Development and validation of a predictive model for endocervical curettage in patients referred for colposcopy:A multicenter retrospective diagnostic study in China

Objective:This study aimed to develop a nomogram that can predict occult high-grade squamous intraepithelial lesions or worse(HSIL+)and determine the need for endocervical curettage(ECC)in patients referred for colposcopy.Methods:This retrospective multicenter study included 4,149 patients who were referred to any one of six tertiary hospitals in China for colposcopy between January 2020 and November 2021 because of abnormal screening results.ECC data were extracted from the medical records.Univariate and multivariate logistic regression analyses were performed to identify factors that could predict HSIL+on ECC.Patients were randomly assigned to a training set or to an internal validation set for performance and comparability testing.The model was externally validated and tested in patients from two additional hospitals.The nomogram was assessed in terms of discrimination and calibration and subjected to decision curve analysis.Results:HSIL+was found on ECC in 38.8%(n=388)of cases.Our predictive nomogram included age group,cytology,human papillomavirus(HPV)status,visibility of the cervix and colposcopic impression.The nomogram had good overall discrimination,which was internally validated[area under the receiver-operator characteristic(AUC),0.839;95%confidence interval(95%CI),0.773-0.904].In terms of external validation,the AUC was 0.843(95%CI,0.773-0.912)for the consecutive sample and 0.843(95%CI,0.783-0.902)for the comparative sample.Calibration analysis suggested good consistency between predicted and observed probabilities.Decision curve analysis suggested this nomogram would be clinically useful with almost the entire range of threshold probabilities.Conclusions:This internally and externally validated nomogram can be easily applied and incorporates multiple clinically relevant variables that can be used to identify patients with occult HSIL+who need ECC.

Diagnostic discrepancy between colposcopy and vaginoscopy:A case report

BACKGROUND Colposcopy currently plays a vital role in the diagnosis and treatment of lower genital diseases.Exposure and biopsy are two key steps in colposcopy.When the whole transformation zone or all lesions cannot be observed,we judge colposcopy as unsatisfactory.Unsatisfactory colposcopic examination may lead to the misdiagnosis of more severe diseases.The combination of colposcopy and vaginoscopy may contribute to accurate diagnosis and clinical decisions.CASE SUMMARY Here,we introduce a case of posthysterectomy deep vaginal apex not fully exposed by colposcopy,and the biopsy result was a vaginal precancerous lesion.We adopted vaginoscopy to extend the observed area and expose the lesion thoroughly,and the biopsy result was vaginal squamous cancer.CONCLUSION The patient received a precise diagnosis and early surgery due to the combination of colposcopy and vaginoscopy.

The Use of Artificial Intelligence on Colposcopy Images, in the Diagnosis and Staging of Cervical Precancers: A Study Protocol for a Randomized Controlled Trial

Rationale and Objectives: Accurate diagnosis and staging of cervical precancers is essential for practical medicine in determining the extent of the lesion extension and determines the most correct and effective therapeutic approach. For accurate diagnosis and staging of cervical precancers, we aim to create a diagnostic method optimized by artificial intelligence (AI) algorithms and validated by achieving accurate and favorable results by conducting a clinical trial, during which we will use the diagnostic method optimized by artificial intelligence (AI) algorithms, to avoid errors, to increase the understanding on interpretation of colposcopy images and improve therapeutic planning. Materials and Methods: The optimization of the method will consist in the development and formation of artificial intelligence models, using complicated convolutional neural networks (CNN) to identify precancers and cancers on colposcopic images. We will use topologies that have performed well in similar image recognition projects, such as Visual Geometry Group Network (VGG16), Inception deep neural network with an architectural design that consists of repeating components referred to as Inception modules (Inception), deeply separable convolutions that significantly reduce the number of parameters (MobileNet) that is a class of Convolutional Neural Network (CNN), Return of investment for machine Learning (ROI), Fully Convolutional Network (U-Net) and Overcomplete Convolutional Network Kite-Net (KiU-Net). Validation of the diagnostic method, optimized by algorithm of artificial intelligence will consist of achieving accurate results on diagnosis and staging of cervical precancers by conducting a randomized, controlled clinical trial, for a period of 17 months. Results: We will validate the computer assisted diagnostic (CAD) method through a clinical study and, secondly, we use various network topologies specified above, which have produced promising results in the tasks of image model recognition and by using this mixture. By using this method in medical practice, we aim to avoid errors, provide precision in diagnosing, staging and establishing the therapeutic plan in cervical precancers using AI. Conclusion: This diagnostic method, optimized by artificial intelligence algorithms and validated by the clinical trial, which we consider “second opinion”, improves the quality standard in diagnosing, staging and establishing therapeutic conduct in cervical precancer.

