European consensus statement on essential colposcopy

Peer reviewedPostprin

Accuracy of colposcopy-directed punch biopsies

Abstract not available</p

Is the colposcopically-directed punch biopsy a reliable diagnostic test in women with minor cytological lesions?

OBJECTIVE:</p

Intravascular leiomyomatosis: A case report and review of the literature

Intravascular leiomyomatosis (IVL) is a rare condition in which histologically benign smooth muscle neoplasms arising from the intrauterine vessels infiltrate and invade systemic veins, including the inferior vena cava (IVC) (CitationCho et al. 2011). These tumours can further extend to the right heart and into the pulmonary arterial system, causing a pulmonary embolism (CitationFasih et al. 2008). This is called intracardiac leiomyomatosis and may result in the development of cardiac symptoms, a murmur, syncope and even death (CitationLou et al. 2011). To correctly diagnose IVL pre-operatively, comprehensive imaging using computerised tomography (CT) and magnetic resonance imaging (MRI), and possibly other modalities, need to be incorporated (CitationPan et al. 2013). Treatment is surgical, with excision of the primary uterine mass and often cardiotomy to remove any intracardiac lesion; though, unusually, we present a case without the need for cardiotomy, a staged approach or cardiothoracic surgery (CitationLam et al. 2003)

Success Rate of cold coagulation for the treatment of cervical intraepithelial neoplasia: A retrospective analysis of a series of cases

Objective To establish the cure rate at 1 year of patients who have undergone cold coagulation for the treatment of cervical intraepithelial neoplasia (CIN).Design Retrospective review of data for all patients at Shrewsbury and Telford NHS Trust who had undergone cold coagulation as part of their treatment for CIN between 2001 and 2011. Follow-up data up to December 2012 were analyzed.Setting Colposcopy Department, Shrewsbury and Telford NHS Trust, United Kingdom.Population Women undergoing cold coagulation for the treatment of CIN between 2001 and 2011, with cytologic follow-up until December 2012.Methods Patients were identified using a local colposcopy database. Data were obtained via the local histopathology reporting systems. Statistical analyses were performed using Stata/IC 10.1 software.Main Outcome Measures Posttreatment cytology and whether subsequent treatment was required, with histology results.Results Data on 557 patients were collected and analyzed. Pre–cold coagulation treatment histologic findings were CIN 1 in 156 patients (28.01%), CIN 2 in 260 patients (46.68%), and CIN 3 in 141 patients (25.31%). The median length of time between cold coagulation treatment and first follow-up smear, used to calculate cure rates at around 1 year, was 406 days (interquartile range 123 days, range 169–3,116 days). The cure rate after cold coagulation was 95.7% at around 1 year.Conclusions Cold coagulation has a cure rate comparable to that of excisional treatments such as large loop excision of the transformation zone and should be considered more widely in patients undergoing primary treatment for CIN, where there is no suspicion of invasive disease on history, examination and cytologic results

European Federation of Colposcopy quality standards Delphi consultation

OBJECTIVE:</p

Colposcopy training and assessment across the member countries of the European Federation for Colposcopy.

&lt;p&gt;&lt;b&gt;OBJECTIVES: &lt;/b&gt;Colposcopy training and assessment is not uniform across Europe with individual countries determining their own required standards and regulations. In light of the significant changes in colposcopic practice that have occurred over the past decade and the expansion of the European Federation for Colposcopy (EFC) membership, a study was conducted firstly, to assess the current requirements for training in each of the member countries and secondly, to review an EFC-approved core training curriculum for colposcopy.&lt;/p&gt;&lt;p&gt;&lt;b&gt;STUDY DESIGN: &lt;/b&gt;A questionnaire survey of the EFC representatives from all member countries investigating their country&#039;s current practices/requirements with regard to training, assessment and accreditation for colposcopy. A two-round Delphi consultation with representation from the full, associate and three potential member countries was conducted using a 5-point Likert scale for scoring opinions. The results were analysed with respect to each country&#039;s population size and World Bank economic classification.&lt;/p&gt;&lt;p&gt;&lt;b&gt;RESULTS: &lt;/b&gt;For the questionnaire survey, responses were received from 31/34 countries invited to participate. Training programmes were reported to be in place in 21 of the 31 countries but only 17 of the 21 countries had a committee overseeing the training programme. An assessment was part of the training programme in 20 countries with multiple choice questions and portfolios the most common assessment tools. Countries with a population size less than 2 million have a statistically significant lower probability of having a structured training/assessment programme, 1/5 compared to 20/26 for a populations greater than 2 million, p=0.013. For the Delphi study, responses were received from 34/39 countries invited to participate. Of the 51 competencies previously identified only 2 did not receive full support: &#039;perform bacterial swabs&#039; and &#039;provide data to national body&#039;. There was no significant difference in the responses given by member, associate member or potential member countries.&lt;/p&gt;&lt;p&gt;&lt;b&gt;CONCLUSIONS: &lt;/b&gt;There is considerable variation in colposcopy training and assessment across Europe. This study has enabled consensus opinion with the EFC on the contents of an EFC core curriculum. The revised curriculum has a mandate from the EFC member countries to be implemented across Europe as the standard for colposcopic training.&lt;/p&gt;</p

