Colposcopy: Principles and Practice, Second Edition

Cover......Page 1
Front Matter......Page 2
ISBN:   9781416034056......Page 3
Copyright
......Page 4
Dedication
......Page 6
Preface......Page 10
List of Contributors......Page 12
The Many Kinds of Risk......Page 15
Geographic Differences and Time Trends in Disease Occurrence......Page 16
Epidemiology and Disease Etiology......Page 17
Follow-Up Studies of Patients......Page 19
Screening for Gynecologic Malignancies......Page 20
Error versus Bias......Page 21
Descriptive Data......Page 22
The Basic Contingency Table......Page 23
Measures of Risk: Absolute, Relative, and Attributable Risks......Page 24
Measures of Intercolposcopist Agreement......Page 26
Screening Terms......Page 28
Problem Areas......Page 30
Standardization of the Scientific Art of Colposcopy......Page 31
References......Page 32
Human Papillomaviruses and Mechanisms of Oncogenesis......Page 35
Role of Specific Viral Oncoproteins Encoded by High-Risk Human Papillomavirus......Page 36
Role of Viral Integration Into the Host Cell Genome......Page 38
Genomic Instability......Page 39
Clinical Evaluation......Page 168
Histology......Page 41
Management......Page 333
Summary......Page 42
References......Page 43
Human Papillomavirus Vaccine......Page 49
Leukoplakia......Page 164
Human PapillomaVirus Vaccine Development......Page 50
Human PapillomaVirus Vaccine Approval By The Food and Drug Administration......Page 54
Biological Risk Factors and Human Papillomavirus......Page 452
Human PapillomaVirus Vaccines in Clinical Practice......Page 56
References......Page 57
Terminology in Cervical Cytology: The Bethesda System......Page 59
Abnormal Cervical Cytology......Page 511
Specimen Adequacy......Page 60
Unsatisfactory Specimens......Page 62
Anal Cancer Screening......Page 468
Other Categories and Reporting of Endometrial Cells......Page 63
Organisms......Page 64
Rationale......Page 65
Sharpness of Peripheral Margins......Page 67
Squamous Intraepithelial Lesions and Carcinoma......Page 68
Glandular Abnormalities......Page 69
Acknowledgments......Page 70
References......Page 321
Interpretation and Triage of Papsure Screening Results......Page 73
Adolescent Women......Page 74
Sampling/Collection......Page 75
Test Sensitivity and Specificity......Page 76
Cytologic nuances associated with the Pap test......Page 77
References......Page 78
Background......Page 80
Limitations of conventional cytology......Page 81
Principles of efficacy of liquid-based cytology......Page 82
Efficacy of Liquid-based, thin-layer technology......Page 83
Molecular testing out of residual material left in the vial......Page 85
Low-Grade Squamous Intraepithelial Lesions......Page 86
High-Grade Squamous Intraepithelial Lesions......Page 87
Atypical Squamous Cells of Undetermined Significance......Page 88
Cytology of Cervical Adenocarcinoma......Page 89
References......Page 90
Adjunctive Testing......Page 93
Types of Probe Tests......Page 94
Hybrid Capture II......Page 95
Colposcopy of The Vagina......Page 328
In Situ Hybridization (ISH)......Page 98
Test Validation......Page 99
Human PapillomaVirus Dna Positivity And Risk Of Future cervical intraepithelial neoplasia 2,3 and Cancer......Page 100
Intertrigo......Page 362
References......Page 102
Screening Guidelines......Page 105
Magnified Visualization with Chemiluminescence: Speculoscopy and the Evidence-based Literature......Page 106
Anal Transformation Zone......Page 370
Cryotherapy......Page 109
References......Page 112
Principles and Technique of the Colposcopic Exam......Page 115
Screening......Page 298
Preparation for Initiation of Colposcopy Services......Page 116
Technique......Page 117
Laser Vaporization of Vaginal Intraepithelial Neoplasia......Page 334
Photographic, Video, and Image Management Systems......Page 121
Cervical Cancer Screening......Page 122
Conclusions......Page 124
Vaginal Sidewall Retractors......Page 125
Monsel's Solution......Page 126
Scenario 1......Page 260
Silver Nitrate......Page 128
Surgical Treatment......Page 490
Technique of Colposcopic Examination......Page 130
Documentation of Colposcopic Findings......Page 131
References......Page 133
Embryology of the Cervix......Page 139