ROLE OF COLPOSCOPY IN THE DIAGNOSIS OF HUMAN PAPI- LLOMAVIRUS INFECTION OF THE UTERINE CERVIX

Among 6706 women screened by cytology, only 9 (0.13%) showed evidence of human pppillomavirus infection (HPVI). In 133 women examined by colposcopy for abnormal cytology or/ and suspected lestions on the cervix, 41.(30. 8%) showed subclinical papillomavirus infection (SPI), while 17. 4% and 5. 3% showed HPVI by histopathology and cytology, respectively. The conformation rate between colposcopy and pathology was 69. 6%. Sixty-nine specimens out of 133 colposcopy piled biopaies were assayed by HPV-DNA dot hybridization with 6B/11, 16, 18 probes to detect the presence of HPV-DNA In the cervical specimens. Thirty-nine (56.5%) gave a positive result. The colposcopic predictive value of positive result for HPVI was 76.7%. The difference between colposcopy (59%) and pathology (20. 5%) is statistically significant (P<0. 01). These results suggest that colposcopy is superior to cytology and hjstopathology for the detection of SPI in the cervix. In colposcopy HPV-DNA positive women, aceto while epithelium was most common (28. 2%) . As it is difficult to differentiate SPI from cervical intraepithelial neoplasia especially the Grade Ⅰ lesion by colposcopy, discrimination criteria are proposed together with the chief colposcopic features of SPI.

Retrospective View of Two Years of Colposcopy Practice in a Gynecologic Clinic in Cotonou

Objective: To analyse the colposcopy results at the Gynaecological Clinic of Houéyiho. Patients and methods: Retrospective, descriptive and analytical studies were conducted by the Clinic of Houeyiho in Cotonou from January 2013 to December 2015. Results: 440 women were received in colposcopy including 251 (57%) referred by health workers for VIA (Visual Inspection with Acétique Acid)/VILI (Visual Inspection with Lugol’s Iodine) abnormalities, forty-seven (47) for abnormal smears (10.7%), thirty-eight (38) for metrorrhagia (8.6%). 10% of cases were mainly concerned with post-therapeutic monitoring (six colposcopies of the vagina fundus after hysterectomy for cervical cancer and four after conization). The average age of patients is 41 years within plus or minus 5 years. Forty (40) cases of Grade 1 Atypical Transformation, twenty-nine (29) cases of Grade 2 Atypical Transformation including two (2) cases of leukoplakia (1 post-conization for CINIII, 1 in a HIV+ patient), ten (10) cases of Grade 1 Atypical Transformation/Grade 2 Atypical Transformation association were recorded. A colposcopy biopsy was performed in 95 patients meaning 21.6% of patients. Five biopsies were realized for a cervical neoplasia suspicion and were sent to Pasteur Cerba laboratory in France for the sake of efficiency and rapidity of results. In Grade 1 Atypical Transformation, 66.6% of CIN1 and condylomata plana were noted. Nevertheless, a case of mucinous adenocarcinoma with metaplasia has been discovered in a TAG1 with a 23-year old patient. In Grade 2 Atypical Transformation, the histology reveals 44.4% of CIN 1, 40.7% of severe dysplasia and 11.1% of carcinomas. Conclusion: The colposcopy may be a good screening method with a good colpo-histology agreement in Cotonou. But it’s relatively expensive (20.000 CFA francs) and the reduced number of colposcopists restricts its use in Benin.

