Patrick Walker

Anxieties in women undergoing colposcopy

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Use of semi-quantitative PCR for human papillomavirus DNA type 16 to identify women with high grade cervical disease in a population presenting with a mildly dyskaryotic smear report.

The aim of this study was to assess whether qualitative or semi-quantitative detection of human papillomavirus type 16 (HPV 16) can help to identify women with major grade cervical intraepithelial neoplasia (CIN 2 and CIN 3) among those referred with a smear suggesting mild dyskaryosis. The study population consisted of 200 women sequentially attending the Royal Free Hospital colposcopy clinic. All women were investigated by cytology, colposcopy and, where appropriate, histopathology, and HPV 16 DNA was detected in cervical scrape samples using the polymerase chain reaction (PCR). A final clinical diagnosis of normal, wart virus infected (WVI), CIN 1, CIN 2 or CIN 3 was made in 179 women. On the basis of the qualitative PCR data, the presence of HPV 16 DNA was of borderline use in identifying women with high grade cervical disease [63/113 (normal/WVI/CIN 1) vs 46/66 (CIN 2/CIN 3); P = 0.065]. However, semi-quantitative PCR analysis showed that a high/medium HPV 16 result was significantly associated with high-grade disease [29/113 (normal/WVI/CIN 1) vs 38/66 (CIN 2/CIN 3); P = 0.0001]. Furthermore, semi-quantitative PCR and cytology were performed on the repeat smear taken immediately prior to colposcopy. The combined laboratory results show that 53/60 women with biopsy proven high-grade disease were identified, as were 26/95 women who were either normal or who had low grade cervical disease. The possibility of using such an approach for selecting women for more rapid or for routine colposcopy appointments in the two groups respectively is discussed.

Anxiety levels in women attending colposcopy clinics for treatment for cervical intraepithelial neoplasia: a randomised trial of written and video information

Objective To assess the effectiveness of video information in reducing the level of anxiety in women attending Colposcopy clinics.

Colposcopic assessment of the accuracy of cervical cytology screening.

Two hundred asymptomatic women in a general practice were screened both cytologically and colposcopically for evidence of cervical intraepithelial neoplasia. The prevalence detected by cytology alone was 5%, but the prevalence detected by cytology and colposcopy together was 11%. None of the larger lesions of cervical intraepithelial neoplasia (affecting more than two quadrants of the cervix) was associated with negative cytology. The false negative cytology rate for smaller lesions was 58%. The clinical importance of the smaller lesions that were not accurately detected by cytology screening is unknown. As these lesions affected 6% of the screened population further studies of their clinical course are urgently required. Local destructive treatment in such cases may represent considerable overtreatment. If these lesions prove to be clinically important, however, the results of this study predict an increasing epidemic of preinvasive and invasive disease of the cervix.

HPV testing as an adjunct to cytology in the follow up of women treated for cervical intraepithelial neoplasia

Objective  To evaluate human papillomavirus (HPV) testing in combination with cytology in the follow up of treated women.

Presence of human papillomavirus DNA sequences in cervical intraepithelial neoplasia.

Twenty two patients referred to a district colposcopy clinic because of an abnormal cervical cytology report or a suspicious cervix and found to have a cervical epithelial abnormality were studied. The techniques of cytology, histology, immunohistochemistry, and DNA-DNA hybridisation were used to detect infection by human papillomavirus. Using an indirect immunoalkaline phosphatase technique human papillomavirus antigen was found in biopsy specimens from six of the 22 patients and DNA of papillomavirus type 6 in biopsy specimens from 13 of these women, including four out of six whose histological diagnosis was cervical intraepithelial neoplasia grade 3. In eight cases where cytological, colposcopical, and histological investigations all indicated the presence of wart virus infection, papillomavirus type 6 DNA was found in seven. Papillomavirus type 6 DNA was found in more than half of the proved cases of cervical intraepithelial neoplasia. The presence of this viral DNA in women with no cervical abnormality is to be studied.

The accuracy of repeat cytology in women with mildly dyskaryotic smears

Summary. A special colposcopy clinic was established at the Royal Free Hospital to investigate women whose referral smears showed mild dyskaryosis. Of 200 women in the study, 66 (33%) had histologically proven CIN II or CIN III, 59 (29%) had CIN I or human papillomavirus changes, and 54 (27%) were considered normal. These findings demonstrate the importance of adequate diagnosis of this group of women. Of 143 women who had had a single mildly dyskaryotic smear, 45 (31%) had either CIN II or III. Age was not useful for predicting which women were at high risk of significant disease. Careful repeat cervical cytology correlated closely with the histological grade of the lesion. Repeat cytology was associated with an overall 24% false‐negative rate, but most missed lesions were of low grade. Repeat cytology correctly identified 82% of all CIN lesions, and 93% of the most significant lesions (CIN II and III). Women who have a mildly dyskaryotic smear followed by a negative smear should not be considered normal, but careful repeat cytology can be considered a reasonably safe practice.

Human papillomavirus types 6 and 16 in multifocal intraepithelial neoplasias of the female lower genital tract

Summary. Five women with multifocal intraepithelial neoplasia of the lower genital tract were investigated for the presence of human papillomavirus (HPV) infection by the method of DNA‐DNA hybridization which detects the viral DNA. The DNA sequences of HPV types 6 and 16 were detected in each of the five patients and in each of the areas biopsied: cervix, vagina and vulva. DNA sequences of both viral types were also found in vulval intraepithelial neoplasia grades I‐III and in cervical intraepithelial neoplasia grades I and III. The detection of HPV DNAs in multifocal letions suggests a possible common aetiology for the lower genital tract intraepithelial neoplasias.

The volume perspective: a comparison of two excisional treatments for cervical intraepithelial neoplasia (laser versus LLETZ)

Please cite this paper as: Phadnis S, Atilade A, Young M, Evans H, Walker P. The volume perspective: a comparison of two excisional treatments for cervical intraepithelial neoplasia (laser versus LLETZ). BJOG 2010;117:615–619.

Incidence of cervical intraepithelial neoplasia grade 2 or worse in colposcopy-negative/human papillomavirus-positive women with low-grade cytological abnormalities.

Please cite this paper as: Kelly R, Walker P, Kitchener H, Moss S. Incidence of cervical intraepithelial neoplasia grade 2 or worse in colposcopy‐negative/human papillomavirus‐positive women with low‐grade cytological abnormalities. BJOG 2012;119:20–25.