Preparation for Colposcopy......Page 537
Histology of the Normal Cervix......Page 140
Recent Findings in Diethylstilbestrol-Exposed and Their Offspring......Page 141
Formation of Squamous Metaplasia......Page 142
Provider-Applied Therapies......Page 403
Tissue Basis and Mechanism of Colposcopic Changes in the Normal Cervix......Page 143
Colposcopic Appearance of the Transformation Zone......Page 146
References......Page 149
Normal Colposcopic Findings......Page 157
Vascular Network in Cervical Intraepithelial Neoplasia......Page 159
Cytology......Page 161
Abnormal Transformation Zone......Page 163
Cytology......Page 165
Uptake or Rejection of Iodine......Page 167
Ulcerations......Page 170
References......Page 173
Colposcopic Grading History......Page 179
Reserve Cell Hyperplasia......Page 180
Vessel......Page 181
Atopic Dermatitis......Page 357
Equipment......Page 207
References......Page 188
What is Required of a Colposcopic Examination?......Page 189
Psoriasis......Page 190
Epithelial Color......Page 194
Vascular Patterns......Page 195
Iodine-Staining Reaction......Page 196
Applying the Reid's Colposcopic Index Scoring System......Page 198
Patient Selection......Page 200
References......Page 201
The Management of Women with Atypical Squamous Cells......Page 203
Progression To Invasion......Page 245
Clinical Significance of An Atypical Squamous Cell Diagnosis......Page 205
Epidemiology and Natural History of Anal Intraepithelial Neoplasia......Page 206
Laser Physics......Page 208
Adolescents With Atypical Squamous Cells of Undetermined Significance......Page 209
Management of Women With Atypical Squamous Cells: Cannot Exclude High-Grade Squamous Intraepithelial Lesion......Page 210
Scenario 2......Page 211
References......Page 212
Low-Grade Squamous Intraepithelial Lesions......Page 215
Loop Electrosurgical Excision......Page 519
Natural History......Page 216
Screening......Page 217
Colposcopic Findings......Page 219
Colposcopic Mimics of Low-Grade Lesions......Page 222
Management Guidelines......Page 225
Normal Columnar Epithelium......Page 226
Complications......Page 227
Atypical Squamous Cells of Undetermined Significance and Low-Grade Squamous Intraepithelial Lesion Triage for Adolescents......Page 229
Management of Anal Intraepithelial Neoplasia and Cancer......Page 230
Scenario 4......Page 231
References......Page 232
History......Page 235
History......Page 236
Figure 12-29......Page 237
History......Page 238
Figure 12-32......Page 239
Initial Management......Page 246
Staging of Cervical Cancer......Page 247
Management in Pregnant Women with HSIL......Page 249
Care and Maintenance of Colposcopic Instruments......Page 251
Etiology and Natural History......Page 252
Colposcopy......Page 253
Management Scenarios......Page 338
Management of Positive Excision Margins......Page 256
Management in Adolescent Women......Page 259
Counseling Scenarios......Page 261
High-Grade Squamous Intraepithelial Lesion......Page 457
References......Page 262
History......Page 264
Figure 13-16......Page 265
Figure 13-18......Page 266
History......Page 267
Figure 13-21......Page 268
Colposcopic Assessment of Invasive and Microinvasive Lesions......Page 275
Additional Diagnostic Biopsy Procedures......Page 278
Microinvasive Carcinoma, Stages IA1 and IA2......Page 281
Reproductive Effects......Page 422
Stage IA2......Page 283
Stages IIB and III......Page 284
Surface Topography Compared with Colposcopic Mimics......Page 301
Survival......Page 285
References......Page 287
History......Page 289
History......Page 290
Figure 14-20......Page 291
Risk Factors and Epidemiology......Page 297
Clear Cell Adenocarcinoma of the Vagina and Cervix......Page 386
Colposcopic Findings......Page 299
Presentations of Adenocarcinoma In Situ and Adenocarcinoma......Page 300
Blood Vessel Patterns Compared with Colposcopic Mimics......Page 303
Scenario 3......Page 305
Cryotherapy Physics......Page 527
Crypt Involvement, Linear Length, Skip Lesions, and Disease Location......Page 307
Algorithms......Page 310
2006 American Society for Colposcopy and Cervical Pathology (ASCCP) Guidelines for the Management of Cytologic Glandular Abnor......Page 311
