The accuracy of colposcopically directed biopsy in patients with suspected intraepithelial neoplasia of the cervix

Underdiagnosis of early cervical cancer with an invisible cervical transformation zone in an elderly patient: A case report

The treatment of cervical intraepithelial neoplasia (CIN) can result in under- or overtreatment. The current report describes a case of undertreatment of a cervical tumor. A 72-year-old woman was preoperatively diagnosed with CIN3. Following surgery, the final diagnosis of the excised specimen was keratinizing squamous cell carcinoma that measured 2.5 cm in size. The exocervical margin and deep margin were negative. The patient received adjuvant therapy with concurrent chemoradiotherapy and never had disease recurrence. In elderly patients, making an accurate preoperative diagnosis based on specimens from cervical biopsies with or without colposcopy is difficult. MRI may be an accurate preoperative indicator of early cervical tumor, although some studies have demonstrated that MRI has a limitation with respect to its diagnostic ability. Other studies have reported that it is necessary to perform conization prior to hysterectomy. Physicians must reconsider the determined preoperative diagnosis of an early cervical tumor and establish standard guidelines for deciding when to use surgical treatment in elderly patients.

Accuracy of Colposcopically Guided Diagnostic Methods for the Detection of Cervical Intraepithelial Neoplasia

Introduction: Many factors can affect the accuracy of colposcopically guided biopsy, endocervical curettage (ECC) and differential cytology, all of which are standard, minimally invasive procedures used to detect cervical intraepithelial neoplasia. Method: All conizations carried out between 2007 and 2013 in the gynecological department of Hannover Medical School were retrospectively reviewed. The agreement between colposcopic diagnosis and histology was evaluated retrospectively. The analysis included 593 complete datasets out of a total of 717 cases treated. Results: The overall agreement was 85.5 %; the accuracy was significantly higher (p = 0.029) when three biopsy specimens were taken rather than just one. The agreement between diagnosis and histological findings from conization was highest for women < 30 years (90.7 %) and lowest for women > 50 years (72.1 %; p = 0.008). The agreement between preoperative differential cytology and histology results after conization was 86.7 % and improved as patient age increased (p = 0.035). The agreement between ECC findings and the results of conization was only 49.1 % irrespective of patient age, transformation zone or the patient's menopausal status. Conclusion: The accuracy of colposcopically guided biopsy appears to increase when three biopsy specimens are taken and is particularly high for younger patients. Differential cytology was also found to be highly accurate and is particularly useful for patients aged more than 50 years. The accuracy of ECC was significantly lower; however ECC can provide important additional information in selected cases.

Comparsion the histopathological findings after cervical biopsy and excisional procedures

INTRODUCTION

A definitive diagnosis of cervical intraepithelial neoplasia (CIN) is confirmed after histopathological (HP) examination of the tissue obtained through the biopsy. The aim of this study was to compare histopathological results obtained with punch biopsy and results obtained through one of the excisional techniques.

MATERIAL AND METHODS

We analysed histology results of 130 patients referred to our institution with abnormal smear. Punch biopsy was performed after colposcopic examination in all patients before one of the excision methods. Excision methods performed were: large loop excision of transformation zone (LLETZ), radio-frequency knife conisation or cold knife conisation. Based on the histopathological examination of the punch biopsy specimen or excisional specimen diagnosis of CIN was established.

RESULTS

CIN and invasive cancer were the most common diagnoses in the 31-40 age group at 45.4% (59/130). Discrepancies in the histological diagnosis between punch biopsy and excisional biopsy was identified in 58.5% (76/130) of the patients. In 6% of the of the cases the biopsy did not detect an invasive carcinoma.

CONCLUSION

The most frequent discrepancies between punch biopsy and excisional biopsy were in the group of patients with a higher grade cervical dysplasia. Mild dysplastic changes diagnosed through punch biopsy, require a more conservative approach, as the majority of this group had negative specimens on the cone after excision, especially in the younger population. It is advisable that the patients above 30 years of age and a higher grade dysplasia in the biopsy specimen, should undergo one of the excisional techniques as a diagnostic/therapeutic method of treatment.

