-type vulvar intraepithelial neoplasia that failed to respond to imiquimod cream: clinical implications

International Journal of Clinical Oncology — Thu, 20 Jan 2011 07:08:14 +0100

Abstract The authors report a case of usual-type (basaloid-type) vulvar intraepithelial neoplasia (VIN) 3 that failed to respond to imiquimod cream. A 51-year-old Japanese woman visited her local gynecologist complaining of vulvar itching. Atypical cells were noted in cytology smears, but nine vulvar biopsy specimens showed benign proliferation of epithelial tissue. The patient was placed under careful observation for 8 months, when the vulvar smears once again showed atypical cells and biopsy specimens revealed VIN3. The patient was then referred to our hospital where she was given a diagnosis of VIN 3, basaloid type of usual type. The biopsy specimens were positive for p16 and the lesions were confirmed to be human papilloma virus (HPV)-related. We recommended simpl...