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Objective: To establish the prevalence of high-grade cervical intraepithelial neoplasia (CIN2+) in women referred to colposcopy with persistent high-risk human papillomavirus (hrHPV) cytology-negative screening sample according to hrHPV genotype, age at referral and colposcopic performance.Design: Prospective cohort study.Setting: Single colposcopy clinic linked to a population-based screening programme.Population: Women referred with persistent hrHPV cytology-negative routine screening samples.Methods: Prospective study with descriptive statistics from a single colposcopy unit between June 2014 and July 2019.Main Outcome Measures: Prevalence of hrHPV genotypes and CIN2+, positive predictive value for colposcopic impression, and inadequate colposcopic examinations.Results: A total of 3107 women were referred. Prevalence of CIN2+ was highest for persistent HPV16 infections (10.7%) compared with HPV18 (3.6%) or HPVO (4.7%). Prevalence of CIN2+ declined with age (25-34 years 14.2% to 55-64 years 1.1%) whereas the percentage of women with an inadequate colposcopic examination increased (25-34 years 0.9% to 55-64 years 29.5%). High-grade colposcopic impression fell over time during the study from 16.1 to 5.1%. The positive predictive value for colposcopic impression of CIN2+ was affected by hrHPV genotype (57.3% for HPV16 versus 32.1% for nonHPV16). The adjunctive use of electrical impedance spectroscopy detected an extra 42 cases of CIN2+, which was irrespective of hrHPV genotype.Conclusions: Primary hrHPV cervical screening increases detection of CIN2+; however, low specificity results in more women being referred to colposcopy with a low prevalence of CIN2+. Colposcopy performs poorly in some groups, particularly with HPVO infections and women over 50 years of age. An appropriate threshold for referral to colposcopy in primary hrHPV screening has not been established.Tweetable Abstract: Low prevalence of CIN2+ in HPV-positive negative cytology samples. HPV genotype, age and prevalence of CIN2+ affect colposcopic performance. [ABSTRACT FROM AUTHOR]

Objective: To investigate the demographics, natural history and treatment outcomes of non-molar gestational choriocarcinoma.Design: A retrospective national population-based study.Setting: UK 1995-2015.Population: A total of 234 women with a diagnosis of gestational choriocarcinoma, in the absence of a prior molar pregnancy, managed at the UKs two gestational trophoblast centres in London and Sheffield.Methods: Retrospective review of the patient's demographic and clinical data. Comparison with contemporary UK birth and pregnancy statistics.Main Outcomes: Incidence statistics for non-molar choriocarcinoma across the maternal age groups. Cure rates for patients by FIGO prognostic score group.Results: Over the 21-year study period, there were 234 cases of non-molar gestational choriocarcinoma, giving an incidence of 1:66 775 relative to live births and 1:84 226 to viable pregnancies. For women aged under 20, the incidence relative to viable pregnancies was 1:223 494, for ages 30-34, 1:80 227, and for ages 40-45, 1:41 718. Treatment outcomes indicated an overall 94.4% cure rate. Divided by FIGO prognostic groups, the cure rates were low-risk group 100%, high-risk group 96% and ultra-high-risk group 80.5%.Conclusions: Non-molar gestational choriocarcinoma is a very rare diagnosis with little prior detailed information on the demographics and natural history. The data in this study give age-related incidence data based on a large national population study. The results also demonstrated the widely varying natural history of this rare malignancy and the marked correlation of disease incidence with rising maternal age.Tweetable Abstract: National gestational choriocarcinoma database indicates a close association between increasing maternal age and incidence. [ABSTRACT FROM AUTHOR]

