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Objective: The purpose of this study was to determine the rate of unsatisfactory Papanicolaou tests between gynecology and nongynecology providers at a single institution., Study Design: Vanderbilt University Medical Center data were used to obtain a list of all liquid-based cervical Papanicolaou smears that were collected between September 2002 and October 2006. Unsatisfactory samples were identified as 2 groups (gynecology vs nongynecology) for statistical comparison., Results: There were 69,129 Papanicolaou smears that had been collected between September 2002 and October 2006; 47,165 smears were in the gynecology group, and 21,964 smears were in the nongynecology group. Of these, 1206 smears were designated to be "unsatisfactory." A nongynecology provider was more likely to have an unsatisfactory Papanicolaou test result, compared with a gynecology physician (3% [602/21,964] vs 1% [604/47,165]; P < .001). The odds of having an unsatisfactory Papanicolaou test result was 2 times higher with nongynecology, compared with gynecology, physicians (odds ratio, 2.17; 95% CI, 1.94-2.43)., Conclusion: Rates of liquid-based smears reported as unsatisfactory are higher among nongynecology providers. Competency-based learning programs might help to address this discrepancy.

Objective: This study was undertaken to determine whether the use of hormonal contraception affects the adequacy of colposcopic examination of the cervix., Study Design: A retrospective chart review of patients seen in the Vanderbilt University Medical Center Colposcopy Clinic from 2000-2002. Patient age, use of hormonal contraception, and adequacy of colposcopic examination were recorded for analysis., Results: Of all the colposcopic records reviewed, 526 of 1156 met inclusion criteria. Study patients ranged in age from 14 to 51 years. The prevalence of the visible squamocolumnar junction ranged from 75% to 91%. The multivariate logistic regression analysis showed that both age and use of hormonal contraception significantly influence adequacy of colposcopic examination (P < .001, P = .001, respectively)., Conclusion: The use of combination oral contraceptives is associated with an increased likelihood of adequate colposcopy.

Objective: Our purpose was to assess the potentials and limitations of the early detection of ovarian cancer in protocols that involve transvaginal color Doppler ultrasonography., Study Design: Retrospective analysis was performed on the data from 206 referred patients who either had surgical or clinical follow-up of ovarian masses evaluated by transvaginal color Doppler ultrasonography. Most of the patients were referrals or had risk factors., Results: In this series of 206 patients, 26 ovarian cancers were detected, > 70% of which were stage I or II., Conclusion: Transvaginal color Doppler ultrasonography is capable of early detection of ovarian carcinoma. An improved detection rate may be realized with better identification of high-risk patients who should be studied with transvaginal color Doppler ultrasonography.

Between 1968 and 1976, 175 patients with severe dysplasia or carcinoma in situ were treated at the University of California, San Francisco. One hundred fourteen underwent therapeutic conization while 61 were treated definitely by hysterectomy. Bleeding was the main complication of cone biopsy. It occurred in 9.9% of all conizations, but only 2% of patients required transfusion. Although follow-up has been relatively short, two patients treated by therapeutic conization, who were lost to follow-up, subsequently developed recurrent invasive cancer and four have developed recurrent carcinoma in situ or severe dysplasia. One patient treated by hysterectomy has developed metastatic cancer and one has had a recurrence of severe dysplasia at the vaginal vault. There have been 32 pregnancies following cone biopsy with no increase in abortion or prematurity.

The effect of cone biopsy for cervical intraepithelial neoplasia on subsequent fertility and pregnancy was evaluated for 314 reproductive age women. Excluding patients lost to follow-up and those who had therapeutic hysterectomy, two study groups totaling 166 patients were obtained. The first consisted of 105 patients who did not become pregnant following conization. We found no evidence of secondary infertility caused by cervical conization. The second group of 61 patients achieved 88 pregnancies following conization. Comparison of these pregnancies with the outcome of 106 pregnancies by these same women prior to conization showed no effect of the operation on spontaneous abortions, preterm delivery, or cesarean section rates. The sole sequela of conization was to alter the duration of the first stage of labor.