Browsing by Subject "colposcopy"

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  • Petry, K. Ulrich; Nieminen, Pekka J.; Leeson, Simon C.; Bergeron, Christine O.M.A.; Redman, Charles W.E. (2018)
    A refinement of quality indicators (Qls) is described whereby the quality of care can be measured across colposcopy services in different countries and healthcare settings. A five-round Delphi process was conducted at successive satellite meetings from 2011 to 2015 of leading European colposcopists to refine the most high-scoring Qls relevant to colposcopic practice. A review and refinement of the wording of the standards and their criteria was undertaken by national society representatives. Six quality indicators were identified and refined. "Documentation of whether the squamocolumnar junction (SCJ) has been visible or not" was changed into "for cervical colposcopy transformation zone (TZ) type (1, 2 or 3) should be documented". The standard "percentage of cases having a colposcopic examination prior to treatment for abnormal cytology" was changed to "percentage of cases having a colposcopic examination prior to treatment for abnormal cervical screening test". The standard "percentage of all excisional treatments/conizations containing CIN2+ (cervical intra-epithelial neoplasia grade two or worse)" was changed into "percentage of excisional treatments/conizations having a definitive histology of CIN2+. Definitive histology is highest grade from any diagnostic or therapeutic biopsies". The standard "percentage of excised lesions/conizations with clear margins" was unchanged. The remaining two Qls define the minimum caseloads required for colposcopists. However, "cytology" was replaced by "screening results"to acknowledge the introduction of human papillomavirus testing to European screening programmes. Six Qls were identified to define good practice in colposcopy. (C) 2018 The Authors. Published by Elsevier B.V.
  • Bergqvist, Laura; Kalliala, Ilkka; Aro, Karoliina; Auvinen, Eeva; Jakobsson, Maija; Kiviharju, Mari; Virtanen, Seppo; Dillner, Joakim; Nieminen, Pekka; Louvanto, Karolina (2021)
    Risk factors for the different human papillomavirus (HPV) genotypes are not well understood, although the risk of cancer is known to vary among them. Our aim was to evaluate the association of diverse behavioral and reproductive factors with genotype-specific HPV prevalence among 879 unvaccinated women aged 18-75 years referred to the colposcopy clinic at Helsinki University Hospital in Finland. Cervical swabs for HPV genotyping were collected in the first visit and assessed for 34 high-risk (hr) and low-risk (lr) HPV genotypes. Participants completed a questionnaire on behavioral, reproductive, and lifestyle factors. Differences in genotype-specific HPV prevalence were analyzed overall and in age groups using binary logistic regression. Smoking was associated with higher prevalence in HPV16 compared with other hrHPV genotypes together with decreasing age, being highest among younger women 20 years of age, with an OR of 0.43 (95% CI 0.23-0.83). This association was not seen with other hrHPV genotypes. Methods of contraception seemed not to have an effect on hrHPV positivity, regardless of the HPV genotype. The genotype specific hrHPV prevalence differs, depending on behavioral factors, especially among younger women referred to colposcopy.
  • Forsell, Sabrina; Kalliala, Ilkka; Halttunen, Mervi; Redman, Charles W. E.; Leeson, Simon; Tropé, Ameli; Moss, Esther; Kyrgiou, Maria; Pyörälä, Eeva; Nieminen, Pekka (2020)
    Simple Summary Cervical cancer prevention is presently undergoing a thorough reformation due to introduction of human papillomavirus (HPV)-testing and vaccines in primary prevention. The screening program, however, is more than a single test or preventive intervention-the possible lesion has to be found, located and treated. Colposcopy plays a major role in this management. Literature dealing with training and learning, especially with colposcopy, is extremely scarce. The aim of the European Federation of Colposcopy, EFC, is to improve the education and training in colposcopy, e.g., by organizing colposcopy courses. The aim of our prospective interventional study was to pilot this intensive participant activating EFC Basic Colposcopy Course on the short- and long-term learning of colposcopy-related knowledge, image recognition and the diagnostic confidence. High-quality colposcopy is essential in cervical cancer prevention. We performed a multicentre prospective interventional pilot-study, evaluating the effect of a six-hour case-based colposcopy course on short- and long-term learning of colposcopy-related knowledge, diagnostic accuracy levels and confidence. We recruited 213 colposcopists participating in three European Federation of Colposcopy (EFC) basic colposcopy courses (Finland, Norway, UK). The study consisted of three tests with identical content performed before, after and 2 months after the course, including ten colposcopic images, ten patient cases and scales for marking confidence in the answers. Outcome measures where mean scores in correct case-management, diagnosis (including high-grade lesion recognition), transformation-zone recognition and confidence in answers. Results were compared between the three tests and stratified according to experience. Mean test scores improved after the course for all participants. The increase was highest for beginners. Confidence in answers improved and the number of colposcopists showing high confidence with low scores decreased. A structured case-based course improves skills and confidence especially for inexperienced colposcopists; however, trainers should be aware of the risk of overconfidence. To complement theoretical training, further hands-on training including high-quality feedback is recommended. Conclusions drawn from long-term learning are limited due to the low participation in the follow-up test.