Contribution of Colposcopy in the Diagnosis of Precancerous Lesions of the Uterine Cervix at the Douala Gynaeco-Obstetric and Pediatric Hospital, Cameroon

Introduction: Cervical cancer is a public health problem in Cameroon, due to low screening and late diagnosis. We sought to assess practice of colposcopy at the Douala Gyneco-Obstetric and Pediatric Hospital (DGOPH) in Cameroon and its contribution to the fight against cervical cancer in our context. Method: This is a retrospective cross-sectional study of 99 colposcopies after which 71 exploitable biopsies were retained at the Douala for a period of 1year (December 1, 2019-December 1, 2020). The nomenclature of the French Society of Colposcopy and Cervico-Vaginal Pathology (SFCPCV) was used. Results: Mean age of the participants was 44 years, mostly multiparous (80%). Cytological abnormalities were the main reference pattern. During the examination 22% of colposcopies were found to be normal, 37% of TAG 1-2A, 31% of TAG 2B-C, and 5% suspected of cancer. After histological analysis of biopsies guided by colposcopy, we found 42% (30/71) of Cervical Intraepithelial Neoplasia (CIN) 1, 15.5% (11/71) of CIN 2 - 3, and 24% (17/71) cancer. Upon analysis of the diagnosed CIN1/CIN2-3/Cancers, we noted a concordance with colposcopy in 62% (23/37), 37% (10/27) and 85% (6/7) respectively. Colposcopic performance in the detection of high-grade lesions and above was 36% (26/71), with a sensitivity of 92.86%, specificity 83.33%, PPV 78.79% and NPV 94.59%. Conclusion: Despite the difficult socioeconomic context, colposcopy retains all its importance in the diagnosis of precancerous lesions of the uterine cervix. With the imminent putting in place of a national health policy, the goals 90-70-90 by 2030 of the World Health Organization for the fight against cervical cancer can be achieved in our sub-Saharan African countries.

Colposcopy at the University Hospital in Conakry: Role of Colposcopy in Screening and/or Diagnosis of Cervical Cancer in the UTH University Teaching Hospital of Conakry

Objective: This study was conducted to evaluate the role of colposcopy in the screening of cervical cancer at the UTH in Conakry. Material and Methods: We conducted a descriptive study on over a period of 18 months of from the 1 July 2004 to December 31, 2005 in the CHU of Conakry Any women aged from 25 to 65 years old who has agreed to the screening of cervical cancer by colposcopy was included. Statistical tests of sensitivity, specificity, and predictive values positive and negative were computed directly and compare among all participants. Results: During the study period, we included a total of 9339 women. For all precancerous and cancerous lesions, sensitivity and specificity were 93% and 64% respectively. With a positive predictive value of 46% and the negative predictive value of 90%, low and high grade precancerous lesions were found with: a sensitivity of 91%, the specificity of 64%. The positive predictive value of 37%, and the negative predictive value of 91% were estimed. Intra epithelial lesions (LIEBG) low-grade squamous sensitivity was 94%, specificity of 62%, the positive predictive value of 31%, the negative predictive value of 95%. For lesions intra epithelial highgrade squamous (LIEHG), the sensitivity was 85%, 10%, the positive predictive value of 74% specificity, negative predictive value of 95%. Conclusion: Colposcopy is a reference method of detection of precancerous lesions of the cervix to promote cancer.

Rapid and efficient characterization of cervical collagen orientation using linearly polarized colposcopic images

Collagen provides tissue strength and structural integrity.Quanti fication of the orientated dispersion of collagen fibers is an important factor when studying the mechanical properties of the cervix.In this study,for the first time,a new method for rapid characterization of the collagen fiber orientations of the cervix using linearly polarized light colposcopy is presented.A total of 24 colposcopic images were captured using a cross-polarized imaging system with white LED light sources.In the preprocessing stage,the Red channel of the RGB image was chosen,which contains no information of the blood vessels because of the low-absorption of blood cells in the red region.OrientationJ,which is an ImageJ plug-in,was used to estimate the local orientation of the collagen fibers.The result shows that in the nonpregnant cervix,the middle zone(Zone 2)has circumferentially aligned collagen fibers while the inner zone(Zone 1)has randomly arranged.The collagen fiber dispersion in Zone 2 is much smaller than that in Zone 1 at all four quadrants region(anterior,posterior,left,and right quadrant).This new analysis technique could potentially combine with diagnostic tools to provide a quantitative platform of collagen fibers in the clinic.