Cytological follow-up after hysterectomy: Is vaginal vault cytology sampling a clinical governance problem? The University Hospital of North Staffordshire approach

ObjectivesVaginal vault cytology sampling following hysterectomy is recommended for specific indications in national guidelines. However, clinical governance issues surround compliance with guidance. Our first study objective was to quantify how many patients undergoing hysterectomy at the University Hospital of North Staffordshire (UHNS) had vault cytology advice in their histology report and, if indicated, whether it was arranged. The second was to devise a vault cytology protocol based on local experience and national guidance.MethodsThe local cancer registry was searched. Clinical, clerical and histological data for all patients undergoing hysterectomy were collected.ResultsIn total, 271 patients were identified from both the gynae-oncology and benign gynaecology teams. Of these, 24% (65/271) were gynae-oncology patients with a mean age of 69 years. The benign gynaecology team had 76% (206/271) of patients with a mean age of 55 years. Subsequently, 94% (256/271) had cytology follow-up advice in their histopathology report. Ultimately, from both cohorts, 39% (18/46) had follow-up cytology performed when indicated.ConclusionA high proportion of cases complied with national guidance. However, a disappointingly high number did not have vault cytology sampling when this was indicated. This is probably a result of the complex guidance that is misunderstood in both primary and secondary care. Vault follow-up of patients after hysterectomy rests with the team performing the surgery. Vault cytology, if indicated, should be performed in secondary care and follow-up should be planned. The protocol set out in this article should be followed to avoid unnecessary clinical governance failings

HPV testing and vaccination in Europe.

&lt;p&gt;Current cytology-based screening has a moderate sensitivity to detect cervical intraepithelial neoplasia grade 3 (CIN 3) and cervical cancer even in those states providing rigorous quality control of their cervical screening programs. The impact of vaccination against human papillomavirus (HPV) types 16 and 18 as well as the incorporation of HPV testing on the detection of CIN 3 and cancer is discussed. HPV testing used as a triage for atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesions, test of cure after treatment, and HPV-based primary screening may improve current cervical screening programs.HPV testing as a triage test for ASCUS seems to offer an improved sensitivity, with a similar specificity as compared to repeat cytology for diagnosing high-grade CIN and has been recommended throughout most EU states. HPV testing as a triage test for low-grade squamous intraepithelial lesions has a low specificity and is not recommended in most member states. HPV test of cure offers an improved sensitivity compared to cytology for women with persistent cervical precancer after treatment. HPV-based cervical cancer screening is more effective than screening with cytology. The effects of HPV-based screening depend on the organization of the program and on adherence to algorithms for screening triage. Otherwise, it is likely that HPV-based screening will increase the referral rate to colposcopy including more women with no detectable cervical lesion. HPV vaccination will require many years to evaluate any beneficial effects on cervical cancer incidence and mortality.&lt;/p&gt;</p

The future role for colposcopy in Europe.

&lt;p&gt;Improvements in the performance of cervical screening may be limited by the diagnostic performance of colposcopy. Nonetheless, colposcopy remains the best available tool to assess women considered at high risk for having or developing cervical cancer. The provision and role of colposcopy across Europe is variable. Introduction of vaccination against human papillomavirus (HPV) types 16 and 18 as well as the possible switch to HPV-based screening is likely to change the profiles of women presenting to colposcopy services and provide management difficulties for the colposcopist.The standard of colposcopy in Europe can be maintained or improved despite a variable availability of screening. The prevalence of cervical intraepithelial neoplasia grade 3 may decrease for women having had HPV vaccination. The incidence of cervical intraepithelial neoplasia grade 3 and cervical cancer in second and subsequent rounds of HPV-based screening are likely to decrease compared to cytology-based screening. In HPV-based screening, the numbers of women with no detectable or minor abnormalities at colposcopy and with screen-detected glandular disease are likely to increase. We have considered how these issues will affect states that have varying implementation of organized cervical screening programs and varying degrees of implementation of HPV testing or vaccination.The development of quality assurance across Europe accompanying these program changes is discussed.&lt;/p&gt;</p