European consensus statement on expert colposcopy.

BACKGROUND: Following the publication of the European consensus statement on standards for essential colposcopy in 2020, the need for standards relating to more complex and challenging colposcopy practice was recognised. These standards relate to colposcopy undertaken in patients identified through cervical screening and tertiary referrals from colposcopists who undertake standard colposcopy only. This set of recommendations provides a review of the current literature and agreement on care for recognised complex cases. With good uptake of human papillomavirus (HPV) immunisation, we anticipate a marked reduction in cervical disease over the next decade. Still, the expert colposcopist will continue to be vital in managing complex cases, including previous cervical intraepithelial neoplasia (CIN)/complex screening histories and multi-zonal disease. AIMS: To provide expert guidance on complex colposcopy cases through published evidence and expert consensus. MATERIAL & METHODS: Members of the EFC and ESGO formed a working group to identify topics considered to be the remit of the expert rather than the standard colposcopy service. These were presented at the EFC satellite meeting, Helsinki 2021, for broader discussion and finalisation of the topics. RESULTS & DISCUSSION: The agreed standards included colposcopy in pregnancy and post-menopause, investigation and management of glandular abnormalities, persistent high-risk HPV+ with normal/low-grade cytology, colposcopy management of type 3 transformation zones (TZ), high-grade cytology and normal colposcopy, colposcopy adjuncts, follow-up after treatment with CIN next to TZ margins and follow-up after treatment with CIN with persistent HPV+, and more. These standards are under review to create a final paper of consensus standards for dissemination to all EFC and ESGO members.

DISTRIBUTION OF INTRAEPITHELIAL LYMPHOCYTES AND MACROPHAGES IN CERVICAL MICROENVIRONMENT DURING THE PROGRESSION OF CERVICAL INTRAEPITHELIAL NEOPLASIA.

Microenvironment plays central role in the development of cervical precancerous and cancerous lesions. Cervical intraepithelial neoplasia (CIN) represents a group of precancerous lesions, divided into three degrees. We investigated the distribution of intraepithelial lymphocytes and macrophages in different grades of CIN. We analysed lymphocyte marker CD103, macrophage marker CD68 and proliferation marker Ki67 using standard immunohistochemistry. In addition, we investigated the distribution of lymphocytes using standard haematoxylin and eosin method. The results of our study indicated thatgrade I CIN which subsequently progressed into grade II CIN was characterised with low lymphocytic infiltration, low lympho-epithelial index and low lymphocyte proliferation index. Similar results were seen in cases of CINII which were later progressed into CINIII or in carcinoma. Therefore, we would like to recommend the analysis of microenvironment alterations in CIN lesions, in order to assess their progression potential.

EVALUATION OF RESIDUAL LESIONS FOLLOWING CONSERVATIVE TREATMENT OF HIGH GRADE CERVICAL INTRAEPITHELIAL NEOPLASIA.

The purpose of this study was to determine the diagnostic value Pap smear test and colposcopy in Georgian National Screening Center, evaluation of efficiency of the excisional treatment and determining the main risk factors for prediction of residual/recurrent disease in patients with high-grade cervical intraepithelial neoplasia. We retrospectively analyzed 613 patients, who underwent excisional treatment of the cervix (LEEP). Follow-up was performed by Pap smear test, colposcopy and histamorphological examinations. Accuracy of Pap smear test and colposcopy prior to the the excisional treatment revealed Pap: Se 83.4%; Sp 76.4%; PPV 72.6%; NPV76.8%; Colposcopy: Se 83.4%; Sp 69.4%; PPV 69.3%; NPV 80.6%; After the excisional treatment: Pap: Se 82.8%; Sp 92.3%; PPV 61.5%; NPV 97.3%; Colposcopy: Se 62.1%; Sp 80.4%; PPV 32.1%; NPV 93.4%. After LEEP colposcopy is less sensitive than before LEEP. After LEEP sensitivity of the Pap smear test exceeds the sensitivity of the colposcopy. Forty one (18.4%) of 223 patients had residual/recurrent lesion during follow-up. According to univariate analysis the patient's age ≥40 years (p<0.01) OR 3.2 (95% CI 1.3-8.4), transformation zone type III (p<0.01) OR 5.0 (95% CI 2.1-11.5), endocervical gland involvement (p<0.01) OR 6.2 (95% CI 2.7 - 15.1 ), smoking status (p<0.001) OR 7.7 (95% CI 3.336-17.8), major abnormal cytology (p<0.05) OR 2.72 (95% CI 0.963-9.512) were significant risk factors for residual/recurrent disease. However, gravidity, parity, severity of disease and positive margins were not relevant factors for the residual/recurrent disease (P>0.05). Consideration and implementation of these predictive factors in patient surveillance protocol will allow avoiding delayed treatment or overtreatment.

Cancer screening program in Georgia (results of 2011).

This paper reviews and summarizes the results and epidemiological data of 2011 Cancer Screening Program in Georgia. The first paragraph of paper underlines main results of capacity building of the program and its implementation. The second paragraph is focused on activities conducted within the program on population behaviour change and communication campaign and the final paragraph analyses the data of epidemiological results collected during year 2011 of breast, cervical, prostate and colorectal cancer screening, reviews and summarizes. Implementation of cancer screening programs is of great medical and social importance. Cancer screening, using simple tests that can cover the general population, and also promotes the early diagnosis of cancer and its treatment in a timely manner, increasing life expectancy and reduce mortality.