Relevance of tumor angiogenesis patterns as a diagnostic value and prognostic indicator in oral precancer and cancer

Tumor angiogenesis occurs by recruitment of endothelial cell precursors or by sprouting of existing capillaries, which differ from the normal vasculature by having an altered morphology that can be exploited for diagnosis and as a prognostic indicator. Improved technologies have propelled diagnosis into a new era. These technologies have to be used with great precision. The diagnosis of a dysplastic premalignant lesion of the oral mucosa cannot be based solely on clinical findings. Therefore histologic evaluation of a representative biopsy specimen is necessary. Accurate judgment of the proper site for biopsy is essential for reaching a correct diagnosis. The aim of this report is to analyze the vascular patterns with the help of direct oral microscopy and the technique of stereo-optical microscopy in the oral cavity to select biopsy sites, and compare the outcome of a directed biopsy with that of biopsy specimens obtained from sites selected solely on the basis of clinical criteria. The study sample comprised 50 oral mucosal lesions. A statistically significant difference was noted between samples judged to be microscopically representative sites. We conclude that this method would aid in early and better diagnosis and treatment planning of oral premalignant and malignant lesions by assessing the various vascular patterns in the mucosa.

Diagnostic accuracy of guided cervical biopsies: a prospective multicenter study comparing the histopathology of simultaneous biopsy and cone specimen

OBJECTIVE

We sought to determine the validity of colposcopically directed cervical biopsies as a diagnostic test to define the degree of cervical intraepithelial neoplasia (CIN).

STUDY DESIGN

In a prospective multicenter trial, patients undergoing excisional procedures of the transformation zone additionally had colposcopy and up to 3 guided cervical biopsies in a single procedure. Cervical biopsies were regarded as a diagnostic test to detect high-grade lesions (CIN 2,3), with the cone specimen as reference standard.

RESULTS

In all, 488 biopsies were performed in 244 cases, with 2 biopsies done in 192 cases. Cervical biopsies underestimated the severity of lesions in 46.7% of cases. Sensitivity, specificity, and positive and negative predictive values were 66.2% (95% confidence interval [CI], 59.4-72.3), 95.0% (95% CI, 83.5-98.6), 98.5% (95% CI, 94.8-99.6), and 35.5% (95% CI, 27.1-44.9), respectively.

CONCLUSION

Our data suggest that cytologically suspected high-grade lesions (CIN 2,3) can be confirmed by biopsy in many cases, but they cannot be excluded.

Cervical squamous intraepithelial lesions of low-grade in HIV-infected women: recurrence, persistence, and progression, in treated and untreated women

BACKGROUND

Human immunodeficiency virus (HIV)-infected patients are more predisposed than HIV-negative women to develop squamous intraepithelial lesions (SIL) of the uterine cervix, and cervical dysplasia may be of higher grade in HIV-positive women than in HIV-negative subjects, with more extensive and multi-centric involvement of the lower genital tract by human papillomavirus (HPV)-associated lesions. Moreover, recurrence and progression rate of cervical intraepithelial neoplasia (CIN) is particularly higher in immunocompromised women.

DESIGN

Retrospective case-control study of HIV-positive women and HIV-negative controls, all affected by low-grade SIL of the uterine cervix, treated by loop excision or followed-up without treatment. Correlation of progression and recurrence of SIL with HIV status and CD4+ count.

PATIENTS

From September 1990 to October 1997, 75 HIV-positive low-grade-SIL patients, 47 treated and 28 followed-up without treatment, and 75 HIV-negative low-grade-SIL controls, 45 treated and 30 followed-up.