Introduction: Primary HPV screening will be implemented into the English Cervical Screening Programme by 2019. Its impact upon women referred to colposcopy, with negative cytology but persistently positive high‐risk HPV (hrHPV), remains unreported from UK Sentinel sites. HPV primary screening was introduced in Sheffield, UK in April 2013; this paper reports its impact on the service. Methods: A retrospective cohort study was performed from June 2014 to July 2016 at the Jessop Wing Colposcopy Unit, Sheffield. UK. Data were obtained from the pathology and colposcopy databases and cross‐referenced with case‐notes and pathology results for women referred with persistently positive hrHPV, cytology negative samples. Patient demographics, hrHPV genotype, biopsy rates, histological diagnoses, management, and outcomes were collected and baseline statistics performed. Results: During the study 1076 women were seen. Most frequent hrHPV genotypes were: hrHPV other, 41%; and HPV16, 33%. The majority (72%) were found to have normal colposcopy; 28% had an abnormal colposcopic assessment (11% low‐grade; 11% high‐grade; 6% inadequate). The majority were discharged (83%) and only 5% underwent LLETZ. No cancers were detected. High‐grade cervical intraepithelial neoplasia (CIN) was found in 7%; overall risk of CIN2 was 1/29; 1/30 for CIN3. Presence of HPV16 was associated with a significantly higher risk of high‐grade CIN; 1/9. Conclusion: This is the first study to report results for women referred to colposcopy with cytology negative, persistently positive hrHPV. Disease prevalence is low, although women with HPV16 have a significantly higher likelihood of high‐grade disease compared to other HPV subtypes. [ABSTRACT FROM AUTHOR]

Purpose of investigation: To evaluate if colposcopy and electrical impedance spectroscopy (EIS) are complementary and hence increase the detection of high-grade cervical intraepithelial neoplasia (HG-CIN). Materials and Methods:A cohort of 1,237 women with an abnormal cervical cytology result referred to a single colposcopy service to assess the value of EIS as an adjunct to colposcopy for the detection of HG-CIN. Results: Fifty-three (12.8%) extra cases of HG-CIN were detected by a combination of colposcopy and EIS (466 vs. 413). Ten cases were referred with high-grade cytology and 43 were associated with low-grade cytology. The increased detection of HG-CIN in women referred with low-grade cytology was 50% (129 vs. 86). The combination of colposcopy and EIS produced a highly significant improvement in the detection of HG-CIN. Conclusions: Comparison of the performance metrics with a previous multi-centre trial shows that use of EIS as an adjunct increases performance over that obtained from colposcopy alone. The largest improvement is in increased sensitivity and NPV when used to detect HG-CIN, particularly in women referred with low-grade cytology. [ABSTRACT FROM AUTHOR]

Background The Jessop Wing Colposcopy Unit identified that between 1st April 2014 and 31st March 2015 the number of women referred with high-grade dyskaryosis and the number of women undergoing treatment increased by 21% and 19%, respectively. There was concern that referral and treatment rates were increasing because we were now seeing women, previously discharged to routine recall with prior low-grade cytology hr HPV positive, re-enter the system for their second round of screening. The aim of this study was to assess the reasons for our significant increase in referral and treatment rates. Methods A retrospective cohort study performed between 1st April 2012 and 30th June 2015 at the Jessop Wing Colposcopy Unit, Sheffield, UK. Results During the study period, 1765 women underwent large loop excision of the transformation zone (LLETZ), of whom 1517 were referred with high-grade dyskaryosis. Fifty-six (4%) women undergoing treatment; and four untreated high-grade referrals were seen in the previous 3-5 years with low-grade cytology hr HPV positive and discharged to routine recall. There were no cases of invasive disease in the previously discharged groups. There was, however, a significantly higher likelihood of a negative LLETZ ( P=.0066) in those women previously discharged to routine recall, and lower rates of CIN2 or worse identified. Conclusion Prior discharge to routine recall does not have any major influence on treatment rates or high-grade referrals. The finding of no invasive disease; lower rates of CIN2 or worse; and a significantly higher likelihood of a negative LLETZ in those women previously discharged to routine recall is reassuring and further reinforces the safety of HPV triage pathways. [ABSTRACT FROM AUTHOR]

