Four and a half year follow up of women with dyskaryotic cervical smears

Fletcher, A. E.; Metaxis, N; Grubb, Chandra; Chamberlain, Jean

doi:10.1016/0020-7292(91)90343-4

Cited by 10 publications

(11 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Thus, a stepwise course may not be obligatory. The finding that women with positive cervical smears and negative follow-up later developed tis- sue-proven CIN 3 is in keeping with the concept of fluctuating cervical lesions and similar to previous findings [24,25].…”

Section: Discussionsupporting

confidence: 76%

Prognostic Implications of Cervical Intraepithelial Neoplasia in a Single Cervical Smear

Bertelsen

Hartveit²

1998

Gynecol Obstet Invest

View full text Add to dashboard Cite

Our aim was to investigate the prognostic implications of a single cervical smear showing cervical intraepithelial neoplasia (CIN) in a group of women with a previous series of negative smears, and to estimate their risk of developing histologically confirmed CIN 3. A retrospective case-control study was set up. It consisted of 171 cases and 513 age-matched controls, all with at least 3 negative and no positive smears between 1981 and 1988 inclusive. In all cases CIN had been diagnosed on cytology in 1989, while the controls had remained negative. The women were followed up to the end of 1995. The outcome was recorded in terms of regression, progression, persistence or surgical treatment. In women with a single smear showing CIN 1 or 2, the risk of developing histologically proven CIN 3 was 14 and 26 times that in women with negative smears. Negative control smears in the short term did not exclude subsequent progression. Thus women with a single cervical smear indicating CIN 1 had a greatly enhanced risk of producing a lesion that demanded intervention. Such cases should be observed closely with repeat smears over a period of at least 6 years.

show abstract

Section: Discussionsupporting

confidence: 76%

Prognostic Implications of Cervical Intraepithelial Neoplasia in a Single Cervical Smear

Bertelsen

Hartveit²

1998

Gynecol Obstet Invest

View full text Add to dashboard Cite

show abstract

“…There are a number of possible reasons why a biopsy‐proven abnormality is not found in the cone biopsy including complete removal by biopsy, pregnancy, delivery and regression 5 . A much greater problem were the 47 patients with true negative cone biopsies who had not had their smear predictions confirmed as histological abnormalities.…”

Section: Discussionmentioning

confidence: 99%

Investigation of 100 consecutive negative cone biopsies

Golbang

Scurry

Jong

et al. 1997

BJOG

View full text Add to dashboard Cite

Objective To investigate the reasons for cone biopsies reported as not containing intraepithelial or invasive malignancy and thereby find ways to decrease their incidence.Design One hundred cone biopsies reported as negative were identified out of a total of 436 consecutive cone biopsies. The patients' cytology, colposcopy and histology reports and cytology and histology slides were reviewed. Further opinions in cases of doubt were obtained in cytology and histology. In cone biopsies still considered negative after reviews, deeper levels were cut, exhausting all paraffin blocks. Follow up cytology, colposcopy and histology were reviewed.Setting Gynaecological oncology unit in a university teaching hospital.Results After re-evaluation the final diagnoses of cone biopsies initially reported as negative were positive (n = 21), unsatisfactory (n = 27) and true negative (n = SI), with one case excluded because of insufficient material for review. The positive cases were diagnosed on review (n = 11) or extra levels (n = 10). The unsatisfactory cases were all due to denudation. The 5 1 true negative cases were divided into those which never had had histologic confirmation by punch biopsy or endocervical curettage (n = 47) and those with a previously confirmed histological abnormality (n = 4). Conclusions The number of negative cone biopsies can be reduced by: 1. taking Pap smears after correction of atrophy and inflammation; 2. more scrupulous colposcopy aimed at reducing the number of unsatisfactory colposcopies or misinterpreted colposcopic findings; this thorough examination should include the vagina and vulva; 3. confirmation of smear and colposcopic findings by biopsy prior to cold-knife conisation and performing a large loop excision of the transformation zone (LLETZ) for cases where there is a discrepancy between the smear abnormality and colposcopy/biopsy findings; 4. good quality cone biopsies using a technique that does not handle the mucosa and is performed after the mucosa has had time to regenerate following the colposcopic investigations; and 5. exhausting all blocks with multiple levels before reporting a cone biopsy as negative. INTRODUCTIONThe traditional management of preinvasive disease of the cervix begins with an abnormal smear detected on routine screening. The patient is referred to a colposcopist who attempts to grade, delineate and biopsy the abnormality. A colposcopic-directed biopsy confirms the smear and colposcopic diagnoses and, at a second visit, the abnormal transformation zone is destroyed. Where there is suspicion of invasion or adenocarcinoma in situ or an unsatisfactory colposcopy (defined as an inability to see the full transformation zone, the endocervical limits of a lesion or a discrepancy between the smear and colposcopic findings) a cone biopsy is performed. The cone biopsy usually provides a definitive diagnosis, with type, grade, extent of the lesion and state of the resection lines. Not infrequently, however, no lesion is found on histological examination of the cone biops...

show abstract

“…Excluding the three carcinomas that occurred in the 434 women who were lost to follow up, this represents an annual incidence of invasive cancer of 143 per 100 000 women8 - hardly reassuring. A similar study in north London found an annual incidence of invasive disease of 420 per 100 000, a rate 60 times greater than the age adjusted background rate 10. In the large British studies of cytological surveillance of women with mild cytological abnormalities the annual incidence of invasive cancer ranged from 143 to 420 per 100 000 8.…”

Section: Surveillance Is Inadequatementioning

confidence: 90%

Controversies in Management: Immediate referral to colposcopy is safer

Soutter

1994

BMJ

View full text Add to dashboard Cite

Four and a half year follow up of women with dyskaryotic cervical smears

Cited by 10 publications

References 0 publications

Prognostic Implications of Cervical Intraepithelial Neoplasia in a Single Cervical Smear

Prognostic Implications of Cervical Intraepithelial Neoplasia in a Single Cervical Smear

Investigation of 100 consecutive negative cone biopsies

Controversies in Management: Immediate referral to colposcopy is safer

Contact Info

Product

Resources

About