  • Leino, Kristina (Helsingfors universitet, 2016)
    Kohdunkaulasyövän seulontojen löydösten ja niitä seuraavien jatkotutkimustulosten korrelaatiosta ei ole Suomessa tehty riittävästi kattavia tutkimuksia. Tutkimuksemme tavoitteena oli tutkia kolposkopiassa käyneiden naisten tulo-papan, kolposkopian yhteydessä otetun papan, Reid Colposcopy Index (RCI)-pisteiden ja kolposkooppisen diagnoosin sekä biopsian PAD:n korrelaatiota. Tutkimuksessa on selvitetty myös olennaiset aikaviiveet tiettyjen tutkimusten ja kirjausten välillä. Aineistona oli 908 seulontaiässä olevaa naista, jotka oli lähetetty kolposkopiatutkimukseen. Tarvittava data kerättiin potilastietojärjestelmistä (Miranda, Endobase) ja lisättiin Excel-taulukkoon. Kerätyt tiedot analysoitiin tilastotieteellisesti. Saimme selville, että tulovaiheen ja kolposkopian yhteydessä otetun irtosolunäytteen tulokset korreloivat toistensa kanssa melko huonosti, kuitenkin paremmin vahvempien muutosten, HSIL, kohdalla. Kolposkopiassa otettu papa-tulos korreloi histologisen diagnoosin kanssa paremmin kuin tulovaiheen vastaava. Korrelaatio oli yleisesti heikkoa, mutta parani vahva-asteisempien muutosten kohdalla. High risk HPV-testi on papa-testiä herkempi löytämään CIN2- ja vahvemmat muutokset. Sen lisääminen seulontaan papa-testin sijaan olisi hyödyksi yli 30-vuotiaiden ikäryhmässä. RCI-pisteiden ja histologisen diagnoosin välinen korrelaatio oli melko vahva. Viive poikkeavasta irtosolunäytteestä kolposkopiatutkimukseen pääsyyn näytti pysyvän hyvin tavoitteissa, paremmin lieväasteisten solumuutosten kohdalla.
  • Heinonen, Annu; Jakobsson, Maija; Kiviharju, Mari; Virtanen, Seppo; Aro, Karoliina; Kyrgiou, Maria; Nieminen, Pekka; Kalliala, Ilkka (2020)
    Colposcopy is often used in follow-up after treatment for cervical intraepithelial neoplasia (CIN) despite its marked inter-observer variability and low sensitivity. Our objective was to assess the role of colposcopy in post-treatment follow-up in comparison to hrHPV (high-risk human papillomavirus) testing, cytology, and cone margin status. Altogether, 419 women treated for histological high-grade lesion (HSIL) with large loop excision of the transformation zone (LLETZ) attended colposcopy with cytology and hrHPV test at six months. Follow-up for recurrence of HSIL continued for 24 months. Colposcopy was considered positive if colposcopic impression was recorded as high grade and cytology if HSIL, ASC-H (atypical squamous cells, cannot exclude HSIL), or AGC-FN (atypical glandular cells, favor neoplasia) were present. Overall, 10 (10/419, 2.4%) recurrent HSIL cases were detected, 5 at 6 months and 5 at 12 months. Colposcopic impression was recorded at 407/419 6-month visits and was positive for 11/407 (2.7%). None of them had recurrent lesions, resulting in 0% sensitivity and 97% specificity for colposcopy. Sensitivity for the hrHPV test at 6 months was 100% and specificity 85%, for cytology 40% and 99%, and for margin status at treatment 60% and 82%, respectively. While the hrHPV test is highly sensitive in predicting recurrence after local treatment for CIN, colposcopy in an unselected population is not useful in follow-up after treatment of CIN.