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Qi Zhou,* Feifei Zhang,* Long Sui, Hongwei Zhang, Lin Lin, Yanyun Li Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yanyun Li Tel +86 21 33189900Fax +86 21 63450944Email liyanyun@fudan.edu.cnPurpose: To evaluate the colposcopic accuracy of the detection of vaginal intraepithelial neoplasia (VaIN) according to the colposcopic terminology for the vagina from the 2011 International Federation of Cervical Pathology and Colposcopy (IFCPC).Methods: A total of 467 women who were suspected of having VaIN and underwent colposcopy at Obstetrics and Gynecology Hospital of Fudan University from January to December 2018 were included in this retrospective cohort study. The 2011 IFCPC revised terminology for the vagina was applied, and the agreement between colposcopic diagnosis and vaginal biopsy pathology was analysed.Results: Agreement between colposcopy and pathology was 69.16% (kappa=0.437, p< 0.001), with 23.34% overestimated and 7.49% underestimated diagnosis for colposcopy. The agreement was the lowest (35.71%) in the high-grade VaIN group, which was significantly different from that of other lesion grade groups (p< 0.01). Among grade 1 findings, thin acetowhite epithelium was the most frequent (80.51%). Grade 2 findings and vascular patterns were rare. The positive predictive values of the micropapillary pattern were 55.98% for low-grade VaIN and 5.98% for high-grade VaIN. The specificity of iodine negativity was 10.92% for low-grade VaIN and 8.30% for high-grade VaIN. There were significant differences in the maximum size of single lesions and in the number of lesions among different grade lesion groups.Conclusion: The agreement between colposcopy findings utilizing the 2011 IFCPC terminology and vaginal pathology is moderate, and more definite findings for high-grade VaIN may be needed. The micropapillary pattern can be considered an alternative low-grade finding, while iodine staining is nonspecific for all lesions. Scattered and spotty lesions suggest low-grade VaIN, while large single lesions suggest high-grade VaIN.Keywords: colposcopy, vaginal intraepithelial neoplasia, VaIN, International Federation of Cervical Pathology and Colposcopy, IFCPC, terminology, cytology, human papillomavirus, HPV

Aim: To evaluate the accuracy of Pap smear and colposcopy as predictors of cervical histopathology in patients undergoing total hysterectomy for benign indications, and to determine the incidence of unexpected cervical pathology in these patients. Study Design: Prospective observational study Patients and Methods: One hundred women scheduled for total hysterectomy for benign indications were subjected to preoperative Pap smear and colposcopy, at Kasr Al-Ainy Hospital, Cairo University, Egypt, during the period from September 2017 to March 2018. Findings were compared with the histopathological results of the cervices of the hysterectomy specimens. Results: Out of 100 patients included in our study, 13 had an abnormal Pap smear and 44 had abnormal findings on colposcopy. Abnormal cervical pathology was found in 30 hysterectomy specimens. Pap smear had a sensitivity and specificity of 33.3% and 95.7%, respectively, while colposcopy had a sensitivity and specificity of 96.7% and 78.6%, respectively. The incidence of unexpected cervical pathology was 66.7% depending on the Pap alone, and 3.3% when depending on colposcopy.Conclusion: Pap smear has a good specificity, but a low sensitivity in predicting cervical histopathology. Meanwhile, colposcopy has a high sensitivity and a reasonable specificity in predicting the histopathology. Colposcopy has a higher sensitivity and specificity as a pathology predictor, when compared to Pap smear.

Background: In Greece the population-level impact of HPV vaccination is unknown due to lacking official registries. This study presents in a pragmatic frame the comparison of cervical pathology data between HPV-vaccinated and unvaccinated women referred for colposcopy. Materials and Methods: This is an observational prospective cohort study performed in 7 academic Obstetrics & Gynaecology departments across Greece between 2009-2019. Cases were women that had completed HPV vaccination before coitarche and were referred for colposcopy due to abnormal cytology. For each vaccinated woman an unvaccinated matched control was selected. Results: A total of 849 women who had been vaccinated before coitarche and 849 unvaccinated controls were recruited. The combination of cytological, colposcopic and molecular findings necessitated treatment in only a single case among vaccinated (0.1%) and in 8.4% among unvaccinated. Conclusion: Despite potential bias, this study’s message is clear: HPV vaccination at a proper age can markedly reduce development of severe cervical precancer and consequently, the need for treatments with their long-term related obstetrical morbidity.

Purpose: Standardization of colposcopic evaluation is important as it is observer dependent.The aim of the study was to compare the strength of association of colposcopic findings by International Federation of Colposcopy and Cervical Pathology (IFCPC) nomenclature and Swede score. Methods: In the prospective study, 150 women aged 30 to 60 years with abnormal screening results underwent colposcopy, the findings were evaluated using both IFCPC and Swede score and biopsy was taken from abnormal areas. Performances by both the methods were calculated taking biopsy as gold standard. Results: Nineteen ≥ CIN2 lesions were detected. The sensitivity, specificity, positive predictive value and negative predictive value for detecting ≥ CIN2 lesion by IFCPC scoring was 63.6%, 96.0%, 78.7%, 91.9%. Using Swede score, sensitivity, specificity, positive predictive value and negative predictive value at cut off of 8 were 42.4, 95%, 96.6% and 81.8% while at cut-off of 5, these were 96%, 88.3%,76.7% and 93.6%. The agreement between IFCPC major lesion and Swede score ≥ 8 for ≥ CIN2 was 0.626 (pConclusion: Swede score is an easier and more objective method for colposcopic evaluation and a score >8 can be applied to the screen and treat programme.

To access prevalence of repeated smears in routine health screening and comparison of its outcome with colposcopy, and HPV testing in early diagnosis of cervical neoplasia. Cross-sectional study. Cervical screening of 1200 healthy patients 21 years and above was carried out at health camp. Conventional Pap staining was done in all cases. Abnormal cases were subjected to further testing. The result of conventional Pap smear, repeat Pap smear, HPV test, and colposcopy was compared in repeated smears. Sensitivity specificity and area under curve (AUC) were calculated with 95% CI with standard histopathology. 31.08% (N = 373) cases were followed by a repeat Pap smear. Sensitivity for conventional Pap smear in detecting CIN was found to be 82.93% and specificity was 84.76%,while sensitivity and specificity for colposcopy were 99.8% and 96.19%, respectively. Sensitivity for HPV in detecting CIN was 48.94%. AUC for Pap was 0.851, 95% CI (0.783–0.905). AUC for colposcopy was 0.981, 95% CI (0.943–0.996). In a routine health camp, as many as 31.08% of cases were repeated. 12.4% of patient’s Pap was repeatedly abnormal which shows a high prevalence of undetected cervical pathology in population. Our study also shows colposcopy has more sensitivity and specificity in detecting CIN as compared to repeat Pap smear in cases of inflammatory reactive and ASCUS cases. HPV, however, has low sensitivity in comparison with both methods.