RESULTS

Among treated patients, 17/47 (36.2%) HIV-positive and 5/45 (11.1%) controls had recurrence (P < 0.0101, O.R. = 4.53, 95% CI = 1.5-13.7), progression of untreated lesion was seen in 15/28 (53.6%) HIV-positive and 7/30 (23%) controls (P < 0.05, O.R. = 3.79, 95% CI = 1.23-11.69). The risk of recurrence or progression of low-grade SIL linked to HIV seropositivity is about 4-5 times higher in comparison with seronegative counterpart, matched for age, risk factors and lesion size. More significantly, considering the cut-off of 200 CD4+/mm(3) in HIV-positive women, 13/17 cases of recurrence (P < 0.05, O.R. = 4.88, 95% CI = 1.28-18.58) and 10/15 cases with progression (P < 0.05, O.R. = 6.67, 95% CI = 1.24-35.73) were immunocompromised (<200 CD4+/mm3), with a significant higher risk of recurrence or progression linked to immunodeficiency status. Considering time of progression or recurrence, during follow-up, Kaplan-Meier curves shows that HIV-positive status and immunodeficiency are correlated with more rapid evolution of cervical dysplasia and HPV-related lesions: comparison of recurrence in treated patients report P < 0.005 and progression in untreated P<0.05 (Mantel-Haenszel log-rank test).

CONCLUSIONS

Immunological status seems to be a determinant factor in prognosis of cervical SIL, HIV-positive women affected by this lesion, even if low-grade, need more aggressive management than the immunocompetent counterpart. Strict cytologic and colposcopic screening is recommended and CD4+ count and HPV-DNA testing may be useful risk indicators. Excisional procedures are preferred, while ablative treatments or wait and see policy may expose to some risk this type of population with poor compliance to follow-up.

Independent determinants of inaccuracy of colposcopically directed punch biopsy of the cervix

OBJECTIVE

The goal of this study was to determine the clinical factors independently associated with inaccuracy of colposcopically directed punch biopsy in defining extent and severity of epithelial lesions of the cervix.

METHODS

The study was conducted in a colposcopy clinic devoted to the management of patients with abnormal Pap smear and/or histology diagnosis of cervical intraepithelial neoplasia (CIN) on punch biopsy or endocervical curettage. Seven hundred and thirty-nine patients (median age, 33 years; range, 18-83 years) referred with a punch biopsy diagnosis of CIN2-3 and treated with electrosurgical conization were evaluated. Cone histology diagnosis was assumed to supply the correct diagnosis. Two types of deviation of biopsy diagnosis were considered: (1). unconfirmed high-grade CIN diagnosis, defined as a cone diagnosis of CIN1 and reactive/reparative changes, and (2). nondiagnosis of carcinoma, defined as a cone diagnosis of microinvasive and invasive squamous carcinoma. Multinomial logistic regression analysis was used to assess the determinants of the probability of each type of deviation.

RESULTS

The probability of unconfirmed high-grade CIN diagnosis (n = 190, 25.7%) was inversely related to number of quadrants involved, severity of referral Pap smear, and grade of biopsy. The probability of nondiagnosis of carcinoma (n = 43, 5.8%) was positively related to patient age, invisibility of the squamocolumnar junction, number of quadrants involved, and cone width. Endo-ectocervical location, cone depth, and time period had no effect whatsoever.

CONCLUSIONS

The study confirmed previous observations regarding the positive association of patient age and invisibility of squamocolumnar junction with the probability of nondiagnosis of carcinoma. The concomitant positive effects of number of quadrants involved and cone width were suggested to mirror the effect of circumferential development and, respectively, surface area of CIN. Severity of referral Pap smear and grade of biopsy were shown to be inversely related to the probability of a cone diagnosis of CIN1 and benign changes.

Direct oral microscopy and its value in diagnosing mucosal lesions: a pilot study

OBJECTIVE

Clinical examination of the oral mucosa often leads to an uncertain diagnosis, and a supplementary biopsy with a histopathologic examination of the lesion is necessary to establish a definite diagnosis. However, the site for the biopsy is a subjective choice that sometimes raises doubts about its representativeness. So far, no simple and reliable method is available for selecting the most appropriate area for biopsy.

