Mahmood I. Shafi

Colposcopically directed punch biopsy: a potentially misleading investigation

Objective— To determine the relation between the histology of an initial colposcopically directed punch biopsy and a subsequent diathermy loop excision biopsy of the transformation zone, and the effect of lesion size on this relation.

Vulvar intraepithelial neoplasia: long term follow up of treated and untreated women.

Objective To investigate the long term outcome of patients with vulvar intraepithelial neoplasia.

Randomised trial of immediate versus deferred treatment strategies for the management of minor cervical cytological abnormalities

Objective To compare immediate and deferred treatment in women with cervical smears showing borderline nuclear abnormalities or mild dyskaryosis.

The management of squamous cell vulval cancer: a population based retrospective study of 411 cases

Objective To audit the epidemiology, management and outcome of vulval cancer in the West Midlands.

Observer variability among colposcopists from the West Midlands region

Objective To assess variation in diagnoses and management decisions among colposcopists when presented with cervical images; to see the impact of the referral cytology report on diagnostic accuracy.

Digital imaging colposcopy, image analysis and quantification of the colposcopic image

Objective To investigate the use of a digital imaging system for colposcopy, its use for image analysis and quantification of the colposcopic features that may predict histological outcome as defined by large loop excision of transformation zone.

Abnormal cervical cytology following large loop excision of the transformation zone: a case controlled study

Objectives To determine factors that may predict cytological outcome at 6 months following large loop excision of transformation zone (LLETZ) for cervical intra epithelial neoplasia (CIN) and to investigate the outcome in women with continuing cytological abnormality.

Vulval intraepithelial neoplasia—management and outcome

Forty‐six patients with a primary diagnosis of vulval intraepithelial neoplasia (VIN) have been managed over a 10‐year period. The prevalence of VIN has increased and the age at presentation has decreased over the last decade; 59% of our patients had histological evidence of human papillomavirus infection. Pruritis was the commonest symptom at presentation (59%). Of the 46 patients 44 were treated by laser skinning vulvectomy, local excision or simple vulvectomy. Symptomatic relief was best achieved by local excision. Clinical and definitive relapse occurred more often in the laser‐treated group. The median time to relapse was 38 months in the laser‐treated group and 74 months in the surgically treated group (excision and simple vulvectomy). Two patients have not been treated and their disease has not progressed. The carbon dioxide laser almost certainly has a role in conservative management and although our data possibly do not reflect its full potential they demonstrate a need for a controlled prospective study.

Cigarette smoking and histological outcome in wom with mildly dyskaryotic cervical smears

Objective To determine which patient related variables, available at the point of referral, predict the presence of high grade intraepithelial neoplasia when the smear result is mild dyskaryosis with or without co‐existent koilocytosis.

Lesion size and histology of atypical cervical transformation zone

We have found the pragmatic approach described to be a well tolerated and effective means of managing PMB. By avoiding the need for anaesthesia, in-patient days are reduced and the anxiety associated with waiting time is minimised. Only one in five of the referred patients required further investigation because endometrial biopsy failcd but in this group there was one endometrial cancer. Endometrial biopsy detected eight of nine endometrial cancers and did not miss any lesion. None of three women referred a second time because of recurrent bleeding had a significant abnormality identified by formal curettage. We have now investigated 100 women for whom there has been an interval of at least 6 months since the endometrial biopsy and there have been no re-referrals after this length of time. The avoidance of general anaesthesia in many elderly patients may have prevented complications. This investigation could be undertaken in a general out-patient clinic but our dedicated clinic had several advantages, including adequate equipment, staffing and time. We used a couch with comfortable leg supports to allow the operator adequate access, which was important for some patients. The pathologists generally found the quality of material satisfactory although some samples of endometrium were too scanty for histological assessment. We regarded this as evidence for an absence of intrauterine pathology and did not investigate cytology in such cases. We found endometrial biopsy to be a very simple technique which can easily be taught. We would stress the importance of sensitivity when dealing with elderly women as well as the need for gentleness in undertaking the procedure. A little experience is required to acquire the necessary confidence for maximal success in cannulating the uterus and, although we generally used a 3 mm curette, a 4 mm instrument can also be used and has the advantage of increased rigidity. We suggest that dilatation and curettage need no longer be regarded as necessary for the investigation of PMB, thus avoiding anaesthesia and reducing waiting time for the large majority of women with no pathology.