OBJECTIVE The aim of the study was to assess the applicability and safety of cervical cancer screening guidelines recommended by the American College of Obstetricians and Gynecologists (2016) and American Society for Colposcopy and Cervical Pathology (2019) for women with solid organ transplants (SOTs). MATERIALS AND METHODS We analyzed data previously abstracted through December 2015 for 971 women (18-60 y) who received their first SOT at Mayo Clinic (Rochester, MN) from January 17, 1995, through December 31, 2011. Inclusion criteria were initial benign findings on cervical cytology after SOT and at least 1 subsequent cytologic screening. RESULTS Of 415 women whose initial cytologic findings were benign, 310 met inclusion criteria. The cumulative incidence of abnormal cervical cytology among these 310 women was 4.3% (95% CI = 1.9%-6.7%) by 30 months and 11.2% (95% CI = 7.1%-15.4%) by 60 months after their initial benign results. Considering all women with SOT, 68.4% (284/415) had no documented abnormal cytologic findings within 60 months (26 had abnormality; 284 no abnormality; and 105 not assessed). In women with negative tests for human papillomavirus, high-grade squamous intraepithelial lesions were not documented on cytology with variable duration of follow-up. No cervical squamous cell carcinoma was identified. CONCLUSIONS Of women with initial benign cervical cytology after SOT, more than two thirds would have been eligible for extended-interval screening. Further study is needed, particularly regarding the role of high-risk human papillomavirus testing.

Background Colposcopy offers an accurate way to the diagnose of cervical precancerous lesions. However, the diagnostic accuracy of colposcopy is unsatisfied. This study was to evaluate colposcopic accuracy according to the 2011 International Federation of Cervical Pathology and Colposcopy (IFCPC) terminology. Methods A retrospective cohort study was performed in 1,838 patients who underwent colposcopy in Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University from October 2013 to April 2018. Using conization or cervical biopsy pathology as the gold standard, the agreement between colposcopic diagnosis and pathologic diagnosis was calculated, and correlations between variables were analyzed. Results As an authoritative and widely used terminology for colposcopy diagnosis, the 2011 IFCPC terminology has certain clinical practicality and diagnostic accuracy. However, some signs such as mosaic, punctation, sharp border, inner border sign and ridge sign had high specificity but unsatisfactory sensitivity, which limited the diagnostic value. Therefore, we discussed the Lugol’s staining, a very common sign in colposcopy, and analyzed the diagnostic significance of bright yellow staining in low-grade squamous intraepithelial lesion (LSIL) and mustard yellow staining in high-grade squamous intraepithelial lesion (HSIL). The results showed that mustard yellow may be a valuable indicator in the diagnosis of HSIL. Conclusion The 2011 IFCPC colposcope terminology has standardized interpretations of the colposcopic findings and improved the accuracy of colposcopy diagnosis. The aceto-white epithelium still has important diagnostic value; however, the value of a few signs is needed to be discussed and new signs are expected to be discovered. Although the significance of Lugol’s staining was diminishing, mustard yellow might be a valuable indicator for the diagnosis of HSIL.

Caracterizar las adolescentes con alteracion citologica que asistieron a confirmacion diagnostica en una institucion de salud. Estudio observacional analitico. La poblacion fueron todas las mujeres menores de 19 anos. La informacion se obtuvo de la base de datos de la institucion. Se analizaron variables relacionadas con el resultado de la citologia y de la biopsia. Se realizo analisis uni y bivariado, se calculo el OR con su intervalo de confianza (IC 95%) y nivel de significancia. Se realizaron calculos exploratorios de la concordancia. La lesion intraepitelial de bajo grado fue la mas frecuente con un 43.8%, la oportunidad en el acceso para la colposcopia tuvo una mediana de 47 dias. Los factores asociados con neoplasia intracervical de alto grado fueron: el regimen de afiliacion a salud p: 0.003 (OR 3.1 IC 1.39-7.0), la lesion intraepitelial de alto grado en la citologia p: 0.0004 (OR 7.66 IC 2.08-28.18) y el resultado de la colposcopia grado I con p: 0.02 (OR 6.33 IC 1.10-36.16) y grado II p

Objectives The history of the diagnosis and treatment of cervical precancer is fragmentary. Findings in the English-speaking and German-speaking areas vary considerably. We aim to describe the history of clinical advances in diagnosis and treatment of cervical precancer and identify areas where further work is required. Study design We conducted a search of PubMed and Google Scholar. Full article texts were reviewed. Reference lists were screened for additional articles and books. 9 basic articles in German and 13 basic articles in books were identified. Results The first images of the ectocervix were published by H. Lebert (1812–1879) in the middle of the nineteenth century. R. Meyer's (1864–1947) theory of erosions, which dominated cervical pathology in the nineteenth century, was later refuted in studies by C. A. Ruge (1846–1926) and J. Veit (1852–1917). In 1908 W. Schauenstein (1870–1943) recognized the step-by-step development of cervical cancer. H. Hinselmann (1884–1959) replaced the purely histopathological approach previously with the use of colposcopy. All conization methods applied today can be traced back to amputation of the ectocervix as first indicated by J. Marion Sims (1813–1883) in 1861. In 1928 M. N. Hyams was the first to describe an excision method that employed electrodiathermy. The method of cold knife conization is based on a publication by J.W. Scott from 1957. The final breakthrough to effective electrodiathermy was achieved with the publications of W. Prendiville. Conclusions This paper is a step toward a better understanding of what we think and do today based on past findings of colposcopists and gynecopathologists.

Central cord syndrome (CCS) represents a clinical phenomenon characterized by disproportionately greater motor impairment of the upper than of the lower extremities, bladder dysfunction. CSS is the most common form of incomplete traumatic spinal cord injury. The initial description of CSS was reported in 1887 secondary to cervical spinal trauma. However, recent literature describes a heterogenous injury patterns including high-energy and low-energy mechanisms and bimodal patient age distributions. Pathophysiology of clinical symptoms and neurological deficits often is affected by preexisting cervical spondylosis. Urgent clinical diagnosis is dependent on neurological examination and imaging studies. Treatment of CSS is dependent on injury mechanism and compressive lesions, neurological examination, preexisting cervical pathology, and patient-specific comorbidities. This article will review the current concepts in diagnosis, pathophysiology, and treatment of CSS with a highlighted case example.