STUDY DESIGN

In a prospective study, we performed direct oral microscopy (oral application of the colposcopy technique used in gynecology) in 35 patients with various clinical diagnoses, such as leukoplakia, oral lichenoid lesions, or suspected malignancy. First, the oral mucosa was examined with direct microscopy, and the most representative site, according to colposcopic criteria, was selected. Then, the mucosa was clinically inspected by an independent examiner. The best site for biopsy according to clinical criteria was noted, and any difference in biopsy sites was recorded. Biopsy specimens were taken from 2 of these sites.

RESULTS

Twenty-nine patients (83%) showed changes in the vascular picture on microscopy, according to the colposcopy criteria. In 14 patients (40%), the biopsy sites identified by direct oral microscopy showed more advanced histologic signs than those selected by routine clinical examination (0.01 < P </=.05). Four patients (11%) had more advanced histologic signs in the biopsy samples, as identified during routine clinical examination. In 17 patients (49%), we found no differences between the biopsy specimens.

CONCLUSION

Direct oral microscopy of mucosal lesions seems to offer advantages in selecting more representative sites for biopsy than routine clinical examination alone.

The correlation between the grade of dyskaryosis on cervical smear, grade of cervical intraepithelial neoplasia (CIN) on punch biopsy and the final histological diagnosis on cone biopsies of the cervix

This study was carried out to assess how reliably a punch biopsy of the cervix predicts the maximum grade of CIN present and whether a colposcopically directed punch biopsy is more reliable than cytology in predicting the grade of intraepithelial neoplasia present in the cervix. The grade of CIN in 107 cone biopsy specimens was compared with the grade of CIN and dyskaryosis in punch biopsies and smears from the same patients. Exact correlations were identified between the highest grade lesions on cone biopsy and those in 63% of punch biopsies and 49% of cervical smears. We conclude that punch biopsy provides a more reliable estimate of the highest grade of CIN present in a subsequent cone biopsy than cervical cytology, but nonetheless fails to give a consistent estimate of the final grade of CIN in a significant percentage of cases.

Positive predictive rate of colposcopic examination of the cervix uteri: an overview of literature

Study of literature revealed that the positive predictive rate of the colposcopic impression is better as the cervical lesion is more severe. When directed biopsies are taken, the positive predictive rate of colposcopy increases considerably. For microinvasive disease, the positive predictive rate is quite poor, probably because of the absence of characteristic features. Large loop biopsies diagnosed all cases of microinvasive disease missed by directed biopsies, but this technique has the disadvantage of considerable "overtreatment" when integrated in the management of all patients with abnormal cytology. The restrictions of colposcopy are the invisibility of the squamocolumnar junction and observer variability in the assessment of the impression. The levels of agreement among experienced colposcopists are in the same range as those in cytological and histopathological diagnosis. It is concluded that colposcopy is an indispensable tool in the management of premalignant cervical disease, as long as the restrictions of the technique are kept in mind by the colposcopist.

Retrospective analysis of non-correlating cervical smears and colposcopically directed biopsies

The purpose of this study is to evaluate the cause of discrepancies between non-correlating cytologic and histologic cervical samples. The biopsy results of 433 women examined colposcopically were compared to their referral cervical smears (RS). There was a discrepancy between the RS and the subsequent biopsy in 120 women (28%). One hundred of these 120 RS were available for review; and in each case, a reason for the discrepancy was established and classified as RS overcall, RS undercall, RS sampling error, or biopsy sampling error. Fifty-one discrepant RS were overcalled. They were reported initially as condyloma (19), mild dysplasia (22), and moderate dysplasia (10). One RS was undercalled. Nine RS were not diagnostic of the biopsy-proven lesion due to smear sampling error. The discrepancies in the remaining 39 cases were due to biopsy sampling error. Twenty-one of these 39 cases had additional biopsies or smears that confirmed the presence of condyloma/dysplasia, and 18 had negative follow-up. In summary, discrepancies were a result of pathologists' interpretative error, predominantly overcalls, in 52% of non-correlating cases, and smear or biopsy sampling error in the remaining 48%.