The Prevalence of Female Genital Bilharziasis (FGB) in the Northern Region of Senegal

Introduction: Female Genital Bilharzia (FGB) is a pathology secondary to infection by Schistosoma haematobium. It is one of the neglected tropical diseases, capable of causing infertility, difficulties in childbirth and even cervical cancer. It represents a real public health problem. We therefore conducted a study in the maternity ward of the Saint-Louis regional hospital, with the overall aim of determining the prevalence of FBG in patients undergoing colposcopy. The specific objectives were to define the patient profile, and to compare colposcopic images with the World Health Organization (WHO) atlas. Methodology: We conducted a descriptive, analytical cross-sectional study of all colposcopic images taken at the maternity ward of the Saint-Louis regional hospital from August 1, 2018, to September 30, 2020, i.e. 25 months. The images were compared with the BGF images described in the WHO atlas. Results: We collected 178 colposcopy images. FBG images numbered 50, or 28%. The mean age of the patients was 44.5 years ±11.4 at the extremes of 18 and 78 years. Mean gestational age was 4.69 ± 2.72. Among patients with a bilharzian lesion on the cervix, visual acid inspection (VIA) was negative in 60% of cases (p = 0.007, Odd Ratio = 3.6 (1.49 - 9.07)). Conclusion: the results of our study show that FBG is a reality in our daily practice. It occurs in adult, multigestating, non-occupational women whose examination reveals a negative visual inspection with acetic acid (VIA). Healthcare providers therefore need to be trained in the recognition of lesions associated with genital bilharziasis, and public awareness needs to be raised.

Value of multi-quadrants biopsy:Pooled analysis of 11 population-based cervical cancer screening studies

Objective:The accuracy of colposcopy-guided biopsy is key to the success of colposcopic triage in cervical cancer screening programs.However,there is no widely adopted biopsy guideline up to date.Our study aimed to determine whether multi-quadrants biopsy improves the yield of cervical lesions.Methods:Eleven population-based cervical cancer screening studies were conducted in China.Cytology,highrisk human papillomavirus(hrHPV)testing and visual inspection were performed for primary screening.Females positive on one or more tests were referred for colposcopy and biopsy.The proportion of detected cervical intraepithelial neoplasia(CIN)2+and yields by quadrant lesion-targeted biopsy or 4-quadrant random biopsy were compared.Results:Among 4,923 females included,1,606 had quadrant lesion-targeted biopsy,and 3,317 had 4-quadrant random biopsy.The cumulative CIN2+yield increased from 0.10 for only one quadrant-targeted biopsy to 0.21,0.34,and 0.58 for at most two,three and four quadrants targeted biopsies.Among hrHPV positive females with high-grade squamous intraepithelial lesion(HSIL)+cytology,the cumulative CIN2+yield of a second targeted biopsy in another quadrant was significantly increased(P<0.05).Among hrHPV-negative females,the yield of 4-quadrant random biopsies was 0.005,and the yield by lesion-targeted biopsies was 0.017.For hrHPV positive females who had 4-quadrant random biopsy,the additional CIN2+yield for HSIL+,low-grade squamous intraepithelial lesion(LSIL)cytology,or abnormal visual inspection via acetic acid and Lugol’s iodine(VIA/VILI)were 0.46,0.11,0.14.Conclusions:A 4-quadrant random biopsy is recommended only for hrHPV positive females with HSIL cytology,and is acceptable if hrHPV positive with LSIL cytology or with abnormal VIA/VILI.Our findings add evidences for an objective and practical biopsy standard to guide colposcopy in cervical cancer screening programs in low-and middle-income countries.

Clinical evaluation of HPV DNA test combined with liquid-based cytology in the diagnosis of cervical disease

