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The article focuses on a symposium on the association between surgical treatment of cervical intraepithelial neoplasia (CIN) and subsequent preterm birth held on February 16, 2015 in London, Great Britain. It is stated that CIN grades 2 and 3 that have been managed surgically were the main focus of the meeting.

Objective: To assess whether there were significant differences in cytologic and colposcopic assessments associated with conization specimens at a colposcopy clinic in New York compared with a colposcopy clinic in London.Materials and Methods: A retrospective histopathologic survey of patients evaluated at the Mt. Sinai Hospital Colposcopy Clinic (MSH) in New York City and the Royal Free Hospital Colposcopy Clinic (RFH) in London between January 1, 1997, and December 31, 1998, was reviewed. Study groups included all patients who underwent conization at either clinic. Referral cytologic results, colposcopic findings, and conization histologic results were compared.Results: Two hundred three cases from MSH and 457 cases from RFH were reviewed. Most patients undergoing conization in either clinic were referred with Pap smears suggesting high-grade squamous intraepithelial lesions (MSH, 77%; RFH, 77%). Colposcopic biopsy was performed on all patients at MSH. At RFH, colposcopic-directed punch biopsy was not performed on 35% of the patients who would have been treated regardless of biopsy results. There is a significant difference in the distribution of cone histologic diagnosis between the two clinics (p = .02); there are proportionally more women diagnosed with high-grade disease in RFH than in MSH, where there are more normal and low-grade cone histologic results. According to the kappa coefficients, there is only slight agreement between the Pap smear cytologic results and punch biopsy with the conization histologic results for either clinic (MSH, kappa = 0.13; RFH, kappa = 0.19), with the RFH performing slightly better.Conclusions: This study shows exact agreement between cytologic and final conization diagnosis and colposcopic biopsy and final conization as 47% to 64%. Treatment decisions and outcomes are different between the two clinics, with the RFH clinic performing fewer biopsies and having more procedures yielding high-grade disease. Recommendations regarding changing colposcopic practices could best be made after a prospective study. [ABSTRACT FROM AUTHOR]

The true value of colposcopy in pregnancy is under debate; the examination may be more difficult depending on the gestation at which a woman presents. Cervical intraepithelial neoplasia does not have an accelerated progression during pregnancy, and treatment is usually deferred until postpartum. The prevalence of cervical intraepithelial neoplasia is greater in women with immune compromise. Those with human immunodeficiency have a higher prevalence, more persistence and less regression of human papillomavirus-related infections. Cervical cancer remains an AIDS-defining illness. Women who have had renal transplants also have a higher risk of developing cervical intraepithelial neoplasia. By contrast, other chronic illnesses that require immunosuppressant therapy do not seem to show this added risk. In young women, human papillomavirus infection is common and cervical intraepithelial neoplasia is also evident, but regression of these lesions is frequent and so conservative review may be appropriate. At the menopause, colposcopy is often unsatisfactory. The use of human papillomavirus testing for triage of low-grade cytological abnormalities may benefit this age group., (Copyright © 2011. Published by Elsevier Ltd.)

Introduction: Often due to benign conditions such as cervical ectopy, post-coital bleeding is a distressing symptom for the patient. However, for the clinician, the identification of the etiology is important in order to effect proper treatment., Case Report: We present a case referred to the colposcopy clinic because of post-coital bleeding and a smear report of 'groups of benign glandular cells of endometrial origin'. Colposcopy was normal but histology of an excised haemorrhagic nodule revealed endometriosis with resolution of symptoms., Conclusion: Cervical endometriosis should be considered in the differential diagnosis of post-coital bleeding with no obvious ectopy or malignancy.

Purpose of Review: There are around 450,000 cases of cervical cancer per year with 300,000 deaths, making it one of the largest causes of death in women worldwide. Dramatic decreases in cervical cancer mortality rates have been seen following the introduction of screening in several industrialised countries. This is despite using a screening test (the cervical smear) that has a fairly poor sensitivity of approximately 55%. Research has centred on finding a better primary or adjunctive test. Issues of cost and acceptability also need to be addressed. It is now widely understood that virtually all cervical cancers are initiated by oncogenic high-risk type human papilloma virus infections, namely human papilloma viruses 16, 18, 30, 31, 33, and 45., Recent Findings: The confirmed negative predictive value (99%) of a negative human papilloma virus test makes it potentially valuable in the triage of minor smear abnormalities and as post-treatment surveillance. In addition to evidence of its value in triage, there is a growing debate about its use as a primary tool in cervical screening, particularly in settings that do not currently have a structured programme. However, the psychological impact of human papilloma virus testing is less clear. Ultimately, advances in vaccination may hold the key to the eradication of cervical cancer., Summary: This article assesses the recent evidence on the place of human papilloma virus testing in three clinical settings, as a primary screening tool, in triage and as a test of cure. It also reviews the current understanding of the psychological impact of a positive human papilloma virus test.

This prospective observational study was carried out to evaluate the efficacy of large loop excision of the transformation zone (LLETZ) as a management strategy for women with four or more smears showing borderline changes or mild dyskaryosis. A total of 102 women with four or more smears showing minor abnormalities and no colposcopic evidence of high-grade disease opted to undergo LLETZ in preference to continued cytological surveillance. Histology of the LLETZ specimens showed 11 cases of CIN2/3, one CGIN, 32 CIN1 and 10 HPV changes. In 97 of the 102 (95%) women, the follow-up cervical smear reverted to negative.

Objective: To assess the effectiveness of video information in reducing the level of anxiety in women attending Colposcopy clinics., Design: An observational study followed by a randomised trial., Setting: Colposcopy Clinic, Royal Free Hospital, London., Participants: Between April and December 1999, all new referrals to the clinic with a cervical smear showing moderate or severe dyskaryosis., Main Outcome Measure: The level of anxiety measured by the Spielberger State Anxiety Inventory., Conclusion: Women attending colposcopy clinics for either diagnosis or treatment, experience a high level of anxiety. The highest levels occur in women attending a one-stop see and treat clinic. The introduction of visual information in the form of an explanatory video prior to attendance significantly reduced anxiety.