Using technology to harmonise treatment approaches in colposcopy in the face of a changing environment.

The overall numbers of precancerous lesions are expected to fall as human papillomavirus (HPV) vaccinated women enter the cervical screening programme. Juxtaposed against an increase in referrals from the introduction of primary high-risk HPV screening, colposcopists expect to see a decreasing incidence of high-grade cervical intraepithelial neoplasia (CIN). Correct identification of lesions will become more challenging, as the prevalence of high-grade lesions becomes minimal and conventional colposcopy is subject to a lower sensitivity. In this review, we explore the scenarios where adjunct technologies could support colposcopists to manage referrals and diagnose treatable lesions with more confidence.

The diagnostic accuracy of colposcopy in previously treated cervical intraepithelial neoplasia.

OBJECTIVE: To determine whether colposcopy is reliable in diagnosing cervical intraepithelial neoplasia in women who have undergone a previous cervical excision biopsy. MATERIALS AND METHODS: A prospective study of women attending the colposcopy clinic at the University Hospital of North Staffordshire was performed between January 1998 and December 1999. RESULTS: A clear histological diagnosis of the grade of cervical intraepithelial neoplasia was available for 469 in the treatment-naive group and 58 in the treatment group. kappa coefficients comparing the colposcopic impression (negative, low-grade, high-grade, or invasion) with histological diagnosis showed that there was no difference between the treatment-naive group, weighted kappa=0.46, and the previous treatment group, weighted kappa=0.47. The sensitivity, specificity, positive predictive value, and negative predictive value of colposcopy for any cervical disease in the treatment-naive women were 93.9%, 51.9%, 96.7%, and 34.1%, respectively, compared with 77.6%, 66.7%, 86.4%, and 35.3% in previously treated women. The sensitivity of colposcopy fell when it was used to differentiate normal and low-grade disease from high-grade disease and invasion: 82.4%, 55.9%, 82.6%, and 49.6% for treatment-naive women, compared with 61.5%, 84.2%, 60.0% and 51.6%, respectively, for the previous treatment group. CONCLUSIONS: Previous treatment to the cervix does not seem to impair the ability of colposcopy to differentiate normal cervix from all grades of cervical abnormality in women where the squamocolumnar junction is visible. However, there is a suggestion that the sensitivity of colposcopy to differentiate negative/low-grade disease from high-grade disease/invasion is lower in previously treated women.

Loss of heterozygosity at chromosome 9q22-31 is a frequent and early event in ovarian tumors.

Loss of heterozygosity (LOH) studies in ovarian tumors, have highlighted the chromosomal regions at 9q22-31 and 9q32-34 as being potentially important in tumor development. We have investigated LOH at 9q22-31 in 85 patients with epithelial ovarian cancer, 15 with non-epithelial tumors and 16 with benign disease. Varying patterns of LOH were observed across the markers used between different tumors, the most common (71%) being interstitial discontinuous losses. LOH was frequent, and was detected at equally high levels in malignant (71%) and benign tumors (70%). LOH occurred in epithelial invasive tumors, borderline tumors, fibromas and dermoid tumors. In malignant epithelial tumors LOH at 9q22-31 was not significantly associated with patient clinical and pathological parameters; however, survival was 29 months at the 50th centile survival, in those women whose tumors displayed LOH compared with 60 months in women whose tumors retained heterozygosity. LOH at 9q22-31 was significantly associated with LOH at the p53 locus (p=0.02) and the ovarian suppressor locus at 3p21 (p=0.05). We conclude that the chromosome region at 9q22-31, flanked by the microsatellite markers D9S1796 and D9S53, is a frequent and early event in ovarian tumorigenesis. With the of extent of discontinuous LOH, high density deletion mapping of this region using LOH as a strategy to identify candidate genes may be problematic. However with the completion of the human genome sequencing project several candidate genes are identified.

Can pre-colposcopy sessions reduce anxiety at the time of colposcopy? A prospective randomised study.

The main objective of this prospective randomised study was to evaluate whether offering pre-colposcopy group sessions reduces anxiety at the time of colposcopy. We also examined whether this strategy improved knowledge about abnormal smears and colposcopy and improved satisfaction with the colposcopy service provided. One hundred and forty-seven women undergoing colposcopy for the first time were randomised into two groups. The control group (n = 75) received conventional management. The study group (n = 72), in addition to conventional management, were invited to attend a pre-colposcopy group session led by a trained colposcopy nurse. Questionnaires were used to determine state anxiety inventory scores and knowledge scores at the time of randomisation, immediately before colposcopy and 6 weeks after the clinic visit. Satisfaction questionnaires were completed 6 weeks after the clinic visit. We found that women attending colposcopy clinics are anxious. Those women who attended the pre-colposcopy session had improved knowledge scores (P = 0.039) at the time of colposcopy and satisfaction (P = 0.037). However, the intervention failed to significantly reduce anxiety at the time of colposcopy (P > 0.05).