European consensus statement on essential colposcopy.

This European consensus statement on essential colposcopy provides standards for the general colposcopist seeing women referred for colposcopy with an abnormal cervical screening test (including cytology and HPV tests) or with a clinically suspicious cervix. The article gives guidance regarding the aims and conduct of colposcopy. Recommendations are provided on colposcopy technique, the management of common colposcopy issues, treatment and follow-up of after treatment of CIN or early stage cervical. Colposcopists should make an informed decision on the management of each individual that is referred and organize appropriate follow-up. Cervical cancer is still a major health issue and the quality of care can only improve if there is a structured guidance for women with an abnormal smear or suspicious cervix.

"Gynaecological cancer screening" or "cervical screening?" The case of Hungary.

In Hungary, "gynaecological cancer screening" by gynaecologists having interest in oncology has had a long history. The screening tool was colposcopy alone embedded in complete gynaecological examination. Later on smear-taking for cytology has been added. This screening protocol has survived until now both in the gynaecological community and public. In the meantime, as it proved its ef- fectiveness, cytological examination has been internationally recommended,\ as sole method of organized cervical screening; in case of non-negative test result, gynaecological examination including colposcopy is justified. Smear-taking can be undertaken by trained paramedical personnel. The authors have made an attempt to argue the use of "cervical screening" instead of "gynaecological cancer screening", which is deeply entrenched into both professional and public consciousness in Hungary.

Repeat conisation or HPV test? What should be done if histology of the primary conisation requires a second conisation?

OBJECTIVE: In our retrospective study we focused on the sensitivity of HPV DNA testing towards reducing the number of repeat (re)conisations. Is the second HPV test (pre repeat conisation) an appropriate method to reduce the number of interventions in histologically positive cases? STUDY: 438 cervical conisations--loop electrosurgical excision procedure (LEEP)--were performed between March 2008 and August 2010 at our Gynaecology Department. Samples for high-risk HPV testing (Genoid, Hungary) were taken from the surface of the cervix and from the cervical canal before the LEEP procedure, and histopathological examinations were performed. Margin positivity was the indication for re-conisation (re-LEEP). RESULTS: 119 (27.2%) out of 438 cases were re-conisations. In cases of histologically proven residual dysplasia (29 of 119) high-risk HPV infection was also detected by HPV testing. In 90 cases of 119 residual dysplasia was not seen by histological examination. In this high-risk group HPV infection had not been detected in 77 cases (85.5%) by the time the second HPV test was performed. HPV tests for high-risk types were positive only in 13 of 90 (14.5%) without residual dysplasia. Furthermore the same HPV type was detected only in three cases taken before the first and second conisation procedure. CONCLUSION: Pre re-conisation HPV testing might be useful in reducing the number of re-conisations where the high-risk HPV test is either negative or does not confirm the previously proven HPV type.