Comparison of Vaginal versus Oral Estradiol Administration in Improving the Visualization of Transformation Zone (TZ) during Colposcopy

Beniwal, Sanjay; Makkar, Binni; Batra, Swaraj; Gandhi, Gauri; Goswami, Deepti; Zutshi,

doi:10.7860/jcdr/2016/19492.8201

Cited by 5 publications

(5 citation statements)

References 9 publications

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“…Caution is therefore advised when interpreting non‐representative biopsies from women with TZ3. To improve the visualization of the TZ and a potential lesion, a few trials have suggested pre‐colposcopic treatment with estrogen or misoprostol 30–32 . Unfortunately, these studies suffer from a small sample size, and future well‐conducted clinical trials are therefore needed to clarify the potential impact of this treatment, including the appropriate dose and duration of treatment.…”

Section: Discussionmentioning

confidence: 99%

“…To improve the visualization of the TZ and a potential lesion, a few trials have suggested pre‐colposcopic treatment with estrogen or misoprostol. 30 , 31 , 32 Unfortunately, these studies suffer from a small sample size, and future well‐conducted clinical trials are therefore needed to clarify the potential impact of this treatment, including the appropriate dose and duration of treatment. Endocervical curettage (ECC) is another possibility for obtaining histopathological material in women with TZ3.…”

Section: Discussionmentioning

confidence: 99%

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Cervical intraepithelial neoplasia in women with transformation zone type 3: cervical biopsy versus large loop excision

Gustafson

Hammer

Bennetsen

et al. 2022

BJOG

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Objective To compare the proportion of cervical intraepithelial neoplasia grade 2 or higher (CIN2+) in cervical biopsies with that in large loop excision of the transformation zone (LLETZ) specimens in women aged ≥45 years with transformation zone type 3 (TZ3). Design Multicentre cross‐sectional study. Setting Three colposcopy clinics in the Central Denmark Region. Population Women aged ≥45 years referred to colposcopy as a result of a positive human papillomavirus (HPV) test and/or abnormal cytology and with TZ3 at colposcopy. Methods Women had multiple biopsies taken and an LLETZ was performed. Main outcome measures Histologically confirmed CIN2+ in biopsies compared with that in LLETZ specimens. Results Of 166 eligible women at colposcopy, 102 women with paired data from biopsies and LLETZ specimens were included for final analysis. The median age was 67.7 years (IQR 62.6–70.4 years), and most were postmenopausal (94.1%) and had undergone HPV‐based screening (81.3%). The CIN2+ detection rate was significantly higher in LLETZ specimens than in biopsies (32.4% vs 14.7%, difference 17.7%, 95% CI 6.3–29.0%), resulting in more than half of CIN2+ cases being missed in biopsies (54.5%, 95% CI 36.4–71.9%). The overall agreement between biopsies and LLETZ was 82.4% (95% CI 73.6–89.2%). Conclusions CIN2+ detection is underestimated in women aged ≥45 years with TZ3 if detection relies on the results of biopsies alone. To reduce the risk of underdiagnosis and overtreatment, future studies should explore the use of new biomarkers for risk stratification to improve discrimination between women at increased risk of CIN2+ who need to undergo LLETZ and women who may undergo follow‐up.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cervical intraepithelial neoplasia in women with transformation zone type 3: cervical biopsy versus large loop excision

Gustafson

Hammer

Bennetsen

et al. 2022

BJOG

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“…Conversion of Type 3 TZ to Types 1 or 2 has not been given adequate attention as evident in the limited number studies in the medical literature. Although oral and intravaginal estradiol have also been tried in converting Type 3 TZ to Types 1 or 2 with promising results ( Beniwal et al, 2016 , Saunders et al, 1990 , Piccoli et al, 2008 ), their multi-dose regimen over 5–10 days increases cost and makes compliance difficult ( Aggarwal et al, 2006 ). However, misoprostol is administered in single dose which is an added advantage ( Pergialiotis et al, 2015 ).…”

Section: Discussionmentioning

confidence: 99%

Effect of misoprostol on type 3 transformation zone of the cervix among Cameroonian women

Manga

Liang

et al. 2022

Gynecologic Oncology Reports

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“…Several investigators recommended cone biopsy in those cases. 5,6 In the present study, we sought to assess the risk of developing high-grade lesions (CIN2þ) among women with low-grade cervical cytology and unsatisfactory colposcopic examination. Additionally, we aimed to identify factors predicting CIN2þ among this cluster of women.…”

Section: Introductionmentioning

confidence: 99%

“…Several investigators recommended cone biopsy in those cases. 5,6…”

Section: Introductionmentioning

confidence: 99%

Predicting Factors for High-Grade Cervical Dysplasia in Women With Low-Grade Cervical Cytology and Nonvisible Squamocolumnar Junction

et al. 2019

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Comparison of Vaginal versus Oral Estradiol Administration in Improving the Visualization of Transformation Zone (TZ) during Colposcopy

Cited by 5 publications

References 9 publications

Cervical intraepithelial neoplasia in women with transformation zone type 3: cervical biopsy versus large loop excision

Cervical intraepithelial neoplasia in women with transformation zone type 3: cervical biopsy versus large loop excision

Effect of misoprostol on type 3 transformation zone of the cervix among Cameroonian women

Predicting Factors for High-Grade Cervical Dysplasia in Women With Low-Grade Cervical Cytology and Nonvisible Squamocolumnar Junction

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