Objectives: To evaluate the sensitivity and accuracy of the HPV DNA test in conjunction with thin prep cytology test as a screening method of human papillomavirus (HPV) infection. To study either the cervical erosion is related to high risk HPV infection or to determine the mean age distribution that is more prone to HPV infection. Material and Methods: The study is a retrospective cohort implemented to determine the real performance of liquid based medium and HPV DNA testing combined in second clinical hospital of Jilin University Changchun, China. The study group included total 150 patients from January 1, 2011 to December 30, 2012. A computerized search identified patients with thin prep test results and high risk HPV DNA testing during a 2-year period was recruited. The patients were chosen after proper speculum examination followed by thin prep cytology (TCT) and HPV DNA test. Cytologic specimens were obtained with endocervical brush, which was rinsed into the vial of Cytyc. The residual samples after the cytology report were taken for reflex HPV DNA test. The manufacture protocol was followed for HPV DNA testing using Hybrid Capture II. Colposcopic biopsy was performed for the diagnosis purpose, in patients who had atypical squamous cells of undeter-mined significance (AUS-US), low grade intraepithelial lesion (LSIL) or high-grade intraepithelial lesion (HSIL) in cytology and with positive results of highrisk HPV DNA. The diagnostic criteria were based on the Bethesda System (TBS). Findings: The high risk HPV positive women with abnormal cytology had a CIN I risk of 73 (86%), whereas 35 (23.3%) high-risk HPV positive women out of 109 (72.7%) normal cytology who underwent histological biopsy had CIN I 16 (10.7%). The risk for cervical intraepithelial neoplasia (CIN) in women with high-risk HPV positive with normal cytology was higher among women invited for the first time 31 - 40 years of age 12 (8%) than among older women 1 (0.7%). Out of 44 (29.3%) women who had I degree erosion with 6 (14%) positive HPV DNA test 38 (86%) had a normal histology biopsy showing no statically significant between them. Conclusion: The data confirm that HR-HPV DNA testing is much more sensitive than cytology alone and that HPV DNA testing helps in identifying women with high risk of serious cervical disease in an efficient and medically acceptable manner. The other most significant advantage of this cervical cancer screening method is that women who are HPV DNA positive can easily and quickly referred for colposcopic examination (within one year), which could identify the precancerous and cancer stage. And those who are HPV DNA negative can safely have much longer screening intervals saving considerable costs. With mean age being 38 ± 10 years, age older than 30 years should undergo HPV DNA testing with cytology triage in primary screening. But in woman younger than 30 years using HPV DNA assay, as an initial screening step can increase the prevalence of abnormal smears and the positive predictive value of HPV followed by TCT. However, close follow-up is essential if the initial biopsy is negative because a considerable number of women may have HPV infection positive in subsequent studies.

Same day colposcopic examination and loop electrosurgical excision procedure (LEEP) presents minimal overtreatment and averts delay in treatment of cervical intraepithelial neoplasia in Kenyatta National Hospital, Kenya

Background: Screening for cancer of the cervix at Kenyatta National Hospital (KNH), follows the recommended three-step strategy;Papanicolaou (Pap) smear, colposcopy/biopsy and loop electrosurgical excision procedure (LEEP)/biopsy. This approach poses the following challenges: multiple clinic visits, costly, time consuming, long turnaround time to treatment, non-compliance and loss-to-follow-up. Objective: To determine the agreement between histologies following colposcopy and LEEP amongst women in KNH as a forerunner for opportunity to shift from the three-step approach to the two-step “see and treat” (same-day colposcopy and LEEP) approach. Methods: This was a retrospective descriptive cohort of Women who underwent LEEP procedure between January 2008 and 31st December 2010 following the three-step approach at KNH, Kenya. Results: A total of 124 patients out of the 132 patients who underwent LEEP were included in the analysis. The 8 patients excluded had missing files. HIV infected, uninfected or unknown women are similar socio-demographically. The mean (SD) age for the HIV infected, uninfected and unknown is 37 (6), 33 (10) and 35 (9) years respectively. Colposcopic and LEEP biopsy histology within patients demonstrated a high weighted kappa statistics agreement of 84%. LEEP increased diagnosis of invasive cancer. Patients had a median (IQR) 5 (4 - 6) clinic visits from Pap smear to LEEP treatment. It took median (IQR) 55 (27 - 116) days between Pap smear to colposcopy result and 167 (101 - 276) days between Pap smear results to LEEP treatment. If a LEEP procedure were to be performed in this cohort of women on the same day of the colposcopy biopsy a median (IQR) 77 (55 - 137) days could have been saved. Conclusion: There is a high agreement between colposcopy and LEEP biopsies in our setting offering a window of opportunity to perform “See and Treat” same-day colposcopy and LEEP treatment procedure, skipping the colposcopy biopsy stage.