Aims: The lesions at uterine cervix cannot be always established only with cytology. Thus, it is very important that cytological abnormality be subsequently correlated with biopsy for confirmation of cervical lesion. Thus it is to see histopathological findings of different types of cervical pathology in cervical biopsies.Methods: This is retrospective analysis of histology result of 1184 cervical biopsy specimens from 2011 to 2016.Results: Out of 1108 histologically adequate cervical specimens, benign cervical lesion formed the major part (44.76%)followed by cervical inflammatory lesion (27.43 %). Malignant and borderline cervical lesion constituted 14.35% and 13.44% respectively; 6.4% biopsy samples were inadequate to report.CIN I was common among borderline lesions followed by CIN III. The most common cervical malignancy was squamous cell type and mostly moderately differentiated.Conclusions:Benign cervical lesions were the most common cervical lesions followed by inflammatory conditions. Among borderline cervical lesions CIN I was commonly found followed by CIN III.

Introduction To test for colposcopic differences between CIN2+ and non CIN2+ lesions of the “major changes” of the RIO 2011 nomenclature of the International Federation of Cervical Pathology (IFCPC). Material and methods Retrospective cohort analysis of colposcopic examinations of patients with histologically confirmed CIN2+ (n = 99) and non CIN2+ (n = 102) lesions during a four years period. Main outcome measures: leukoplakia, coarse mosaic and punctuation, dense acetowhitening, sharp boarders, ridge sign, atypical vessels. Results Only coarse punctuation (P ≤ 0.001; OR 9.64; 95% CI 2.15–43.13), coarse mosaic (P ≤ 0.001; OR 4.00; 95% CI 1.83–8.73) and dense acetowhitening (P ≤ 0.05; OR 1.86; 95% CI 1.06–3.26) occurred more frequently in CIN2+ lesions which were confirmed as predictors by a regression analysis. Conclusions Only coarse punctuation and coarse mosaic followed by dense acetowhitening as part of the “major changes” of the IFCPC Rio 2011 nomenclature achieve predictive values for CIN2+ lesions and should be therefore emphasized in colposcopy.

The American Society for Colposcopy and Cervical Pathology (ASCCP) Colposcopy Standards recommendations address the role of and approach to colposcopy for cervical cancer prevention in the United States.The recommendations were developed by an expert working group appointed by ASCCP's Board of Directors. This article describes the rationale, evidence, and recommendations related to risk-based colposcopy practice.Women referred to colposcopy have a wide range of underlying precancer risk, which can be estimated by referral screening tests including cytology and human papillomavirus testing, in conjunction with the colposcopic impression. Multiple targeted biopsies, at least 2 and up to 4, are recommended to improve detection of prevalent precancers. At the lowest end of the risk spectrum, untargeted biopsies are not recommended, and women with a completely normal colposcopic impression can be observed. At the highest end of the risk spectrum, immediate treatment is an alternative to biopsy confirmation.Assessing the risk of cervical precancer at the colposcopy visit allows for modification of colposcopy procedures consistent with a woman's risk. Implementation of these recommendations is expected to lead to improved detection of cervical precancers at colposcopy, while providing more reassurance of negative colposcopy results.

The American Society for Colposcopy and Cervical Pathology (ASCCP) Colposcopy Standards recommendations address the role of colposcopy and directed biopsy for cervical cancer prevention in the United States (US). The recommendations were developed by an expert working group appointed by ASCCP's Board of Directors. An extensive literature review was conducted and supplemented by a systematic review and meta-analysis of unpublished data. In addition, a survey of practicing colposcopists was conducted to assess current colposcopy practice in the US. Recommendations were approved by the working group members, and the final revisions were made based on comments received from the public. The recommendations cover terminology, risk-based colposcopy, colposcopy procedures, and colposcopy adjuncts. The ASCCP Colposcopy Standards recommendations are an important step toward raising the standard of colposcopy services delivered to women in the US. Because cervical cancer screening programs are currently undergoing important changes that may affect colposcopy performance, updates to some of the current recommendations may be necessary in the future.

Introduction: Colposcopy is a tool to evaluate women with cervical pre-cancer and cancer. To interpret the colposcopic findings, various scoring systems are used but with inter observer variations. To improve the quality of colposcopy, International Federation of Cervical Pathology and Colposcopy (IFCPC) has introduced a colposcopic nomenclature in 2011. Colposcopic scoring helps to select patients who need treatment for cervical intraepithelial neoplasia. Aim of the Study: The study aimed to evaluate the agreement between colposcopic diagnosis with the modified IFCPC terminology and cervical pathology in patients with abnormal screening tests and to assess the utility of this colposcopic scoring system in low resource settings. Methodology: Patients with abnormal screening tests who underwent colposcopic assessment in the department of Gynaecological oncology were included in the study. Colposcopic scoring was done by the modified IFCPC nomenclature. The results were compared with cytology and the final histopathology. Results: 56 patients were included in the study. The colposcopic scoring when compared to histopathology showed agreement in 65.7% which indicated the agreement was substantial and was statistically significant (P = 0.0001). With cytology the colposcopic score showed agreement in 35.6% indicating a fair agreement and this was also statistically significant (P = 0.001). Conclusion: Colposcopic scoring by modified IFCPC 2011 criteria showed substantial agreement with cervical histopathology. Compared to traditional methods, 2011 international terminology of colposcopy could improve colposcopic accuracy.

Introduction/Background Cytological classification and management of abnormal smears remains a controversial issue, as various classification systems have been proposed over the years. Management of most abnormal smears is by colposcopic guided biopsies, while management of cervical intraepithelial lesions varies according to the degree. Correlation between cytology and colposcopy is very important for assessment of sampling technique, sensitivity and specificity of methods used for screening and diagnosis. Methodology 431 abnormal smears were included that were managed at the cervical pathology department between 2013–2017. The Bethesda and the CIN classification systems were used to classify the results. Results ASC-US with positive HPV DNA testing was 37.04%, LSIL 32.44%, ASC-H 17.67% and HSIL 12.83%. The ASC-US smears were 27.45% normal, 29.41% HPV infected, 27.45% CIN 1, 13.07% CIN 2, 01.96% CIN 3 and 0.65% cancer, while the LSIL smears were 20.14% normal, 08.95% HPV infected, 45.52% CIN 1, 20.89% CIN 2, 04.47% CIN 3. The ASC-H smears were normal in 15.06%, HPV infected 10.95%, CIN 1 26.02%, CIN 2 17.80%, CIN 3 28.76% and cancer 01.36%, while the HSIL smears were normal 09.43%, HPV infected 01.88%, CIN 1 15.09%, CIN 2 16.98%, CIN 3 50.94% and cancer 05.66%. Conclusion ASC-US and LSIL have a low risk of moderate-severe intraepithelial neoplasia or cancer (15.68% vs 25.39% respectively), therefore monitoring with repeat smear or using surrogate markers (HPV DNA methylation) may be of use in clinical management. ASC-H and HSIL have a high risk of moderate-severe intraepithelial neoplasia or cancer (47.97% vs 73.60% respectively), which indicates that excisional procedures (cone biopsy) are usually required. Disclosure Nothing to disclose