Loop electrosurgical excision procedures for cervical dysplasia: experience in a community hospital

OBJECTIVE

The study was undertaken to evaluate the use of the loop electrosurgical excision procedure as an outpatient hospital or surgicenter procedure.

STUDY DESIGN

The records of 358 patients treated for cervical intraepithelial neoplasia at a large community hospital over a 1-year period were reviewed.

RESULTS

The specimens obtained by loop electrosurgical excision procedure and laser cone excision were comparable in size but smaller than those by means of cold-knife conization. Seventy-two percent of loop electrosurgical excision procedure specimens consisted of two to eight tissue fragments (mean 3.4). In addition, 48% of the loop electrosurgical excision procedure specimens and 38% of laser cones had moderate or severe thermal artifacts. Fragmentation and cautery damage precluded orientation of tissue and evaluation of margins in 19% of the cases.

CONCLUSIONS

The advent of the loop electrosurgical excision procedure has shifted the management of cervical intraepithelial neoplasia from the office to the outpatient surgery centers. This negates and, in fact, reverses the advantage of loop electrosurgical excision procedure over other methods in regard to cost and convenience through evaluating and treating a patient with cervical intraepithelial neoplasia in one office visit. Loop electrosurgical excision procedures provide specimens that are inferior compared with cold-knife cones; therefore the role of loop electrosurgical excision procedure for the management of cervical intraepithelial neoplasia outside the office appears limited.

Invasive carcinoma of the cervix following local destructive treatment for cervical intraepithelial neoplasia

OBJECTIVE

To investigate the occurrence of invasive carcinomas following local destructive treatment for cervical intraepithelial neoplasia (CIN) and to evaluate the factors responsible.

DESIGN

A multicentre retrospective study.

SUBJECTS

Forty-nine women registered with the British Society for Colposcopy and Cervical Pathology from 24 centres throughout Great Britain between 1985 and 1992, who had been treated by local destructive methods for CIN and who subsequently developed invasive carcinoma of the cervix.

RESULTS

Of the 49 women whose details were submitted, 42 had squamous cell carcinoma, six adenosquamous carcinoma and one adenocarcinoma. Eight had microinvasive carcinomas (Stage Ia) at the time of diagnosis, 24 had Stage Ib tumours and eight Stages II to IV. Thirteen women have died. Thirty-five women had been treated by laser vaporization, ten by cold coagulator, two by diathermy and two by cryosurgery. In 19 women (39%) the diagnosis of invasive carcinoma was made on the first follow up visit or within one year of treatment. Five patients did not present with invasive disease until more than five years after treatment.

CONCLUSIONS

The data presented suggest that many, but not all, of the invasive carcinomas presenting after local destructive treatment for CIN resulted from failure to recognise early invasive disease at the time of the initial assessment. The importance of thorough evaluation before undertaking these forms of treatment is emphasised. The use of excisional procedures should further reduce the small risk of invasive carcinoma developing after treatment for CIN.

Outpatient excisional management of cervical intraepithelial neoplasia. A prospective, randomized comparison between loop diathermy excision and laser excisional conization

OBJECTIVE

The purpose of our study was to compare loop diathermy excision and laser excisional conization with respect to treatment time, reliability, effectiveness, and safety.

STUDY DESIGN

Three hundred women with cervical intraepithelial neoplasia attending our colposcopy clinic were randomized to treatment with either loop diathermy excision (group 1, n = 150) or carbon dioxide laser excisional conization (group 2, n = 150), both performed with local anesthesia on an outpatient basis. Student's t or Mann-Whitney test were used to compare continuous data; the chi 2 test was used for categoric data.