Subsequent Management......Page 313
Specimen Guidelines......Page 314
2006 ASCCP Guidelines for the Management of Histologic Glandular Abnormalities......Page 315
Negative Specimen Margins......Page 316
Positive Specimen Margins......Page 317
Scenario 2......Page 459
Scenario 1......Page 318
Scenario 2......Page 319
Scenario 3......Page 320
Case Study......Page 324
Vagina: Normal, Premalignant, and Malignant......Page 325
Epidemiology and Risk Factors of Vaginal Intraepithelial Neoplasia and Vaginal Cancer......Page 326
Cytologic Screening......Page 327
Histology......Page 332
Other Treatments for Vaginal Intraepithelial Neoplasia......Page 335
Invasive Cancer......Page 336
Human Papillomavirus Testing in Adolescents......Page 339
References......Page 340
Case Study 1 Questions......Page 343
Case Study 1 Answers......Page 344
Image Atlas......Page 345
Normal Vulvar Architecture......Page 355
Anatomic Variants......Page 356
Contact Dermatitis......Page 359
Vaporization Technique......Page 525
Histopathology of Human Papillomavirus-Related Anal Disease......Page 473
Scenario 2......Page 371
Scenario 3......Page 372
Scenario 4......Page 373
Scenario 5......Page 374
References......Page 375
Vulvar Intraepithelial Neoplasia......Page 381
Medical Therapies......Page 384
Therapeutic Human Papillomavirus Vaccines......Page 387
Human Papillomavirus-Unrelated, Differentiated Vulvar Intraepithelial Neoplasia (VIN-d)......Page 388
Summary......Page 390
References......Page 391
Transmission/Acquisition......Page 395
Clinical Significance and Viral Correlates......Page 396
Technique of Colposcopy in Pregnancy......Page 431
Specimen Adequacy and Normal Components......Page 469
General Considerations......Page 400
Patient-Applied Therapies......Page 408
Prospect for Human Papillomavirus Vaccines......Page 411
Lower Genital Tract Changes Associated with In Utero Exposure to Diethylstilbestrol......Page 415
Vaginal Epithelial Changes......Page 416
Structural Changes of the Cervix and Vagina......Page 417
Colposcopic-Directed Biopsy and Endocervical Curettage in Pregnancy......Page 433
Natural History of Squamous Intraepithelial Lesion......Page 455
References......Page 423
Colposcopy in Pregnancy......Page 425
Risks Factors and Epidemiology......Page 426
Colposcopy in Pregnancy......Page 429
Management of Abnormal Cytology in Pregnancy......Page 434
Treatment of Cervical Intraepithelial Neoplasia and Cervical Neoplasia in Pregnancy......Page 436
Scenario 2......Page 437
References......Page 438
History......Page 441
Image Atlas......Page 443
Prevalence and Incidence of Human Papillomavirus in Adolescents......Page 451
Endocervical Curettage......Page 454
Histology of Squamous Metaplasia......Page 456
Treatment of Cervical Intraepithelial Neoplasia, Grades 2,3......Page 458
Scenario 3......Page 460
Summary......Page 461
References......Page 462
Epidemiology of Anal Cancer......Page 465
Epidemiology and Natural History of Anal Human Papillomavirus Infection......Page 466
Organisms......Page 471
HIGH-Resolution Anoscopy......Page 474
Anal Biopsies......Page 476
Features of the Normal Anal Transformation Zone......Page 477
Atypical Anal Transformation Zone......Page 478
Typical Lesion Patterns......Page 482
Other Findings on High-Resolution Anoscopy......Page 483
Case Study......Page 494
Risk Factors and Epidemiology......Page 497
Indications......Page 499
Patient History......Page 500
Clinical Findings......Page 501
Biopsy......Page 502
Topical Therapies (Clinician Applied)......Page 503
Surgical Treatment......Page 504
Postoperative Instructions......Page 505
Case 4......Page 506
References......Page 507
Image Atlas......Page 509
Interventions......Page 512
Intervention......Page 514
References......Page 516
Equipment......Page 520
Technique......Page 521
Carbon Dioxide Laser......Page 523
Technique......Page 524
Excisional Conization Technique......Page 526
Equipment......Page 528
Technique......Page 529
Technique......Page 530
References......Page 531
Failure To Follow Guidelines......Page 535
Tips for Cervical Screening......Page 536
Colposcopic Exam......Page 538
Selection of A Biopsy Site......Page 541
How To Take A Biopsy......Page 542
Index......Page 545