Objetivo: evaluar la concordancia interobservador por nivel de entrenamiento al aplicar la escala Swede utilizando imágenes digitales de colposcopias. Materiales y métodos: estudio de concordancia ensamblado en un estudio de corte transversal. Se incluyeron pacientes remitidas para colposcopia por resultado de citología anormal, en un centro de referencia de patología cervical de Bogotá, Colombia. Muestreo por conveniencia. Variables medidas: edad, grado de escolaridad, estado civil, factores de riesgo para cáncer de cérvix (paridad, edad de inicio de la vida sexual, número de contactos sexuales); método de planificación, reporte de la citología y resultado de la colposcopia de acuerdo con los criterios de la escala Swede. Se utilizó estadística descriptiva, la concordancia se calculó usando el estadístico kappa (k) ponderado. Resultados: el análisis se realizó con un set de 3 imágenes colposcópicas digitales de 251 pacientes. Para el puntaje total de la escala, dos ginecólogos expertos mostraron una concordancia baja (k = 0,38; IC 95 %: 0,26-0,44), una pareja de dos ginecólogos con diferente nivel de entrenamiento mostró una concordancia baja (k = 0,27; IC 95 %: 0,20-0,38) y el otro par mostró una concordancia moderada (k = 0,45; IC 95 %: 0,34-0,53). Para los criterios individuales de la escala Swede la mejor concordancia se dio para “reacción acetoblanca” y “tamaño de la lesión” (k = 0,43; IC 95 %: 0,33-0,53). Conclusiones: la concordancia interobservador utilizando la escala Swede en imágenes colposcópicas digitales varió de baja a moderada según el nivel de entrenamiento de los ginecólogos.

In 2009, the Cytopathology Education and Technology Consortium issued a statement on human papillomavirus (HPV) DNA test utilization that was published in multiple journals.1 This statement was a concise summary of the clinical indications for high-risk or oncogenic HPV testing based on guidelines from the American Society for Colposcopy and Cervical Pathology (ASCCP) and the American Cancer Society (ACS) published from 2002 through 2007.2,3 These organizations have since published newer consensus guidelines addressing HPV testing,4,5 and the previous summary no longer reflects current screening and management guidelines. High-risk HPV testing has proven utility in both cervical cancer screening and management. The 2012 screening guidelines endorsed by the ACS, ASCCP, and the American Society for Clinical Pathology state that combined cervical cytology and HPV testing is now the preferred strategy for women 30 years and older. The 2012 ASCCP guidelines for the management of abnormal cervical cancer screening tests and cancer precursors utilize cotesting extensively as both a sensitive and efficient way to manage and follow these women. Inappropriate or too-frequent screening, including HPV testing, can lead to increased costs without proven benefit and may also cause patient harm by overtreatment. The educational statement below is intended to improve adherence to current guidelines, thereby improving the health care of women. The American College of Obstetricians and Gynecologists affirms these recommendations and …

Objective to provide a practical tool for the evidenced-based management of adenocarcinoma in situ (AIS) of the uterine cervix, a challenging diagnosis encountered by colposcopists in their daily practice. Methods the proposed recommendations were drafted by the Italian Society of Colposcopy and Cervical Pathology (SICPCV) based on comprehensive reviews of previous guidelines, large uncontrolled studies, metanalysis, and sytematic reviews. The quality Level and the strength of the recommendations were graded and respectively expressed in Roman numbers (I–VI) and letters (A–E). Results Women with all subcategories of abnormal glandular cells and AIS on cervical citology should be offered colposcopy with endocervical sampling (Strength of recommendation: A). In women with cytological AIS and negative colposcopy or endocervical curettage, an excisional treatment under colposcopic guidance is recommended (Strength of recommendation: A). If immediate post-conization endocervical sampling is positive, further conization is indicated (Strength of recommendation: C). In women who desire to preserve fertility with positive cone margins, further conization should be performed (Strength of recommendation: B). If colposcopy is adequate, a cylindrical excision that includes the whole transformation zone and at least 1–1.5 cm of endocervix beyond the squamous-columnar junction should be performed (Strength of recommendation: B). If colposcopy is inadequate, it is recommended that conization includes the whole transformation zone with a depth of 20–25 mm (Strength of recommendation: B). Hysterectomy is the standard definitive treatment for AIS in women who do not wish to preserve fertility (Strength of recommendation: B). Conclusion the proposed recommendations should enable clinicians to correctly diagnose, treat and follow AIS patients, avoiding mismanagement.

Aim. Assessment of impact of probiotic lactobacilli complex on treatment efficiency and normalization of immune status in women with human papillomavirus infection (PVI).Methods. Total of 65 patients of reproductive age with cervical pathology and PVI were examined. «Provag» was included into the standard therapy as the source of probiotic lactobacilli complex. Immunological studies were conducted before and after the treatment. The phenotypic profile of peripheral blood lymphocytes was determined by means of flow cytometry. The concentration of immunoglobulin A, G and M in serum was determined by ELISA.Results. Decreased amounts of T- and NK-cells were observed in PVI patients on day 1. Regardless of treatment method, by day 30 the number of T-lymphocytes in the blood of women with PVI increases. Percentage of NK-cells remained below the normal values on day 30 in the group of patients who received traditional scheme of PVI treatment. Patients with PVI taking additionally probiotic lactobacilli complex showed an increase of NK-cells by the end of the treatment. On day 1 decrease of relative and absolute numbers of T-helper cells was detected. Regardless of the method of treatment by day 30 the number of T-helper cells increases to the reference level. IgM and IgG levels in peripheral blood of women with PVI were increased even on day 1. By the end of the observation period their concentration in patients with conventional treatment scheme remained increased. Patients receiving the standard therapy supplemented with «Provag» demonstrated the decrease of these classes of immunoglobulins to the reference level.Conclusion. As a result of treatment normalization of NK-cells and T-helpers numbers was observed whereas the IgG and IgM levels remained increased.

