records Cytologic evaluation was done on all Pap smears according to the Son, Kyung-A; Kim, Minji; Kim, Yoo Min; Kim, Soo Hyun; Choi, Review Date 12/1/ Updated by: Subodh K. Lal, MD, Gastroenterologist. Liabsuetrakul, Tippawan; Choobun, Thanapan; Peeyananjarassri, Krantarat; Islam, Q Monir. Main · Videos; Single moms dating diary es papanicolaou yahoo dating que es papanicolaou yahoo dating introvert dating problems introvert dating problems. E-mail: [email protected] de degré inférieur, que dans la différenciation d' une maladie de degré inférieur du cou normal. Son rôle intégrant dans le traitement de la maladie cervicale précoce est donc justifié. It is perhaps of interest that the colposcope predates the Papanicolaou (Pap) smear – exfoliative .
Inclusion criteria for the selection of articles were as follows: This was done to assess the methodology that was employed in the study. Articles that reported work done by other people would not assure that the selection criteria had been met.
This was necessary to truly assess the ability of the colposcopist to recognise the lesion. This ensured that data needed for statistical analysis was provided. Exclusion criteria were as follows: Such studies were excluded because unsatisfactory colposcopy implies that a definitive colposcopic impression could not be made prior to subsequent biopsy, therefore, there would be no basis for comparison.
Most of the studies were rejected because they only presented summary results and did not provide raw data to enable statistical analysis. The characteristics of these articles are summarised in Table 1.
The outcome measured was the correlation between colposcopic impression and histologic diagnosis as measured by statistical references, with histologic diagnosis as the criterion standard. Terminology, Data Tabulation and Analysis Colposcopic impression refers to the colposcopist's opinion as to the nature of the underlying lesion based on classic colposcopic features.
Histologic diagnosis refers to the report of the histologist on the colposcopically directed biopsy specimen. For ease of cross reference, the terminology used for categorisation of grades of abnormality is the Bethesda system33, to which earlier classification systems were converted. Cases of carcinoma in situ, microinvasive carcinoma or frank invasion could not be separately stratified and were grouped together with high grade lesions due to their low numbers.
By pairing colposcopic-histologic findings, each coloscopic impression was placed in one of four possible categories, namely, true positive TPfalse positive FPtrue negative TN and false negative FN. The parameters used to assess the validity of colposcopy were as follows: All these values are reported in percentages.
Likelihood ratios express how many times more or less likely a test result is to be found in diseased compared to non-diseased people. To calculate these ratios, the study population was divided into those with disease present and those with disease absent.
Likelihood ratios less than 0. First, the ability to differentiate a normal cervix from an abnormal one was examined. Next, a different cut off was chosen to examine the same characteristics for colposcopic ability to recognise a high grade abnormality versus other grades, i. This shift in threshold value was done to examine colposcopic performance over different ranges of abnormality. It is seen from this table that the tendency at colposcopy to diagnose a lesion as more severe is the same as the tendency to diagnose a lesion as less severe.
By choosing a different cut-off point where only high grade lesions are regarded as abnormal, a fall in sensitivity is observed with a concomitant large increase in specificity.
This is depicted in Table 2b. This shift in threshold value also reflected in appreciable increases in the positive predictive values. These results suggest that colposcopy is more efficient in distinguishing high grade from low grade lesions than in distinguishing low grade from normal cervical tissue.
The likelihood ratios of obtaining a particular result for a given disease state are presented in Table 3 and a definite trend is preserved throughout all the studies. There is a consistent increase in the values in moving from one stratum to another. This is further evidence that colposcopy is more efficient in diagnosing high grade lesions, with the implication that there is a more appreciable difference when distinguishing HSIL from less serious diagnosis than when distinguishing LSIL from normal cervical findings.
It is a disease for which screening is suitable and early treatment is beneficial. In the past, cold knife conisation biopsy was the traditional method employed to provide definitive histological diagnosis in patients with abnormal cervical smears. A cone biopsy though accurate and useful carries with it complications that cannot be ignored.
It requires hospitalisation and the patient's reproductive capability is often jeopardised. The accuracy of colposcopy in the clinical diagnosis of cervical neoplasia in patients with abnormal cytology has been variously documented by several investigators in various clinical settings, in different cohorts of patients and using different outcome measures.
It has tried to eliminate possible sources of bias due to patient selection, intervention methodology and outcome measure bias as much as possible while trying to aggregate a homogenous collection of patients suitable for such analysis. However, language and publication bias proved difficult obstacles to surmount in the circumstances. The validity of colposcopy as an integral part of the management of early cervical neoplasia is confirmed by this review. Test Performance The validity of colposcopy to diagnose early cervical neolplasia is attested to by the very high level of accuracy of this review.
