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Gynaecology
Published in Roy Palmer, Diana Wetherill, Medicine for Lawyers, 2020
While the first two are in the hands of the clinician, the third depends upon the skill of the cytological screener and cytopathologist. Dyskaryosis describes the appearances of isolated individual cells, whereas dysplasia describes abnormalities in the direction of cancer within the context of cell architecture, and is possible only with tissue biopsy. Colposcopy allows the examiner to determine which area of the cervix should be sampled, so as to examine for dysplasia. If colposcopy cannot identify the source of the abnormal cells the whole cancer-bearing area should be sampled in a cone biopsy. Cervical screening and recent litigation arising from it has been fully discussed elsewhere.17–20
Effects on Female Offspring and Mothers After Exposure to Diethylstilbestrol
Published in Takao Mori, Hiroshi Nagasawa, Toxicity of Hormones in Perinatal Life, 2020
J. Rotmensch, K. Frey, A. L. Herbst
Colposcopy is often useful to adequately evaluate the DES-exposed patient. Colposcopic examination has made it possible to identify abnormal areas for biopsy and followup in subsequent examinations. During the examination, the entire transformation zone and the extent of the lesion should be noted. Care must be taken to visualize all vaginal folds and structural abnormalities. Vaginal adenosis often appears as grapelike reddish areas. Colposcopy changes in DES-exposed females can be difficult to interpret without histological confirmation. Areas of punctation and mosaicism may represent metaplasia. Colposcopic findings suspicious for neoplasia and all abnormal lesions should be biopsied.
Diagnosis
Published in William Bonnez, Guide to Genital HPV Diseases and Prevention, 2019
Eugene P. Toy, Mark H. Stoler, Patti E. Gravitt, Robert C. Rose
Cervical adenocarcinoma and squamous cell carcinoma are preceded by the abolition of normal maturation and differentiation patterns. Colposcopy is the examination using magnifying optics (the colposcope) of the cervix, and by extension of lower genital tract tissues to identify these areas of aberrant differentiation. Enhancing the visualization, the application of 3–5% acetic acid or white vinegar acts as a mucolytic and causes, by a mechanism that is not well-understood, the whitening of the tissues that have abnormal nuclear to cytoplasmic ratio. The more severely abnormal lesions will require more time to produce acetowhitening, but ultimately the changes will be more pronounced (Fig. 5.1). These color changes guide the clinician to obtain biopsies from the most suspicious areas. Table 5.1 details the colposcopic nomenclature and a lesion classification scheme.
Endocervical sampling using brush versus curette: a single centre experience and literature review
Published in Journal of Obstetrics and Gynaecology, 2023
Cristina Mitric, Rosa Lakabi, Gilit Kligun, Emad Matanes, Susie Lau, Walter H. Gotlieb, Shannon Salvador
Data were extracted from the computerised database containing the electronic medical records by one researcher and verified by another researcher. The following demographic and clinical characteristics were retrieved: age, gravidity, parity, menopausal status, smoking status, method of contraception, and human papilloma virus (HPV) vaccination status. The retrieved colposcopy results included Pap tests, cervical biopsies, endocervical samples, as well as endometrial biopsies, if applicable. Depending on the clinical scenario or whether discrepancies in results were encountered, colposcopy results up to 18 months prior and 12 months after the endocervical sampling were reviewed to assess whether high grade lesions were missed and whether access to care was delayed in either technique. Analysis was performed using the Statistical Package for Social Sciences (SPSS version 26, IBM New York) to obtain averages, standard deviations, means, as well as t-test and p-value assessments.
Long-term quality of life assessment after excisional treatment for cervical dysplasia
Published in Journal of Obstetrics and Gynaecology, 2022
Radmila Sparić, Zoran Bukumirić, Radomir Stefanović, Andrea Tinelli, Stoyan Kostov, Rafał Watrowski
Following ECT due to SIL, women have an increased long-term risk of disease recurrence, eventually necessitating repeat treatment (Chen et al. 2019; Bogani et al. 2020, 2021), as well as a lifetime risk of perinatal morbidity (Kyrgiou et al. 2016; Zhuang et al. 2019). The necessity for follow-up after a SIL diagnosis is widely accepted, but no ideal surveillance strategy exists (van der Heijden et al. 2015; Chen et al. 2019; Heinonen et al. 2020). The minimal requirement is conventional cytology; the role of colposcopy and HPV-testing are controversial (van der Heijden et al. 2015; Heinonen et al. 2020). Biomarker-based monitoring and screening tools have the potential to complement the conventional methods in the near future (Valenti et al. 2017). Only few studies have looked at predictors of long-term psychological sequelae after SIL diagnosis and treatments (Sharp et al. 2015; O’Connor et al. 2016; Sparić et al. 2019a, 2019b). Our previous research showed that 26% of women experienced discomfort during follow-up colposcopy, and 27% of patients showed less interest in sexual intercourse two or more years after treatment (Sparić et al. 2019a, 2019b). These women developed higher levels of anxiety and depression and reported more worries about possible disease progression (O’Connor et al. 2016; Sparić et al. 2019a, 2019b).
Factors Correlated with the Accuracy of Colposcopy-Directed Biopsy: A Systematic Review and Meta-Analysis
Published in Journal of Investigative Surgery, 2022
Hongyan Ren, Mengzhe Jia, Shujun Zhao, Hongyu Li, Suzhen Fan
For women with questionable cervical cancer test results, colposcopy is required. colposcopy is required to complete the overall visual assessment of the cervix. Colposcopy provides enlarged images of the external cervix at different magnification, allowing doctors to look for abnormal hyperplasia changes after previously using a 5% acetic acid solution. Sense of sight changes consists of boundary features, reaction to acetic acid, pathological changes size, boundary profile, vascular morphology, and iodine uptake. The results of normal colposcopic include primary squamous epithelium, columnar epithelium, ectopy/valgus, metaplasia squamous epithelium, Naboth cysts, crypt (gland) opening, decidual disease during pregnancy, submucosal branching vessels. Colposcopy was considered to be satisfactory when the transformation zone was fully seen. The feature of the abnormal colposcopic findings will be lesion(s) present (acetowhite or other). Biopsy samples were taken if necessary. Biopsy was conducted in the irregular areas of the cervix. For patients with more serious cytological results than colposcopy and patients with unsatisfactory colposcopy, curettage was performed in the cervical canal.