Relevance of the study of cervical pathology in pregnant women due not only to high frequency, the development of socially active women age and the ability to transition to the malignant form, but ineffective existing methods of diagnosis and treatment The objective : To investigate cytological, colposcopic features of cervical cancer in pregnant women with great interhenetyc interval. Patients and methods . We examined 81 women 40 women with great intergenetichnim intervals in the course of pregnancy, childbirth and the postpartum period – Group 1; 27 pregnant women who gave birth for the first time at the age of 30 years, 2-nd group, 14 pregnant women who have a break between the first and subsequent births was 3-5 years old – Group 3. The study of the cervix uteri of pregnant women with large intergenetic intervals in later stages performed by colposcopic and cytological methods. Statistical processing osuschstvlyali standard methods. Results. The data show elevated levels of precancerous cervical pathology in pregnant women with great interhenetyc intervals and in the age of pregnant women compared to young pregnant women in which the interval between births is small – 3–5 years. A small percentage difference precancerous lesions of the cervix, 22.5% – women in group 1 and 22.2% – women in group 2, but said that with increasing age probability themselves elimination papillomavirus is reduced accordingly increases the risk of precancer and cervical cancer. Conclusion . 1. The study showed that the problem of the status of the cervix in women with large intergenetic interval remains relevant and not studied until the end. 2. Pregnant women for the first time after 35 years and with more multiparous intergenetichnim interval must always be at the first visit to the antenatal clinic in addition to taking a Pap smear colposcopic spending review. 3. In case of LSIL and HSIL in this category of women – colposcopic and cytological control 1 every 3 months during pregnancy with mandatory HPV PCR WRC. Key words: cervical pathology, pregnancy, colposcopy, cytology.

The colposcopically directed punch biopsy has been an integral component of colposcopic practice. In light of the changing landscape of the cervical screening programme, a study was conducted to investigate the current practice of British Society of Colposcopy and Cervical Pathology-accredited colposcopists on technique and rationale for performing a punch biopsy.A web-based questionnaire survey was e-mailed to all British Society of Colposcopy and Cervical Pathology-accredited colposcopists. Questions included selection criteria for performing a punch biopsy, number of biopsies, and technique. Results were analyzed by specialty, experience, and workload.A total of 749 colposcopists responded, 50.2% of the 1,493 total. The respondents were obstetrician and gynecologists (42.9%), gynecologists/oncologists (33.6%), and nurse colposcopists (19.8%). Most colposcopists (78.3%) had more than 5-year colposcopy experience and saw in excess of 11 new cases (73.4%) of abnormal cervical cytology/month. Most colposcopists (56%) aimed to take 2 biopsies to diagnose cervical intraepithelial neoplasia, and very few (16.2%) reported routinely taking random biopsies from normal areas of cervix. Looking at the trends in management in the case scenarios, there was a lower threshold for performing punch biopsy before large loop excision of the transformation zone in younger (age,25 years) or nulliparous women versus older women (age,40 years; p.05). Colposcopists were more likely to take biopsies in women with low-grade cytology/colposcopic findings (71.2%, always or most of the times) as compared with high-grade cytology/colposcopic findings (40.3%, never or rarely).Colposcopically directed punch biopsy is routinely used by colposcopists; however, techniques, number of biopsies taken, and rationale for performing a biopsy vary greatly between colposcopists.

Cervical cancer is considered to be particularly amenable to prevention and highly treatable in its early stages. The real-time optoelectronic method of cervix examination seemed to be very promising in the detection of cervical squamous intraepithelial lesions and demonstrated relatively good efficacy. Although this method was introduced into clinics almost 10 years ago, it has not found its place in diagnostic schemes. At the moment, cytological smears and HPV detection with genotyping are still essential. TruScreen seems to be a slightly forgotten test. The aim of the study was to evaluate the efficacy and accuracy of TruScreen in detecting cervical pathology: CIN and cervical cancer confirmed with a histopathological diagnosis in comparison with other methods–cytology and colposcopy over four years of observations. The study was conducted on 130 women with abnormal Pap smear results. We can conclude that a real-time optoelectronic method like TruScreen can be useful as an effective initial cervical cancer screening in developing countries, possibly in combination with other methods. The combination of cytology and TruScreen examination may help clinicians to take decision about the next diagnostics steps (e.g. colposcopy) and contribute to better primary screening for cervical cancer.

Cervical cancer screening of women of appropriate age followed by treatment of the screen-detected abnormalities can significantly reduce the incidence of cervical cancer and also the mortality from the disease. Colposcopy is an important triage tool interposed between screening and histopathological diagnosis and treatment; therefore, a thorough knowledge of the procedure is essential for the providers. The characteristics of cervical intraepithelial neoplasia (CIN) on colposcopy depend on the grade of the lesion, and its diagnosis can be mastered by the providers with the help of the subject knowledge, clinical practice and self-evaluation by colposcopic-histopathological correlation. The key features that are evaluated during colposcopy are acetowhiteness, blood vessels, iodine staining, margin/surface of the lesion and lesion size. The International Federation of Cervical Pathology and Colposcopy (IFCPC) introduced a new system of nomenclature for colposcopy in the year 2011, in which the abnormal findings have been categorized as grade 1 or minor findings, grade 2 or major findings, suspected invasion and non-specific findings. The benign abnormalities have been grouped as miscellaneous findings. Describing the type of transformation zone and the final scoring of the abnormalities using the ‘Swede score’ has been made mandatory in the new nomenclature system.

As per the American Society for Colposcopy and Cervical Pathology guidelines, human papillomavirus (HPV) testing is currently used as part of cervical cancer screening and during colposcopy follow-up. The present project evaluated if the application of acetic acid (AA) impacts HPV test results. Methods We conducted a prospective nonrandomized interventional study. Participants referred for colposcopy were eligible if immunocompetent, older than 18 years, and not pregnant. Women in group A (controls) received 2 consecutive HPV tests without application of AA. Women in group B had a first HPV sample collected before the application of AA and a second sample collected 3 minutes after application of AA. Samples were tested for HPV DNA with Hybrid Capture 2 (HC2) according to the manufacturer's instructions. Results From October 17, 2012, to January 10, 2013, approximately 101 women were recruited in 2 colposcopy clinics. In each group, concordance was 98%, with only 1 participant having discordant results (testing negative on the first sample and positive on the second sample). We found no statistically significant difference in relative light units(RLUs) between groups (median of difference, - 0.02 vs -0.05 RLU; p = .93). Conclusions The results of this study suggest that acetic acid at concentrations of 3% to 5% and sequential cervical sampling do not modify the result of HPV testing by Hybrid Capture 2.

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.