Objective This study looks at the importance of large loop excision of the transformation zone ( LLETZ) excision margins and residual cervical intraepithelial neoplasia ( CIN) in women undertaking high-risk human papillomavirus (hr HPV) test of cure ( TOC). Methods A retrospective cohort study with interval analysis performed June 2007 and June 2012 on all women undertaking treatment for CIN and subsequent hr HPV TOC 6 months post LLETZ. Results Final analysis group comprised 2093 women treated by LLETZ (1396 completely excised; 697 incompletely excised). 298 out of 1794 women (13%) were hr HPV positive at TOC. Thirty-six women who failed TOC and attended colposcopy had residual CIN. No statistically significant difference existed between the completely and incompletely excised groups with regards to the detection of residual CIN at 6 months post-treatment. There was no correlation of margins of excision with hr HPV status at TOC. The overall cure rate at TOC was 98%. Conclusions TOC pathways recommend subsequent follow-up in primary care. This study identified no safety issues with TOC pathways. We can no longer assess histological failure rates at 12 months; we, therefore, recommend that this measure of treatment failure be redefined for post TOC women. It seems time to question the benefits of routine excision margins reporting, in the absence of invasion, for treated CIN. Future reporting needs to be reconsidered by the Royal College of Pathologists. [ABSTRACT FROM AUTHOR]

Objective: To determine the outcome of women with persistently raised but falling human chorionic gonadotrophin (hCG) levels 6 months after surgical evacuation of a molar pregnancy.Design: An 11-year retrospective review.Setting: The United Kingdom supra-regional trophoblastic disease treatment centres at Weston Park Hospital (Sheffield) and Charing Cross Hospital (London).Population: Women with raised but falling serum human chorionic gonadotrophin (hCG) levels 6 months after evacuation of a molar pregnancy.Methods: Retrospective case note review of eligible women identified by the electronic databases held at each supra-regional centre.Main Outcome Measures: The proportion of women that attain normal hCG levels spontaneously without chemotherapy. In addition, rates of gestational trophoblastic neoplasia (GTN), drug resistance, disease relapse and overall survival are reported.Results: Thirty-five women with molar pregnancy and raised but falling serum hCG levels continued surveillance 6 months after evacuation. Levels of hCG in 30 of the patients (86%) fell to normal levels spontaneously. One woman defaulted follow up prior to hCG normalisation (3%) and the remaining four women (11%) were treated with chemotherapy due to a plateau or rise in serum hCG levels indicating GTN. All treated women were successfully salvaged by either first (n = 1) or second line (n = 2) chemotherapy or found to have persistently raised low level hCG of uncertain clinical relevance (n = 1). No women developed relapsed disease and overall survival was 100%.Conclusions: Women with a molar pregnancy and a raised but falling hCG level beyond 6 months from uterine evacuation can be safely observed with regular hCG monitoring and can usually avoid potentially toxic chemotherapy.Tweetable Abstract: Women with treated molar pregnancy may avoid chemotherapy if 6-month hCG levels are raised but falling. [ABSTRACT FROM AUTHOR]

This national audit assessed whether UK specialist vulval clinics adhere to the British Society of Vulval Diseases (BSSVD) document ‘Standards of care for women with vulval conditions’ published in 2013 and benchmarked clinician attitudes towards nurse practitioners in vulval services. Audit standards were based on the BSSVD guidance. All BSSVD and British Society for Colposcopy and Cervical Pathology or BSCCP members were surveyed via two electronic questionnaires. Results demonstrate that the majority of specialist vulval clinics in the UK are non-compliant with the standards set out for specialist vulval services. The majority of clinicians would support the introduction of clinical nurse specialists to vulval services, but there is need for development of a national training programme. In conclusion, significant improvements are required in provision of patient information, guidelines, access to multidisciplinary services, multidisciplinary team or MDT processes and data recording in UK specialist vulval services. [ABSTRACT FROM PUBLISHER]