Screening for Cervical Cancer by Visual Inspection with Acetic Acid (VIA) in Nabil Choucair Health Center—Dakar (Senegal)

OBJECTIVES: 1) To draw up the epidemiological profile of patients who have benefited from cervical cancer screening by visual inspection after application of acetic acid (VIA) and then describe the results of the test, the colposcopy, histological and therapeutic aspects in case of dysplasia. 2) To evaluate the performance of IVA in cervical cancer screening and its feasibility in low-resource countries. MATERIALS AND METHODS: This was a prospective and descriptive study carried out from 06 June 2015 to 31 January 2016 (7 months) at the Maternity Center at Nabil Choucair health center in Dakar. The patients had been screened for cervical cancer by visual inspection, which consisted of applying 3% acetic acid after setting up a vaginal speculum. The test was considered positive if there were intense white areas in the cervix. Colposcopy was performed in case of a positive VIA result. This colposcopy included an unprepared examination, an examination after application of 3% acetic acid and an examination after application of Lugol solution. The colposcopic report is made according to the terminology of the French Society of Colposcopy and Cervico-Vaginal Pathology. Patients with major changes or unsatisfactory colposcopy had undergone diathermic loop resection. Surgical specimens were sent to pathologic anatomy and follow-up was performed according to the results of the histology. The studied parameters concerned the socio-demographic aspects, the results of the VIA test, the results of the colposcopy after a positive test, the therapeutic aspects in case atypical transformation zone grade 2 or of unsatisfactory colposcopy, the results of the histology after the conization and the followed. The collection of data was done thanks to a file and the statistical analysis thanks to the software Epi-info version 7. RESULTS: 899 patients were involved in the study. The epidemiologic profile of our patient was a multipara in a period of genital activity, aged 42.2 years with a mean gestational weight of 4.5, and a parity of 4. In our series, the patients had their first sexual intercourse with 20.8 years old. In our study, 84 patients (10.2%) had positive results after visual inspection after acetic acid applications. All patients with positive results after application of 3% acetic acid had colposcopy. In our study, 27 patients had major changes and/or unsatisfactory colposcopy and underwent diathermic loop resection for diagnostic and therapeutic purposes. Anatomo-pathological examination of the cone room revealed cervicitis in 22.2% of cases, flat condyloma in 7.4% of cases, CIN2 in 22.2% of cases, and CIN3 in 18.5% of cases. All the conizations were in sano. The postoperative course was simple. CONCLUSION: Cervical cancer is a real public health problem in developing countries. To do to human resources, developing countries like Senegal must put in place simple, inexpensive, effective strategies that must globally respond to “screen and treat”.

Diagnostic value of the combination of TruScreen and Pap smear in screening cervical epithelial lesions: Does it add advantages over the Pap smear alone?

Introduction: Pap smear is a well known test in screening of epithelial cell abnormalities of the cervix. However, adding other screening methods to this test may increase the sensitivity and specificity of case finding. Current study has been designed to assess the sensitivity and specificity of the combination of Tru-Screen and Pap tests in comparison to Pap smear alone in women referred for annual screening. Methods: This case-control study was conducted in two groups of 66 and 73 women with epithelial cell abnormality and normal results on Pap smear, respectively. Both groups were subsequently tested with Tru-Screen and colposcopy. Positive finding in any of the three studies made the patient candidate for biopsy as the standard diagnostic test. SPSS software was used to analyze sensitivity, specificity, positive predictive value, and negative predictive value of TruScreen, Pap smear, colposcopy and the combination of TruScreen and Pap tests. Results: 105 out of 139 women underwent biopsy. Of these, 32 (30.5%) had abnormal result in biopsy. Combination of True screen and Pap smear led to a sensitivity of 93.8% and specificity of 79.5% which means an improvement in both parameters. False negative rate decreased to 6.3% but false positive rate increased to 82.2%. Positive and negative predictive values of the combined tests were 33.3% and 86.7%, respectively. Conclusion: Combination of TruScreen and Pap smear is associated with a significant improvement in both sensitivity and specificity for early screening of preneoplastic and neoplastic cervical epithelial lesions.