A high sensitivity was observed at the expense of the specificity but identifying lesions as cancer is more important than avoiding overcalling of lesions. However, when the threshold of diagnosis was raised, a marked improvement in specificity was observed.
The implication of this is that colposcopy performs better in the identification of higher grades of intraepithelial neoplasia than it does in the recognition of low grade lesions. This fact is also attested to by the observed likelihood ratios Table 3which show a consistent pattern among all the studies. There was clear demarcation among diagnoses with small but consistent and important shifts occurring between normal cervix, low grade and high grade SIL.
This information supports that presented for the distribution of proportional sensitivities and specificities, indicating that clinically there is a larger appreciable difference when distinguishing high grade SIL and cancer from less serious diagnoses than when distinguishing low grade SIL from normal cervix and inflammation. This difference supports the validity of the Bethesda classification. However, there was an equal proportion of false positives as there were false negatives, although false positive results were more likely with low grade lesions Table 3.
Several reasons have been adduced for the false positive rate of colposcopy. There are some benign lesions of the cervix such as papillomatous lesions in which colposcopic differentiation from a malignant lesion is extremely difficult or sometimes impossible, where a directed biopsy is necessary to establish the correct diagnosis. There is also the potential for measurement error by colposcopists because of their knowledge of previous Pap smear result.
Underestimation may occur when a high grade lesion may be overlooked because it is placed within a larger area of prominent aceto-white epithelium typical of low grade disease. The apparent colposcopic overestimation of low grade disease may be an excessive representation based on a falsely negative histologic standard.
Colposcopy is a visual technique that requires extensive training and experience. The limiting factor in the use of this diagnostic tool is the clinical skill and experience of the operator.
As is true with the use of any scientific instrument, the accuracy of the method is directly related to the expertise of its operator. In this regard, to ensure that colposcopy continues to yield a satisfactory level of accuracy, proper training and certification of colposcopists is recommended with appropriate quality control programmes.
An appropriate volume of patients must be seen yearly in order to maintain these skills41, therefore, it may be necessary to centralise services within geographical areas to ensure that the highest possible level of care is rendered to patients requiring colposcopic assessment.
The false negative rate of colposcopy is of particular concern as under-diagnosis is as important as over-diagnosis. Endocervical curettage has been considered by a number of observers and its use varies from none13,51, to use only when it would contribute to management52,53, and use in all patients54, Some workers believe the results are always positive in patients with invasion. Randomised controlled trials are needed to provide evidence of best practice. Implications for Research A number of new clinical management strategies and technologies are being proposed and tested to address the need to improve screening and detection of squamous intraepithelial neoplasia and cervical cancer.
These include HPV testing, cervicography, speculoscopy, the polar probe, and fluorescence spectroscopy. Some of these have been proposed to supplement colposcopy as a diagnostic tool while others have been proposed to replace colposcopy.
Arguments have been largely centred around cost effectiveness. These reasons are quite valid but to determine their optimal clinical role, these strategies must be shown to have a performance better or at least at par with the current standard of colposcopy.
Efforts must continue to strive to provide the best colposcopy can offer. Such facility has been reported with promising results. It may be used for on site training, continuing evaluation, certification and ongoing collaborative support.
The technique is particularly attractive because it removes the need for practice eligibility registrations in intended host institutes, visa restrictions, and travel as well as living expenses. The inter-observer variability, which is dependent on skill and expertise of the operator, is a potential limitation of colposcopy. The use of computerised image analysis of the colposcopic appearance is a method worthy of exploring through research in order to deal with this limitation.
Anyone using colposcopy must be satisfied that this fundamental criterion is met. The final conclusion is that colposcopy is an indispensable tool in the evaluation of a patient with an abnormal cytology.
Colposcopically directed biopsy provides a histopathological diagnosis and colposcopic impression provides information concerning the lesion size and location, which form the basis of additional management. Overview of literature revealed that colposcopy is a diagnostic technique with qualities within acceptable clinical standards. SUMMARY A review of literature revealed that colposcopy is very accurate in the diagnosis of early cervical neoplasia and it has a high sensitivity for detection of lesions.
The positive predictive rate is better, as the cervical lesion is more severe. The limitation of colposcopy is its dependence on observer variability and relatively weaker performance in differentiating normal cervix from low grade lesions.
Innovations to improve its performance in this regard are needed. Recently, computer assisted analysis of the colposcopic image is being evaluated. It is concluded that colposcopy is an indispensable tool in the management of premalignant cervical disease as long as the limitations of the technique are kept in mind by the operator.