Objective: When the Sheffield screening laboratory changed the high-risk human papillomavirus (hrHPV) platforms from hybrid capture 2® (HC2; Digene Ltd) and to cobas 4800® (Roche) an unexpected and substantial increase in the number of cytology-negative/hrHPV-positive test-of-cure (ToC) samples after large loop excision of the transformation zone (LLETZ) was noted. We explore the potential reasons for these increased rates and discuss the implications this may have on the English NHS cervical screening programme (CSP). Methods: A retrospective cohort study with interval analysis between June 2007 and June 2012. Results: ToC was performed on 1530 women with HC2 and 396 with cobas 4800: 95.1% and 92.4% of women had negative cytology at ToC in the HC2 and cobas4800 testing period, respectively. Of these 13.9% and 27.8% tested positive for hrHPV in the HC2 and cobas 4800 group, respectively (P = <0.0001). No clinically significant increase in the number of cases of cervical intraepithelial neolpasia (CIN) was detected by the cobas4800 test in spite of doubling the number of cytology-negative/hrHPV-positive ToC samples. Conclusions: As far as we are aware, this is the first study reporting potential differences between different HPV platforms currently available in the English programme. The immediate impact of this increase in rates of hrHPV detection with cobas4800 is an increased number of colposcopy referrals to our service. The NHSCSP needs to assess whether this increase is acceptable and, if not, whether specific HPV platforms more suited to screening in a ToC scenario should be recommended. [ABSTRACT FROM AUTHOR]

Extramammary Paget's disease (EMPD) is a rare intraepidermal adenocarcinoma that can affect the vulval skin. Surgical excision is the gold-standard treatment, however, recurrence rates are high and extensive excisions can produce long-lasting cosmetic and functional defects. We describe one of the largest case series to-date (n = 6) on the use of topical 5% imiquimod cream as a novel treatment option and discuss our experiences. With the addition of our six cases to the literature, there are now 29 documented cases of vulval EMPD treated with 5% imiquimod cream. Of these, 50% of primary disease cases and 73% of recurrent primary disease cases have achieved clinical resolution with 5% imiquimod therapy alone. These findings suggest that imiquimod provides a viable alternative to surgical excision for vulval EMPD. However, we acknowledge that this is a simple retrospective analysis and that treatment scheduling and follow-up needs investigation in a trial setting. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Palmer J, Wales K, Ellis K, Dudding N, Smith J, Tidy J. The multidisciplinary colposcopy meeting: recommendations for future service provision and an analysis of clinical decision making. BJOG 2010;117:1060–1066. Objective In 2004 the NHS Cervical Screening Programme (NHSCSP) recommended that multidisciplinary meetings should be incorporated into patient management. No data has been provided since then regarding its functionality or benefits. We aim to address this issue. Design Retrospective review. Setting Jessop Wing colposcopy multidisciplinary meeting (MDM), Sheffield, UK. Population All women referred to the MDM from September 2003 to September 2009. Methods Retrospective review of the colposcopy database (Sept 2003–Sept 2009), cross-referenced with multidisciplinary team (MDT) letters, patient notes and the hospital results reporting system. Baseline statistics were used for data analysis. Main outcome measures Indications for MDT referral; concordance rates from cytopathology and histopathology review; concordance rates between MDT treatment decisions and final patient management. Results A total of 535 cases were discussed at 62 MDT meetings during the allocated study period. Discrepancy between referral cytology and cervix punch biopsy was the most common referral (49%). Cytology and histology review concurred with the initial reports in 75.8 and 97.8% of cases, respectively; the MDT decision was concordant with the final patient management in 97% of cases. The main reason for discordance (67%) resulted from patient factors. Conclusions When significant discrepancies exist between colposcopy, cytology and histopathology, then MDT discussion seems pertinent as MDT discussion can lead to the avoidance of over-treatment. To improve timeliness of treatment, MDT meetings should occur at least monthly. The results of each case discussion should be recorded in the patient case notes, the minutes of each meeting should be circulated to all MDT members and a letter describing MDT recommendations must be sent to the colposcopist responsible for patient care. [ABSTRACT FROM AUTHOR]