RESULTS

The mean age, parity, histologic features, depth of excision, and occurrence of residual or recurrent disease were similar; however, the mean time required to complete treatment and hemostasis (2.5 +/- 3.6 vs 24.2 +/- 11.8 min), patient discomfort, blood loss (2.77 +/- 3.76 vs 27.15 +/- 17.51 ml; p < 0.001), and considerable thermal artifact affecting histologic interpretation of excision margins (5 cases vs 25 cases; p < 0.01) were significantly less in group 1 than in group 2.

CONCLUSION

In our experience outpatient loop diathermy excision is an equally effective, quicker, safer, and more reliable excisional technique than laser excisional conization.

Analysis and outcome of 502 cases of laser excision cone (LEC) at the Samaritan Hospital for Women, London

When performed based on cytology, histological accuracy of the laser cone specimen improved with the more severe cytology. The incidence of adenocarcinoma in situ is 1.0%. With and without residual disease, the rate of abnormal cytology after laser excision cone are 0.6% and 1.6% respectively. There is good correlation between colposcopic biopsy and cone specimen in the more severe lesions. Out of 139 cases of incomplete excision, only 3 cases had abnormal cytology at follow-up. The complication rates are very low.

Is large loop excision of the transformation zone (LLETZ) more accurate than colposcopically directed punch biopsy in the diagnosis of cervical intraepithelial neoplasia?

In 100 women with suspected cervical intraepithelial neoplasia (CIN) attending the colposcopy clinic the histological diagnoses made from excision biopsies taken by large loop excision of the transformation zone (LLETZ) were compared with those from colposcopically directed punch biopsies taken concurrently. One unsuspected microinvasive tumour was found and the diagnosis made by LLETZ was significantly worse than that made by punch biopsy in 24 cases (24%: 95% CI 15.6 to 32.4%). LLETZ improves the accuracy of diagnosis of CIN.

Reliability of colposcopy and directed punch biopsy

A group of 118 women underwent laser cone biopsy. Data were collected routinely on proforma case notes and entered into a computerized database. The histology of the cone biopsies was compared with that of previous, colposcopically directed punch biopsies, with the cytology of smears taken in the clinic and with the colposcopic diagnosis. The punch biopsy had a 54% false negative rate and neither of the two microinvasive carcinomas biopsied in this way were detected by the biopsy. Ten of 24 women with negative punch biopsies had CIN III in the cone. When the punch biopsy showed CIN II or worse, the cone biopsy confirmed the presence of CIN in 86%. There was some evidence of false negative cone biopsies. The data suggest that management should not be based solely upon the punch biopsy result but should include consideration of the cytology and colposcopy findings. Excisional methods of treatment are more likely to reveal early invasion and adenocarcinoma-in-situ.

20-year experience of follow-up of the abnormal smear with colposcopy and histology and treatment by conization or cryosurgery

During the period 1967 to 1977, 1466 women with Pap smears suggesting cervical epithelial neoplasia (CIN) II or worse were evaluated by colposcopy, portio biopsy, and endocervical curettage. Women who had CIN III were treated first by conization and later by cryosurgery. Cytological diagnosis was inaccurate compared to colposcopical and histological diagnosis, with 27% having a worse histological diagnosis. In 22% of the cases histology was two degrees less or worse than suggested by cytology. Presence of atypical vessels was associated with invasive cancer in 17% of cases. A total of 635 patients were treated by conization. After an average follow-up of 10 years, the cure rate was 96% compared to 87% by cryosurgery (104 cases). Hysterectomy was, mainly because of old age, performed on 154 patients; the cure rate was 97%. Although most treatment failures occurred within the first 5 years, some were seen after as long as 15-20 years.