The Prevalence of High Grade Cervical Intraepithelial Neoplasia (CIN) in a Primary Human Papillomavirus (HPV) Cervical Screening Programme Population with HPV Positive and Cytology Negative Smear Results

High-risk HPV is found in 99.7% of cervical cancers. The causative role of HPV in cervical cancer has led to the inclusion of HPV testing as part of cervical screening. A pilot of HPV testing as primary screening was commenced in 2013 at six pilot sites in England. North Cumbria Integrated Care (NCIC) NHS Foundation Trust took part in the pilot, in which women with an HPV-positive/cytology-negative result were recalled at 12 months. Women with HPV type 16/18 found at initial screening and persisting at 12 months in spite of negative cytology were referred to Colposcopy services at 12 months. Women with smear positive for hrHPV other than 16/18 types were recalled twice at 12 and 24 months before referral to colposcopy. Persistent hrHPV positive/cytology negative smear at 12 and 24 months initiated a colposcopy referral. Objective: To assess the prevalence of high grade CIN and invasive cancer in patients referred to colposcopy services at NCIC NHS Foundation Trust with hrHPV positive/cytology negative smears. Method: The study was conducted at NCIC NHS Foundation Trust between January 2015 and December 2017. Data was collected retrospectively from the colposcopy data base (INFOFLEX). All patients with HPV positive/cytology negative smears seen in colposcopy clinic during the study period were included. Patients with high grade CIN, cervical glandular intraepithelial neoplasia (CGIN) or invasive cancer were recorded. Results: 763 women were included in the study. A total of 50 (6.6%) women had high grade CIN, CGIN or invasive cancer. 40 of these 50 women (80%) were treated by large loop excision of the transformation zone (LLETZ). Conclusion: HPV primary screening is more effective than cytology-based screening. A high grade HPV positive result with negative cytology, persisting for one year in type 16/18 and for two years in other high-risk HPV types, warrants referral for colposcopy, as 6.6% of women in this study had high grade or invasive pathology.

The “behind-the-knee” test for menstrual tampon irritation

Colposcopic inspection of the vagina is a routine component of the safety assessment of intravaginal products. However, colposcopic findings occur frequently in healthy women, raising questions about their relevance to intravaginal product safety. Practical disadvantages limit the utility of colposcopy for evaluating menstrual tampons, among them the presence of background microtrauma, the inability to assess effects during menstruation, and, importantly, the question of whether post-hoc assessments are sufficiently sensitive to detect small inflammatory changes. The Behind-the-knee (BTK) test is an alternative for evaluating inflammatory and tissue dryness effects of physical articles by their repeated application to the popliteal fossa under an elastic bandage. It enables concurrent parallel comparisons of experimental and control articles over time and substantially increases the sensitivity of detecting small changes in tissue inflammation. With this protocol, uncompressed experimental and control tampons yielded comparable relative and absolute erythema scores (after overnight recovery) as did colposcopic assessment of the lower genital tract 3 to 48 hours after menstrual use. Scoring erythema in the BTK test immediately after product removal increased the level of visually discernible inflammation 6-fold. In a study of commercial menstrual pads, subclinical inflammation visualized with cross-polarized light correlated with the frequency of subjective reports of discomfort during the test and discriminated the relative tolerability of the two products determined by market surveillance, providing added confidence in the predictive value of the test. We believe the BTK test to be a valuable alternative to colposcopy for assessing inflammation and dryness associated with menstrual tampons.

电子阴道镜检查对诊断宫颈病变的临床观察

目的:分析阴道镜检查在宫颈疾病诊断中的作用。方法:选取2008年3月至2009年12月在我院门诊就诊的431例患者进行阴道镜检查,并与组织病理结果对照。结果:431例电子阴道镜检查中,行组织活检291例。病理学检查诊断为慢性宫颈炎146例,宫颈上皮内瘤样病变CINⅠ33例,CINⅡ37例,CINⅢ20例,宫颈癌36例,宫颈湿疣15例,正常宫颈4例。诊断的正确率98.1%,假阳性率4.3%,敏感度为95.2%,特异度为89.1%。结论:阴道镜检查在基层医院具有重要作用,尤其在分流宫颈良恶性病变和诊断CIN及宫颈浸润癌有重要作用,结合组织病理学检查可以提高诊断的准确率。