The diagnostic value of vaginal smears in carcinoma of the uterus. Am J Gynecol Obset ; Early Carcinoma of the Uterine Cervix: Grune and Stratton, Effect of cervical cancer screening in Scandinavia. Obstet Gynecol ; Trends in the incidence of cervical cancer in the Nordic countries. Trends in cancer incidence, causes and practical implications. Colposcopic assessment of the accuracy of cervical cytology screening.
Br Med J ; These are ages under 30 and over 49 years and being unmarried.
The major sources of information about various reproductive health matters and programmes among young people include relations and friends, school, health facilities, mass media, public lecture, among others. In recent times, however, the use of the internet is becoming increasingly popular among Nigerian undergraduates and young people in general.
Goold et al observed that the internet could be a practical and accessible way of delivering sexual health education to young people, particularly if it is incorporated into websites they enjoy. Many undergraduates fall into this age category. It also assesses their awareness about the disease and its prevention. Materials and Methods This cross-sectional study was conducted among female undergraduates of the University of Ibadan.
Pre-testing of the questionnaire was done among 20 students before the final questionnaire was developed.
Twenty five per cent over-sampling was done to allow for incomplete responses. Hence, a sample size of was used. The questionnaire was administered to a random sample of students from the three female hostels in the university in Each room had four occupants.
Respondents were recruited from the hostels by fellow female undergraduates, who were trained for the purpose. This involved prior provision of an information leaflet stating the protocol for the study in clear terms. Thereafter, willing respondents completed the consent form before they were given the self-administered questionnaires.
In cases where there was apparent lack of knowledge about cervical cancer or Pap smear, attempts were made to explain what the condition or procedure was by the interviewer. Initial analysis was by generation of frequency tables while further analysis involved cross-tabulations to explore statistical relationships between variables. Graphs and figures were drawn using the Microsoft Excel software.
Results Demographic Characteristics Four hundred and eighty three respondents completed the questionnaire; 62 were incompletely filled, leaving The age of respondents ranged from 16 to 36 years.
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Their mean age was Table 1 shows the distribution of respondents based on their demographic characteristics and sexual activity. Three hundred and eleven They were distributed across the College of Medicine and seven other faculties in the university, but the College of Medicine had more respondents Three hundred and forty eight Sexual Activity Three hundred and forty three Two hundred and eighteen Their ages at sexual debut ranged from 11 to 27 years.
This is illustrated in figure 1.
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Two hundred and forty Two hundred and fifty five Awareness Three hundred and eighty two Ninety six per cent of students of the College of Medicine were aware of cervical cancer, compared to Among married respondents Proportions of respondents who were aware of the tumour were similar among the religious groups Table 3 shows that Other means of awareness were friends, colleagues and relations 8.
In contrast, only The remaining Of the College of Medicine students, Comparable percentages of students had knowledge of Pap smear across the religions, tribes and sexual activity. The majority 91 or Of the respondents that were aware of Pap smear, Also, 91 respondents Others thought that the test is reserved for women who have started childbearing or elderly women.
Of those who were aware of Pap smear However, level of knowledge about correct use of the test was comparable across marital status, religion, tribe and sexual activities.
Use rate also varied with the year of study; from Three hundred and eight Reasons for this included belief in not being at risk of cancer of the cervix Discussion The lower age limit for admission into most Nigerian universities is 16 years. Therefore, most undergraduates are in their late teens and early twenties.
This was similar to findings by Arowojolu et al among a similar population. Others are low prevalence of condom use, high parity and poor utilisation of screening facilities. Many of them also had early sexual debut. Over half of them The pattern of sexual behaviour seen in this study is similar to what was found in previous studies.
A similar low rate of condom utilisation was reported by Unuigbe and Ogbeide in a study on sexual practices among adolescents in Benin City, Nigeria. Awareness of cervical cancer was high but needs to be improved, considering how common the disease is in developing countries.
However, the factors that were in favour of knowing about the disease included being a student of the College of Medicine, marriage and sexual activity Table 2. The religion and tribe of respondents had no statistically significant effect on knowledge about the disease. The determinants of awareness were, being a student of the College of Medicine and marriage. This is only followed by the mass media Table 3. Married women often visit the hospital when they are pregnant.
The majority of those who were aware of the test knew its correct use The only factor identified to be associated with correct knowledge was being a student of the College of Medicine. This is expected, as the medical students are more likely to have come across information on the disease and its prevention in the course of their training. This is in line with the findings of Lindau et al, which suggested that health literacy is a better predictor of cervical cancer screening knowledge than formal education or ethnicity.
It was however observed that the married, the sexually active and students in the third year and above were more likely to have the test were Table 4. Less frequent reasons were lack of knowledge of centres where the test could be done