Objective To compare the distribution of International Federation for Cervical Pathology and Colposcopy (IFCPC) transformation zone (TZ) types among women in different age groups referred to 8 colposcopy clinics. Materials and methods Between February 2012 and February 2013, we prospectively collected individual patient data from 8 clinics within the German Colposcopy Network (G-CONE). Data were analyzed using ODSdysplasie, software designed to allow continuous quality assessment in colposcopy clinics. The distribution of IFCPC-classified TZ was compared between different centers for the following age groups: younger than 30 years, between 30 and 50 years, and older than 50 years. Results Of 3,761 patients included in the analysis, 2,153 (57%) were classified as having type 2 TZ, 906 (24%) as type 1 TZ, and 702 (19%) as type 3 TZ. Type 3 TZ was the most commonly reported type in women older than 50 years (70%). We found that the relative distribution of type 3 TZ between age groups was similar in the participating colposcopy clinics. However, there was evidence of heterogeneous distribution of types 1 and 2 TZ between age groups in different clinics, ranging from 7.8% to 66.4% for type 1 TZ in women younger than 30 years and 28.9% to 78.1% for type 2 TZ in women 30 to 50 years old. Conclusions Although IFCPC type 3 TZ seems to be a reproducible finding, the distribution of types 1 and 2 TZ showed significant heterogeneity. A more precise anatomic distinction between types 1 and 2 TZ in the IFCPC terminology could improve reporting of colposcopy findings.

A formidable threat to the health of women, cervical carcinoma can be prevented in many cases with adequate screening. The current guidelines for cervical carcinoma screening were created as joint recommendations of the American Cancer Society (ACS), the American Society for Colposcopy and Cervical Pathology (ASCCP) and the American Society for Clinical Pathology (ASCP) in 2012, and later accepted and promoted by the American Congress of Obstetricians and Gynecologists (ACOG). The 2012 recommendations underscore the utility of molecular testing as an adjunct to cytology screening for certain women and provide guidance to clinicians based on different risk-benefit considerations for different ages. This manuscript will review screening techniques and current recommendations for cervical cancer screening and human papilloma virus (HPV) testing, as well as possible future screening strategies.

OBJECTIVES The American Society for Colposcopy and Cervical Pathology (ASCCP) Colposcopy Standards recommendations address the role of and approach to colposcopy and biopsy for cervical cancer prevention in the United States. The recommendations were developed by an expert working group appointed by ASCCP's Board of Directors. Working group 3 defined colposcopy procedure guidelines for minimum and comprehensive colposcopy practice and evaluated the use of colposcopy adjuncts. MATERIALS AND METHODS The working group performed a systematic literature review to identify best practices in colposcopy methodology and to evaluate the use of available colposcopy adjuncts. The literature provided little evidence to support specific elements of the procedure. The working group, therefore, implemented a national survey of current and recent ASCCP members to evaluate common elements of the colposcopy examination. The findings of this survey were modified by expert consensus from the ASCCP Colposcopy Standards Committee members to create guidelines for performing colposcopy. The draft recommendations were posted online for public comment and presented at an open session of the International Federation for Cervical Pathology and Colposcopy 2017 World Congress for further comment. All comments were considered in the development of final recommendations. RESULTS Minimum and comprehensive colposcopy practice guidelines were developed. These guidelines represent recommended practice in all parts of the examination including the following: precolposcopy evaluation, performing the procedure, documentation of findings, biopsy practice, and postprocedure follow-up. CONCLUSIONS These guidelines are intended to serve as a guide to standardize colposcopy across the United States.

ObjectivesThe American Society for Colposcopy and Cervical Pathology Colposcopy Standards address the role of and approach to colposcopy and biopsy for cervical cancer prevention in the United States. Working Group 1 was tasked with defining the role of colposcopy, describing benefits and potential harms, and developing an official terminology.MethodsA systematic literature review was performed. A national survey of American Society for Colposcopy and Cervical Pathology members provided input on current terminology use. The 2011 International Federation for Cervical Pathology and Colposcopy terminology was used as a template and modified to fit colposcopic practice in the United States. For areas without data, expert consensus guided the recommendation. Draft recommendations were posted online for public comment and presented at an open session of the 2017 International Federation for Cervical Pathology and Colposcopy World Congress for further comment. All comments were considered for the final version.ResultsColposcopy is used in the evaluation of abnormal or inconclusive cervical cancer screening tests. Colposcopy aids the identification of cervical precancers that can be treated, and it allows for conservative management of abnormalities unlikely to progress. The potential harms of colposcopy include pain, psychological distress, and adverse effects of the procedure. A comprehensive colposcopy examination should include documentation of cervix visibility, squamocolumnar junction visibility, presence of acetowhitening, presence of a lesion(s), lesion(s) visibility, size and location of lesions, vascular changes, other features of lesion(s), and colposcopic impression. Minimum criteria for reporting include squamocolumnar junction visibility, presence of acetowhitening, presence of a lesion(s), and colposcopic impression.ConclusionsA recommended terminology for use in US colposcopic practice was developed, with comprehensive and minimal criteria for reporting.

OBJECTIVES This study aimed to evaluate the incidence of anal dysplasia in women at high risk of developing those lesions and to assess the relationships between positive anal cytology and different risk factors. MATERIALS AND METHODS We performed an observational cross-sectional study involving a patient survey and chart review. The study was conducted at the cervical pathology unit at the Hospital Universitario 12 de Octubre, Madrid, Spain, from 2011 to 2015. Patients were 215 women aged 18 to 65 years old with risk factors for anal dysplasia, for whom anal evaluation was indicated. Anal cytology was performed in all patients. High-resolution anoscopy and anal biopsy were used to investigate abnormalities. All patients completed a survey regarding sexual practices. The patients' demographic and clinical data were collected by using a retrospective chart review. The main outcome measure was the incidence of anal dysplasia in this population. RESULTS Of the 215 patients, 45 (21.0%) presented with cytological abnormalities (atypical squamous cells of undetermined significance, 13.5%; low-grade squamous intraepithelial lesion, 5.6%; high-grade squamous intraepithelial lesion, 1.9%). Anoscopy was performed in 31 patients (14.4%) and 2 patients (0.9%) had abnormal findings. One case (0.5%) of low-grade anal intraepithelial neoplasia was identified. Only immunosuppression (p = .01) and smoking status (p = .02) were significantly correlated with positive anal cytology results. Limitations of the study include the small single-center sample, a lack of controls, the retrospective design, potential survey response biases, and the nonstandardized survey. CONCLUSIONS The incidence of abnormal cytological findings was 21.0%, whereas low-grade anal intraepithelial was confirmed in 0.5% of the patients. There is a higher incidence of cytological abnormalities among immunosuppressed women and smokers.