Maternal epithelial ovarian cancer (EOC) is rare, and consequently, management strategies remain unclear due to the low incidence and paucity of reported data. Management depends on gestation, disease stage, future fertility desires, and the mother’s wishes to continue pregnancy. Forty-one cases of maternal EOC were identified in the literature. Reporting of clinicopathological variables, treatment regimens, and follow up varied markedly. There are currently no definitive guidelines regarding the management of maternal EOC. Case reporting should contain detailed information on clinicopathological variables, treatment regimens, and maternal and neonatal outcomes. Data centralisation may be beneficial in identifying optimal management strategies in these rare tumours. [ABSTRACT FROM AUTHOR]

A prospective postal questionnaire study aimed to identify variables that predict a woman’s intention to attend and her subsequent attendance/default at colposcopy clinics. One thousand two hundred and fifty-eight women attending colposcopy clinics of a university hospital were sent a postal questionnaire 3 weeks before their second appointment at colposcopy. An intention to attend the colposcopy clinic was the most significant predictor for colposcopy attendance during the next 15 months. Smoking and a longer travel time were associated with default. Our study shows that while interventions tried by service providers can reduce default rates, there will remain a cohort of women who do not fully participate in the screening programme. [ABSTRACT FROM AUTHOR]

Objective To compare women’s experiences of either see and treat (ST) or defer and treat (DT) at first visit to colposcopy following abnormal cytology. Design A prospective postal questionnaire survey. Setting Colposcopy clinics of a University Hospital. Sample A total of 272 women with high-grade cervical intraepithelial neoplasia (CIN) referred to colposcopy. Methods A total of 136 women receiving ST and a matched sample of women receiving DT ( N= 136) were sent a postal questionnaire 7 days after first appointment at colposcopy to assess evaluations of their experience, psychological distress and relief. Subsequent appointment keeping was extracted from medical records. Main outcome measures Anxiety and subsequent behaviour. Results Women undergoing ST were significantly less anxious and more relieved than those undergoing DT. They also evaluated their first appointment as more motivationally congruent. While women undergoing ST were less likely than DTs to keep their second appointment, there was no overall difference in did not attend (DNA) rates at 15-month follow up. Conclusions ST is psychologically beneficial and may be preferred by women with CIN2/3. [ABSTRACT FROM AUTHOR]

Surgery for ovarian cancer carries a risk of bowel resection to either achieve optimal debulking or relieve obstruction. This prospective study assessed the likelihood of bowel resection in 842 women undergoing surgery for ovarian cancer and identified factors associated with increased risk. Bowel resection was performed in 8.6% of women. The likelihood of bowel resection increased significantly ( p 2 test) with: Secondary surgery (22% vs 5.8% at primary surgery).Symptoms of bowel disturbance (21.9% vs 6.3% if no symptoms).FIGO stage III/IV disease (12.8% vs 2% in stage I/II).CA125 levels ≥2500 (12.9% vs 4.8% if CA125 [ABSTRACT FROM AUTHOR]

In common with other E2F1 responsive genes such as p14(ARF) and B-myb, the promoter of p73 is shown to be positively regulated in cell lines and primary human keratinocytes by E7 proteins from oncogenic human papillomavirus (HPV) types 16, 18, 31 and 33, but not HPV 6. Mutational analysis revealed that transactivation of the p73 promoter by HPV 16E7 requires association with pRb. Expression of p73 in normal cervical epithelium is confined to the basal and supra-basal layers. In contrast, expression in neoplastic lesions is detected throughout the epithelium and increases with grade of neoplasia, being maximal in squamous cell cancers (SCC). Deregulation of expression of the N-terminal splice variant p73Delta2 was observed in a significant proportion of cancers, but not in normal epithelium. The frequent over-expression of p73Delta2, which has recognized transdominant properties, in malignant and pre-malignant lesions suggests a role in the oncogenic process in cervical epithelium. [ABSTRACT FROM AUTHOR]