Effectiveness of Co-Testing in Cervical Cancer Screening Program in Macao SAR

Background: Cervical cancer remains a significant public health concern in Macao SAR despite the implementation of a cervical cancer screening program and HPV vaccination. To improve early detection, Macao SAR introduced HPV DNA testing alongside cytology (co-testing) as the primary screening method in 2019. This study evaluates the effectiveness of co-testing in identifying cervical precancerous lesions (CIN2+) compared to cytology alone. Methods: We conducted a retrospective analysis of women aged 30 - 65 years who participated in the routine cervical cancer screening program in Macao SAR Primary Healthcare Centers from 2019 to 2022. Data from over 70,000 women were analyzed, comparing the detection rates of CIN2+ through co-testing and cytology alone. Women with abnormal cytology or positive HPV results were referred for colposcopy. Results: The introduction of co-testing led to a significant increase in the detection of CIN2+, particularly in women with atypical squamous cells of undetermined significance (ASCUS) or negative for intraepithelial lesion or malignancy (NILM) cytology results. Between 2019 and 2022, the percentage of women with ASCUS/NILM and any high-risk HPV (hrHPV) positive who were diagnosed with CIN2+ after colposcopy were 24%, 13%, 10% and 7.5% respectively. This highlights the ability of co-testing to identify high-risk individuals who would have been missed by cytology alone. Discussion: Our findings demonstrate the effectiveness of co-testing in improving the sensitivity of cervical cancer screening in Macao SAR. The inclusion of HPV DNA testing allows for better risk stratification of women with ASCUS/NILM cytology, leading to more targeted referrals for colposcopy and timely detection of precancerous lesions. The initial high positive rate in 2019 (24%) might be attributed to the small sample size and potentially reflects a backlog of undiagnosed cases prior to co-testing implementation. Conclusion: The implementation of co-testing in Macao SAR’s cervical cancer screening program significantly improves the early detection of precancerous lesions, particularly in women with ambiguous cytology results. This proactive approach contributes to reducing cervical cancer morbidity and mortality and improving women’s health outcomes in Macao SAR.

Diagnostic Accuracy of Colposcopically Directed Biopsy and Loop Electrosurgical Excision Procedure for Cervical Lesions

Objective:The aim of this study is to evaluate the diagnostic accuracy of colposcopically directed biopsy(CDB)and loop electrosurgical excision procedure(LEEP)for cervical lesions and assess their ability to detect glandular involvement.Methods:This retrospective study reviewed 4689 cervical lesions that were tested by CDB and LEEP at a tertiary hospital.The sensitivity,specificity,and predictive value of CDB and LEEP and the ratio of glandular involvement detected by these two methods were analyzed.Results:CDB and LEEP had sensitivities of 95.4%and 80.0%,respectively,for diagnosing high-grade intraepithelial or more severe lesions(HSIL+)(P=0.000)and 31.8%and 87.9%,respectively,for diagnosing adenocarcinoma in situ or more severe lesions(AIS+)(P=0.001).CDB and LEEP had sensitivities of 18.1%and 90.2%,respectively,for diagnosing invasive squamous cell carcinoma(P=0.000)and 5.9%and 98.0%,respectively,for diagnosing invasive adenocarcinoma(P=0.000).The negative predictive values of CDB and LEEP for diagnosing HSIL+were 88.6%and 64.4%,respectively(P=0.000).The ratios of glandular involvement were 0.2%(CDB)and 2.4%(LEEP)in low-grade intraepithelial lesions(LSILs)and 8.9%(CDB)and 59.0%(LEEP)(P=0.000)in HSIL+.Conclusions:LEEP is superior to CDB for diagnosing AIS and detecting early invasive cancer.It should be offered as an additional investigation to all patients with AIS,HSIL,or LSIL with glandular involvement on CDB.

电子阴道镜诊断宫颈疾病1900例临床分析

目的探讨电子阴道镜检查在宫颈疾病诊断中的价值。方法2002年2月至2007年3月对本溪市中心医院1900例患者进行电子阴道镜检查,并与组织病理学检查结果对照。结果1900例电子阴道镜检查中,行活体组织病理学检查802例,病理学检查诊断为宫颈炎452例,宫颈上皮内瘤样病变(CIN)Ⅰ～Ⅲ320例,宫颈癌12例,宫颈湿疣14例,正常宫颈4例。诊断正确率98.4%,假阳性率3.7%,敏感度为96.1%,特异度为90.1%。结论电子阴道镜检查对诊断宫颈疾病,尤其对诊断CIN和宫颈癌有重要价值,结合组织病理学检查可以提高诊断的准确率。