Quality assurance and research in colposcopy and cervical pathology require standardized terminologies and reporting. However, clinical and histologic definitions of the cervical transformation zone (TZ) and squamocolumnar junction (SCJ) vary considerably. We aimed to identify areas of agreement and areas where work is required to standardize the definitions of the TZ and the SCJ. We conducted a survey among the board members of the European Federation of Colposcopy member societies and members of the International Society of Gynecological Pathologists. Overall, 22 expert colposcopists and 34 gynecologic pathologists responded. There was broad agreement that the TZ is the area where squamous metaplasia has occurred. There was consensus that the original SCJ can appear colposcopically indistinct in cases of maturation of the metaplastic squamous epithelium but can be identified histologically by the presence of the so-called last cervical gland. It was agreed that the border between the metaplastic squamous epithelium and the columnar epithelium on the surface of the cervix is called the new SCJ. Areas where work is required include the questions as to whether the cervical crypts lined by columnar epithelium in the field of squamous metaplasia are an integral part of the TZ or not and whether the individual microscopic borders between the metaplastic squamous epithelium of glandular crypts and the residual columnar epithelium of glandular crypts should be considered as part of the new SCJ or not. This paper is a step in an attempt to standardize colposcopic and histologic definitions among colposcopists and pathologists.

Over the past five decades, the Pap smear for cervical cancer screening has become standard of care across the United States and other countries, and its implementation in the routine gynecologic examination has dramatically reduced the rates of invasive cervical cancer. As we have come to understand the nuances of this routine screening and are increasingly better able to identify precancerous cervical lesions, we have also developed improved screening and treatment modalities. This progress has led to ever-changing diagnostic and management guidelines. Over the last several years, the American Society for Colposcopy and Cervical Pathology (ASCCP) has revised its guidelines for cervical cancer screening and issued new recommendations for treatment and management of cervical dysplasia. In addition, investigators across the world are exploring improved methods of screening, treatment, and identification of precancerous cervical lesions. Such methods include optimizing HPV testing, genotyping HPV and identifying associations with cervical dysplasia, and optimizing the timing and efficacy of treatment. This article will review and critically evaluate the literature published within the past year with regard to the diagnosis and management of precancerous cervical lesions.

Background/Aims: To assess the performance of colposcopists and correlate it with their experience when diagnosing cervical pathology by reviewing conventional colposcopy (CC) digital images and the Dynamic Spectral Imaging System (DySIS) cervical map. Methods: Images from 50 women with normal and abnormal cervix collected during CC and the corresponding DySIS maps were projected consecutively to 63 participating colposcopists. Participants were asked for their diagnosis (normal, abnormal findings or cancer). The clinical experience of the participants was divided into low (n = 27), medium (n = 18) and high (n = 18), considering the number of colposcopies each one performed routinely. Results: The mean of overall correct diagnoses was significantly higher with DySIS than CC for the low and medium experience group (20.4 vs. 24.4, and 21.9 vs. 26.0, respectively; p < 0.001), but not in the high experience group. The correct diagnosis was significantly higher with DySIS than CC for all experience groups in cases with a normal cervix and cervical intraepithelial neoplasia 2+ (CIN2+), but not for those with CIN1. All groups agreed that DySIS guides biopsies better, offers more information and allows performing colposcopy even without extensive experience. Conclusions: The results of evaluating projected colposcopy images were more successful with DySIS than with CC in the diagnosis of cervical pathology, especially among less experienced colposcopists.

The purpose of this article is to review the diagnostic possibilities of 5-aminolevulinic acid (5-ALA)-based fluorescence diagnosis of preinvasive cervical changes. Reviewed papers were selected from the PubMed database with keywords combining the terms individual cervical neoplasia and fluorescence diagnostics. The regular colposcopy procedure lacks specificity; therefore, new methods are continually sought for superior diagnosis of cervical pathology. 5-ALA-based fluorescence diagnostics is under investigation as an up-to-date diagnostic technique for cervical intraepithelial neoplasia (CIN). This method is grounded on the topical or systemic application of 5-ALA, which induces excess production of the endogenous photosensitizer protoporphyrin IX (PpIX) in tissues where carcinogenesis has begun. The conversion of PpIX to the heme is less efficient in tumors; therefore, higher amounts of PpIX tend to accumulate in premalignant and malignant tissues. Illumination with light of the appropriate wavelength initiates excitation of PpIX fluorescence, which in turn helps to localize PpIX-rich areas and identify potentially malignant tissues. A number of investigations suggest that because of its high selectivity for tumors and low toxicity to healthy tissues, 5-ALA-based diagnosis seems a promising tool for the noninvasive identification of cervical intraepithelial neoplasia.

This statement from the Cytopathology Education and Technology Consortium summarizes appropriate and inappropriate uses of human papillomavirus testing in cervical cancer screening based on guidelines from the American Society for Colposcopy and Cervical Pathology and the American Cancer Society. © 2014 S. Karger AG, Basel.

In July 2012 a revised terminology on colposcopic examinations of the cervix uteri was adopted by IFCPC. Central aspect is a description of characteristics that should aid in the definition of the disease entity cervix uteri. The nomenclature is built up in such a way that the examiner can evaluate colposcopic criteria according to a specific scheme. Firstly it is assessed whether the colposcopy is representative. Then it should be clarified whether or not the findings are normal. If the findings are not normal but rather abnormal the severity of the lesion is classified according to the so-called grade 1 (minor change) and grade 2 findings (major change). Specific abnormal findings such as leukoplakia, erosion and Lugol's finding are also not defined at this point. Characteristics suspicious for an invasion are described separately, in particular, atypical vessel patterns are mentioned here. As already held in the previous revised nomenclature (Barcelona), various findings are described in a last group: congenital transformation zones (CTZ), congenital anomalies, condylomas (papillomas), endometriosis, polyps (ectocervical, endocervical), inflammation, stenosis, postoperative changes (scarred portio, vaginal stump).Im Juli 2012 wurde eine überarbeitete Nomenklatur zur kolposkopischen Untersuchung der Cervix uteri durch die IFCPC verabschiedet. Im Mittelpunkt steht die Beschreibung von Merkmalen, die helfen sollen, Krankheitsbilder an der Cervix uteri zu definieren. Die Nomenklatur ist so aufgebaut, dass der Untersucher nach einem bestimmten Schema kolposkopische Kriterien beurteilt. Zunächst wird geprüft, ob die Kolposkopie repräsentativ ist. Dann soll geklärt werden, ob ein Normalbefund vorliegt. Liegen keine Normalbefunde, sondern abnorme Befunde vor, wird die Schwere der Läsion in sog. Grad-1- (minor change) und Grad-2-Befunde (major change) festgelegt. Es werden auch nicht spezifische abnorme Befunde – die Leukoplakie, die Erosion und die Lugol-Probe – definiert. Gesondert werden Merkmale beschrieben, die verdächtig auf eine Invasion sind, insbesondere wird hier auf die atypischen Gefäßmuster hingewiesen. Wie schon in der letzten überarbeiteten Nomenklatur (Barcelona) werden in einer letzten Gruppe verschiedene Befunde beschrieben: kongenitale Transformationszone (KTZ), kongenitale Anomalie, Kondylome (Papillome), Endometriose, Polypen (ektozervikal, endozervikal) Entzündung, Stenose, postoperative Veränderung (vernarbte Portio, Scheidenblindsack).