The accuracy of colposcopically directed biopsy in diagnosis of CIN

During the last decade there has been an increasing interest in the use of the colposcope. A quality-control study for the evaluation and understanding of the limitations of cytology and colposcopy in our clinic is presented. The results in 132 patients are analysed and compared to previous reports from the literature. Cytologic results correlated with the histological diagnosis only in 47% of the patients. Colposcopically directed biopsies were accurate in 88.8% when the entire squamocolumnar junction was visualized. The accuracy of the directed biopsies in patients with unsatisfactory colposcopy was 58.3%. In the presence of a Gardnerella vaginalis cervicitis the colposcopic accuracy decreased to 70.9%.

Artefactual fetal heart trace in an undiagnosed dead fetus

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Screening for cervical intraepithelial neoplasia and cancer in the Sheffield STD clinic

I undertook a prospective study of the incidence of histologically confirmed cervical intraepithelial neoplasia (CIN) and cancer in women attending a sexually transmitted disease (STD) clinic, and correlated the findings to cervical cytology reports, age, and history of STD of the affected women. Of 2017 women screened, 75 (3.7%) had dyskaryotic cervical smears. Colposcopically directed biopsy tests gave an overall detection rate of 0.55% for CIN3, which was similar to the national average. The false negative rate was 2.9% and cytology tests alone underestimated the degree of pathological change in 12 (30%) of 40 women with mild dyskaryosis. Women under 20 years old made up 43% of those with CIN1 and 38% of those with CIN2. The detection rate of CIN3 was 0.65% for women aged 15-34, which was higher than the national average and suggested earlier onset of CIN3 in our clinic population. There was a high association between genital warts and cervical precancer. This preliminary study confirms the need for routine non-selective screening of women attending STD clinics by cervical cytology tests, colposcopic examination, and biopsy tests where indicated.

Cryosurgical treatment of cervical intraepithelial neoplasia (CIN III) in 102 patients

Results of cryosurgical treatment in 102 patients with a histologically confirmed diagnosis of severe dysplasia or carcinoma in situ of the uterine cervix (CIN III) are presented. The colposcopic evaluation performed in all patients required full visualization of the squamocolumnar junction. In 95 of the 102 patients no significant cytological abnormalities were found during the follow-up period, which amounts to a success rate of 93%. In seven patients (7%) treatment was considered to have failed because cervical smears persistently suggested CIN II or III. In five of them this was in all probability due to a residual lesion, since the abnormal smears occurred within 12 weeks after cryosurgery. It is concluded that in selected cases cryosurgery is a safe alternative for conisation in the treatment of CIN III. However, thorough colposcopic expertise is essential for adequate preoperative screening, as is careful selection of patients, and the latter may result in the withholding of cryosurgical therapy from 30% of patients with CIN III.

Management and follow-up of cervical intraepithelial neoplasia treated by CO2 laser vaporization method

Forty-four patients with cervical intraepithelial neoplasia (CIN) II and 31 patients with CIN III were followed up for up to 6 months after cervical cone vaporization with carbon dioxide laser. In addition to colposcopy and pap smear, all patients underwent cervical biopsies as part of their follow-up. This protocol permitted a diagnosis of persistent disease in the presence of normal colposcopy and pap smear.

Cytologic, colposcopic, and histologic correlation in young females

The purpose of the reported study was to correlate the cytologic and colposcopic patterns with the histopathologic diagnosis. This was accomplished in 81 young females who underwent direct colposcopic biopsy because of suspicious appearance of the cervix and abnormal or suspicious cytology. Among them 17 were intrauterine DES-exposed females. The results of our study showed that the white epithelium plus punctuation, punctation alone, white gland openings, mosaism, white epithelium plus mosaism, white epithelium, and atypical vessels were the mot common findings compatible with cervical intraepithelial neoplasia (CIN). Cytology and colposcopy together as diagnostic procedures were the most suitable and successful combination for the diagnosis of CIN in young patients with suspicious appearance of the cervix.