p73 was studied in squamous cancers and precursor lesions of the vulva. Over-expression of p73 occurred commonly in both human papillomavirus (HPV)-positive and -negative squamous cell cancers (SCC) and high-grade premalignant lesions. Whereas expression in normal vulval epithelium was detected only in the basal and supra-basal layers, expression in neoplastic epithelium increased with grade of neoplasia, being maximal at both protein and RNA levels in SCC. p73 Δ2 was the principal over-expressed isoform in the majority of cases of vulval SCC and often the sole form expressed in SCC. Over-expression of p73 was associated with expression of HPV-encoded E7 or with hypermethylation or mutation of p16[SUPINK4a] in HPV-negative cases. There was a close correlation between expression of p73 and p14[SUPARF] in cancers with loss of p53 function. The frequent over-expression of p73D2 in neoplastic but not normal vulval epithelium, and its co-ordinate deregulation with other E2F-1 responsive genes suggests a role in the oncogenic process. [ABSTRACT FROM AUTHOR]

Over-diagnosis of hydatidiform mole in early tubal ectopic pregnancy Aims: Tubal ectopic hydatidiform moles are rare lesions, and only 40 cases have been reported in the world literature. We investigated the apparently high incidence of tubal ectopic hydatidiform moles in women referred for treatment to a Supraregional Trophoblastic Tumour Screening and Treatment Centre between 1986 and 1996. Methods and results: Of 4261 women referred during the study period, 25 (0.6%) had a suspected tubal ectopic hydatidiform mole and paraffin-embedded tissue was available in 20 (80%) of these. Each case was reviewed by two pathologists and DNA flow cytometric analysis was undertaken when the histological diagnosis was initially deemed equivocal or suggestive of hydatidiform mole. On review, 17 cases (85%) showed no evidence of hydatidiform mole (circumferential trophoblastic proliferation, hydrops, scalloped villi, and stromal karyorrhexis). Of these, 11 cases (65%) showed features of early placentation and six (35%) showed hydropic abortion. DNA flow cytometry was performed in 14 (82%) of these cases and revealed a diploid population in each case. Three cases of molar pregnancy (15%) were identified. Each of these cases had the histological features of an early complete hydatidiform mole. Sufficient tissue was available for DNA flow cytometric analysis in two of these cases and confirmed the presence of diploidy in each. Conclusions: Our results show that tubal ectopic hydatidiform mole is a rare entity and demonstrate that it is over-diagnosed. Polar trophoblastic proliferation and hydropic villi are features of early placentation and of hydropic abortion. Sheets of extravillous trophoblast may be particularly prominent in tubal ectopic gestation. In the absence of circumferential trophoblastic proliferation combined with hydropic change a diagnosis of gestational trophoblastic disease should be avoided. [ABSTRACT FROM AUTHOR]

SummaryBackground: High-grade anal intraepithelial neoplasia (Bowen’s disease) may predispose to anal carcinoma. Treatment options include surgical resection but effectiveness remains uncertain. This paper reports long-term follow-up of patients with high-grade anal intraepithelial neoplasia treated by surgical resection. Methods: Between 1989 and 1996, 46 patients were identified with high-grade anal intraepithelial neoplasia. Thirty-four underwent local excision of all macroscopically abnormal disease and the resulting defect was left open, closed primarily or skin grafted. Regular follow-up subsequently included anoscopy and biopsy of any suspicious lesions. Results: Median follow-up was 41 (range 12–104) months. Total excision was difficult; 19 patients had histological evidence of incomplete excision at the time of initial resection. Some 12 of 19 had histo-logically proven recurrent high-grade intraepithelial neoplasia within 1 year. Even with microscopically complete excision two of 15 patients subsequently developed recurrent high-grade intraepithelial neoplasia at 6 and 32 months after operation. No patient developed carcinoma but five had complica-tions of anal stenosis or faecal incontinence. Conclusion: Although no definite recommendations can be made for the treatment of high-grade anal intraepithelial neoplasia, these results illustrate some potential drawbacks of surgical excision with a high potential for incomplete excision and persistent disease, even after complete excision in some patients, and a high morbidity rate. Presented to the Association of Coloproctologists, St Helier, Jersey 1998. [ABSTRACT FROM AUTHOR]