This article describes the current nomenclature of colposcopic findings in the lower genital tract as defined by the International Federation for Cervical Pathology and Colposcopy (IFCPC) and agreed at their Triennial General Meeting in July 2012 in Rio de Janeiro. It builds on previous nomenclature published by the IFCPC over the last two decades and introduces for the first time the concept of transformation zone excision types. Vulval and vaginal colposcopic terminology is described.

As the newest colposcopic terminology, the 2011 International Federation for Cervical Pathology and Colposcopy (IFCPC) classification provides standardized interpretation of colposcopic findings. In this study, we analyzed the colposcopic accuracy and the significance of individual findings according to the 2011 IFCPC classification in 525 patients, reviewed by 13 trained colposcopists. Results show that colposcopic diagnoses are in 64.95% perfect agreement with cervical pathology, with 63.64% sensitivity and 96.01% specificity for high-grade squamous intraepithelial lesion (HSIL+). And the accuracy is reproducible across different experienced examiners. Many individual findings, especially the two new signs, inner border sign and ridge sign, are proved to have good predictive accuracy, while iodine negativity demonstrates an inferior performance. However, the distribution of three cervical transformation zone (TZ) types is heterogeneous in examiners. A comparison was also made of the findings of another two colposcopists without nomenclature training according to the Reid Colposcopic Index (RCI), modified RCI, and Swede Score. Results show that colposcopic accuracies in them are lower than in those nomenclature trained colposcopists. The 2011 IFCPC nomenclature improves colposcopic accuracy in trained colposcopists, like speaking the same language. However, the reproducibility of TZ and the predictive value of a few signs remain to be discussed.

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

h Abstract Objective. This study aimed to present the clinical and colposcopic terminology of the vulva (including the anus) of the International Federation of Cervical Pathology and Colposcopy. Materials and Methods. The terminology has been developed by the International Federation of Cervical Pathology and Colposcopy Nomenclature Committee during 2009Y2011. Results. The terminology is part of a comprehensive terminology of the lower genital tract, allowing for standardization of nomenclature by colposcopists, clinicians, and researchers taking care of women with lesions in these areas. The terminology includes basic definitions and normal findings that are important for the clinician lacking experience with management of vulvar disease. This terminology introduces definitions for abnormal findings recently accepted by the International Society for the Study of Vulvovaginal Disease and includes patterns to identify malignancy. Conclusions. The terminology differs from past terminologies in that it includes colposcopic patterns and anal colposcopy. Nevertheless, the role of the colposcope in the management of vulvar disease is limited. h

New colposcopy terminology was prepared by the Nomenclature Committee of the International Federation of Cervical Pathology and Colposcopy after a critical review of previous terminologies, online discussions, and discussion with national colposcopy societies and individual colposcopists. This document has been expanded to include terminology of both the cervix and vagina. The popular terms "satisfactory colposcopy" and "unsatisfactory colposcopy" have been replaced. The colposcopic examination should be assessed for three variables: 1) adequate or inadequate, with the reason given; 2) squamocolumnar junction visibility; and 3) transformation zone type. Other additions were the localization of the lesion to either inside or outside the transformation zone and determinants of size as well as location of cervical lesions. Two new signs were included in the terminology-the "inner border sign" and "ridge sign." The following definitions have been added: congenital transformation zone, polyp (ectocervical or endocervical), stenosis, congenital anomaly, and posttreatment consequence. In addition, the terminology includes standardization of cervical excision treatment types and cervical excision specimen dimensions. The International Federation of Cervical Pathology and Colposcopy recommends that the 2011 terminology replace all others and be implemented for diagnosis, treatment, and research.

OBJECTIVE To estimate changes in clinical practice in a cervical cancer screening program after the American Society for Colposcopy and Cervical Pathology's issuance of 2006 consensus guidelines (2006CG) for managing abnormal Pap tests. METHODS Screening and diagnostic procedure records were extracted from the operational database of a Centers for Disease Control and Prevention-funded cervical cancer screening program in Alaska. New software was developed to compare these records to the American Society for Colposcopy and Cervical Pathology algorithms. Of the 16 algorithms, 11 were encoded, and results of patients with abnormal Pap results in 2 study windows (cohort A: 2005-2006: n = 1,431; cohort B: October 2007 to September 2008: n = 1,369) were compared with 2006CG recommendations. Comparisons between the practices in the 2 study windows were made using the Fisher exact test. RESULTS Among adolescents with low-grade squamous intraepithelial lesion or atypical squamous cells of undetermined significance Pap results, 117 (48%) of 243 in cohort A were given colposcopies compared with 28 (23%) of 192 in cohort B (p < .0001). There was no difference in the rate of human papillomavirus testing between cohorts A and B (23% vs 26%, p = .449). Among adults with low-grade squamous intraepithelial lesion, 63 (16%) of 402 in cohort A were given repeat Pap tests instead of colposcopies compared with 25 (7%) of 367 in cohort B (p < .0001). Temporal compliance was significantly improved (p = .025), with 75% in cohort A and 91% in cohort B being graded as timely or early. CONCLUSIONS Clinical practice has moved toward 2006CG recommendations in this program, although gaps remain. This evaluation will be used to inform a compliance improvement program. The software can be easily modified as 2006CG evolves and can be ported to other algorithmic practice guidelines.

This study aimed to analyse the satisfaction levels of patients treated for cervical dysplasia. At the Orbis Medical Center, all cases of abnormal cervical cytology are referred for colposcopy; however, there are three possible routings for patients: i) Patients are informed by the gynecologist about the colposcopy in a visit to the outpatient clinic, and colposcopy is planned in a second visit; ii) patients are informed by the gynecologist immediately before the colposcopy (a single visit); or iii) patients are called by a nurse practitioner 1-2 weeks prior to the colposcopy. The nurse practitioner informs patients about their Pap smear result, the colposcopy procedure and the follow-up (single visit plus telephone conversation). Patient satisfaction was analysed in the diagnostic and occasionally in the therapeutic colposcopies, with regards to information, treatment, appeasement and number of visits. The issue of whether the introduction of nurse practitioners improved patient satisfaction was also assessed. Patient satisfaction questionnaires were sent to all 593 patients who underwent a colposcopic examination for the first time following an abnormal smear test result. Data were analysed using SPSS 14.0. For statistical analyses, χ(2) tests and the Mann-Whitney U test were used. P