The aim of our study was to assess the cumulative 5-year diagnoses of CIN2, CIN3 or invasive cervical cancer (CIN2+) after concurrent screening by high-risk HPV test and Pap smear in a primary screening setting. Four thousand thirty-four women from Eastern Thuringia/Germany were recruited from 1996 to 1998 for baseline screening that included routine cytology, high-risk HPV testing by consensus primer PCR GP5+/6+ and routine colposcopy. After a median of 59 months 3,153 women participated in final screening using identical methods. Women with abnormal cytology or colposcopy or a positive high-risk HPV test at any time during the study period were recalled for expert colposcopy and histologic verification. CIN2+ was detected in 160 women resulting in a cumulative 5-year proportion of 4.4% (95% CI: 3.7-5.0%). Of 3,702 women who were high-risk HPV negative at baseline, 34 (1.1-95% CI: 0.7-1.4%) had either prevalent CIN2+ or developed CIN2+ within the observation period. HPV/cytology double negatives at baseline were at lowest risk for CIN2+ (1.0-95% CI: 0.7-1.4%) compared to screening positives (16.8-100% depending on combined test results). The 5-year negative predictive value in HPV2/Cyto2 women was 99.0% (95% CI: 98.6-99.3%). This suggests that a prolongation of the screening intervals in this group is feasible. However, it should be noted that 1 woman developed a microinvasive carcinoma within the observation period. Moreover, 2 women with prevalent cancer were missed by both tests. The prognostic relevance of concurrent highrisk HPV/cytology screening needs to be verified further by randomized trials. ' 2005 Wiley-Liss, Inc.Key words: cervical cancer; high-risk HPV; cytology; predictive value Changes within the current primary screening setting for prevention of cervical cancer are under active discussion. It has been shown that infections with high-risk human papillomaviruses are carcinogenic.1 However, before a HPV test can be recommended for screening the efficiency and cost-effectiveness of the new system has to be demonstrated. Whereas higher sensitivity and negative predictive value of HPV testing has been shown in several, mainly cross-sectional studies, the long-term impact on incidence and mortality has been evaluated in models only.2,3 Thus, the current recommendations of various scientific societies and expert groups are controversial. The IARC working group on efficacy of cervical cancer screening concluded that there is sufficient evidence that HPV testing can reduce mortality from cervical cancer. However, further work has to be done to have an affordable, simple and reliable test.4 So far, no updated, comprehensive model calculations for the cost-effectiveness of HPV testing have been published for Europe since important data are still lacking. Our study funded exclusively by the government may add additional knowledge to this important issue of women's health.We followed a cohort of women originally recruited in the scope of a HPV diagnostic study 5 over a period of about 5 years to prove the ...

Ridge sign is a highly specific marker for CIN 2 or 3 and associated with HPV 16 and young age.

Inner border is a rare colposcopic phenomenon but highly specific for CIN 2 or 3 in young women.

Hysteroscopic sterilization is a minimally invasive, nonincisional method of permanent sterilization that is a valid alternative to laparoscopic sterilization, the conventional method of female sterilization. Under hysteroscopic guidance, an expanding microinsert is introduced into the proximal portion of each fallopian tube; local fibrosis and, ultimately, complete tubal occlusion occurs within 3 months. This retrospective study examined trends in sterilization in women at an outpatient surgery center and university teaching hospitals following the introduction of Essure hysteroscopic sterilization in 2002. A chart review was conducted on women undergoing interval sterilization procedures and postpartum sterilization procedures between 2002 and 2007. Interventions evaluated included minilaparotomy tubal ligation, laparoscopic sterilization, Essure hysteroscopic sterilization, and postpartum tubal ligation performed after vaginal delivery or at the time of cesarean section.Of the 5509 permanent sterilization procedures examined, 2484 were interval sterilization procedures and 3025 were postpartum tubal ligations. For all interval sterilizations performed during the 6-year-study period, a shift toward Essure hysteroscopic sterilizations from 0.0% to 51.3% corresponded significantly with a decrease in laparoscopic sterilizations from 97.9% to 48.5% (P Ͻ 0.001). During the study period, the number of postpartum tubal ligations performed after vaginal delivery decreased significantly from 7.9% to 3.3% of all vaginal deliveries (P Ͻ 0.001), whereas the number of tubal ligations performed at the time of cesarean section did not change significantly (P ϭ 0.51).These findings suggest the high likelihood that Essure hysteroscopic sterilization will replace the laparoscopic approach as the method of choice for permanent sterilization. ABSTRACTIt is becoming increasingly common to enable a woman to see her ambulatory hysteroscopy procedure on a monitor. However, there is only limited evidence on the potential impact of seeing or not seeing the procedure on patient mood, perception of pain, and patient-physician interaction. This randomized controlled trial compared the effects of seeing or not seeing the screen during an outpatient hysteroscopy procedure on patient's experience. At two outpatient clinics, 157 women scheduled for a hysteroscopy procedure were randomized either to see the screen (n ϭ 81) or not to see the screen (n ϭ 76). Before and after the procedure, the patients completed questionnaires to evaluate various parameters of their experience (mood, pain perception, illness cognitions, and communication with the health professional). After 232Obstetrical and Gynecological Survey Office Gynecology 233ABSTRACT Some investigators have reported that presence of the inner border may be a colposcopic sign for the presence of high-grade cervical neoplasia. The inner border can be defined as a sharp acetowhite demarcation or transformation zone within a less opaque acetowhite area. The association of the colposcopic si...