Two neighbouring centres, both located in an area where the prevalence of neural tube defects (NTDs) is low, were compared to determine if there was any advantage in their differing policies as regards the antenatal detection of NTDs. At both centres routine ultrasound examinations were performed at 16-18 weeks gestation but at Hospital A serum alpha-fetoprotein (AFP) was measured at 16 weeks gestation. The prevalence of NTDs was 1.3 per 1,000 births at Hospital A and 1.7 per 1,000 births at Hospital B. The detection of anencephaly at both hospitals was 100%, however, only 43% of spina bifidas were detected at Hospital A compared with 60% at Hospital B. These results, the loss of two fetuses following amniocentesis at Hospital A and the lower detection rate for NTDs at the hospital employing AFP measurement are discussed. [ABSTRACT FROM AUTHOR]

Infection with high risk human papillomavirus (HPV) is integral to the development of vaginal cancer, but what remains unclear is the proportion of women who develop vaginal cancer de novo or as a complication of inadequate treatment of cervical intraepithelial neoplasia (CIN). Incomplete excision of CIN at the time of hysterectomy results in persistence of intra-epithelial neoplasia at the vault of the vagina, known as VaIN. Women with prevalent CIN will include women who have failed previous repeated local excisions or have had multiple previous successful treatments, but for whom hysterectomy may be the only remaining treatment option. [Extracted from the article]

Women with vulval intraepithelial neoplasia (VIN), lichen sclerosus (LS) and Paget's disease are referred either to gynaecologists or to dermatologists. We have ascertained the caseloads, referral patterns and treatment modalities used in the two specialties. A postal questionnaire was sent to 540 consultant gynaecologists and 225 consultant and senior registrar members of the British Association of Dermatologists. 350 gynaecologists and 161 dermatologists returned completed questionnaires. The workload of LS and Paget's disease was evenly distributed, with 54% of dermatologists and 58% of gynaecologists seeing more than six cases of LS per annum and less than I% seeing more than five cases of Paget's disease. 92% of responding gynaecologists saw at least one case of VIN per year whereas 43% of dermatologists saw no cases. Patients with VIN and Paget's were referred to gynaecologists for treatment by 66% of dermatologists. Both groups are equally prepared to treat LS. Indications for treatment of VIN and LS were suspicion of invasion and symptoms. Local excision of VIN is the treatment of choice by both gynaecologists and dermatologists. LS is predominantly treated with topical steroids but gynaecologists also use topical oestrogen and testosterone. The great majority of responders favoured establishing a national register to study the outcome of vulval lesions. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Anaesthetic choice in the colposcopy clinic: a retrospective analysis of routinely collected data," by D. R. Swancutt and colleagues in a previous issue.

Vaginal anaerobic infection is the most common cause of vaginal discharge in women. We present a case of recurrent vaginal anaerobic infection and cervical carcinoma and discuss the association of the two conditions. More frequent cytology/colposcopy may be indicated in women who give a history of recurrent or persistent vaginal anaerobic infection. [ABSTRACT FROM PUBLISHER]

The article presents abstract on the comparative study on the cervix of pregnant and non-pregnant women through electrical impedance. The preliminary study manifests the ability of the electrical impedance to segregate the pregnant and non-pregnant cervix. The difference seen in pregnancy showed the reduction in resistivity which could be accounted for by the rise in tissue hydration, recognized as a feature of the ripening process which precedes delivery.