European consensus statement on essential colposcopy Redman, C.W.E.; Kesic, V.; Cruickshank, M.E. ...
European Journal of Obstetrics & Gynecology and Reproductive Biology,
January 2021, 2021-Jan, 2021-01-00, 20210101, 2021-01, Letnik:
256
Journal Article
Recenzirano
Odprti dostop
This European consensus statement on essential colposcopy provides standards for the general colposcopist seeing women referred for colposcopy with an abnormal cervical screening test (including ...cytology and HPV tests) or with a clinically suspicious cervix. The article gives guidance regarding the aims and conduct of colposcopy. Recommendations are provided on colposcopy technique, the management of common colposcopy issues, treatment and follow-up of after treatment of CIN or early stage cervical.
Colposcopists should make an informed decision on the management of each individual that is referred and organize appropriate follow-up. Cervical cancer is still a major health issue and the quality of care can only improve if there is a structured guidance for women with an abnormal smear or suspicious cervix.
Zusammenfassung
Klinisches Bild, Prognose und Verlauf einer HPV(humane Papillomviren)-Infektion der Frau sind abhängig vom HPV-Typ, Ort der Infektion und dem Zeitpunkt der Diagnose. High-risk ...HPV-Infektionen führen am häufigsten zu Erkrankung an der Cervix uteri. Schwerwiegende HPV-assoziierte Erkrankungen lassen sich durch regelmäßige Krebsfrüherkennungsuntersuchungen verhindern. Schwieriger ist die Diagnostik vaginaler HPV-assoziierter Veränderungen. Die rechtzeitige Erkennung einer VAIN (vaginale intraepitheliale Neoplasie) durch zytologisches Screening und kolposkopische Verifizierung bietet aber die Chance, die Entstehung eines Vaginalkarzinoms zu verhindern. Erkrankungen der Vulva nehmen in den letzten Jahren deutlich zu. Entsprechend der unterschiedlichen Pathogenesen des Vulvakarzinoms werden 2 grundsätzlich differente präinvasive Plattenepithelläsionen klassifiziert: „squamous intraepithelial lesion“ (SIL) und differenzierte vulväre intraepitheliale Neoplasien (d-VIN). SIL repräsentieren HPV-assoziierte intraepitheliale Läsionen, in Analogie zu Zervix und Vagina werden low SIL (LSIL) und high SIL (HSIL) unterschieden. Die Abklärung vulvärer Veränderungen erfolgt durch die kolposkopische Untersuchung, abnorme kolposkopische Befunde sind atypische Gefäße, essigweißes Epithel, eine unregelmäßige Oberflächenstruktur und die Punktierung. HPV-assoziierte Veränderungen der Vulva können in gleicher Weise die Analregion betreffen, anale Läsionen treten aber auch ohne begleitende vulväre Läsionen auf. Zur Abklärung analer Präkanzerosen wird eine „high-resolution anoscopy“ (HRA) gefordert, sie entspricht einer kolposkopischen Untersuchung mit Anwendung der Essigsäureprobe, der Lugol-Probe und der Entnahme einer Biopsie.
European consensus statement on expert colposcopy McGee, A.E.; Alibegashvili, T.; Elfgren, K. ...
European journal of obstetrics & gynecology and reproductive biology,
11/2023, Letnik:
290
Journal Article
Recenzirano
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Following the publication of the European consensus statement on standards for essential colposcopy in 2020, the need for standards relating to more complex and challenging colposcopy practice was ...recognised. These standards relate to colposcopy undertaken in patients identified through cervical screening and tertiary referrals from colposcopists who undertake standard colposcopy only.
This set of recommendations provides a review of the current literature and agreement on care for recognised complex cases. With good uptake of human papillomavirus (HPV) immunisation, we anticipate a marked reduction in cervical disease over the next decade. Still, the expert colposcopist will continue to be vital in managing complex cases, including previous cervical intraepithelial neoplasia (CIN)/complex screening histories and multi-zonal disease.
To provide expert guidance on complex colposcopy cases through published evidence and expert consensus.
Members of the EFC and ESGO formed a working group to identify topics considered to be the remit of the expert rather than the standard colposcopy service. These were presented at the EFC satellite meeting, Helsinki 2021, for broader discussion and finalisation of the topics.
The agreed standards included colposcopy in pregnancy and post-menopause, investigation and management of glandular abnormalities, persistent high-risk HPV+ with normal/low-grade cytology, colposcopy management of type 3 transformation zones (TZ), high-grade cytology and normal colposcopy, colposcopy adjuncts, follow-up after treatment with CIN next to TZ margins and follow-up after treatment with CIN with persistent HPV+, and more. These standards are under review to create a final paper of consensus standards for dissemination to all EFC and ESGO members.
In July 2012 the IFCPC adopted a revised terminology for colposcopic examinations of the uterine cervix. In 2012, the Boards of the
(AGK - Austrian Society of Colposcopy), the
(AGKOL - Swiss Society ...of Colposcopy and Cervical Pathology) and the
(AGCPC - German Society of Colposcopy and Cervical Pathology) accepted the validity of the 2011 IFCPC nomenclature and recommended its use in general clinical practice across German-speaking countries. The revised nomenclature was devised so that examiners can evaluate colposcopic criteria according to a specific scheme. At the start of the examination, the examiner must assess whether the colposcopy is representative or not. 1. Can the examination be classed as adequate or inadequate (reasons must be given)? 2. How would you describe the visibility of the squamocolumnar junction and categorize the transformation zone? Below we discuss some aspects of this general assessment as outlined in the nomenclature which were found to require further clarification for general practice.
Abstract
In July 2012 a revised terminology on colposcopic examinations of the cervix
uteri was adopted by IFCPC. Central aspect is a description of
characteristics that should aid in the definition ...of the disease entity
cervix uteri. The nomenclature is built up in such a way that the examiner
can evaluate colposcopic criteria according to a specific scheme. Firstly it
is assessed whether the colposcopy is representative. Then it should be
clarified whether or not the findings are normal. If the findings are not
normal but rather abnormal the severity of the lesion is classified
according to the so-called grade 1 (minor change) and grade 2 findings
(major change). Specific abnormal findings such as leukoplakia, erosion and
Lugolʼs finding are also not defined at this point. Characteristics
suspicious for an invasion are described separately, in particular, atypical
vessel patterns are mentioned here. As already held in the previous revised
nomenclature (Barcelona), various findings are described in a last group:
congenital transformation zones (CTZ), congenital anomalies, condylomas
(papillomas), endometriosis, polyps (ectocervical, endocervical),
inflammation, stenosis, postoperative changes (scarred portio, vaginal
stump).
Abstract
In July 2012 the IFCPC adopted a revised terminology for colposcopic examinations of the uterine cervix. In 2012, the Boards of the
Arbeitsgemeinschaft Kolposkopie
(AGK – Austrian Society of ...Colposcopy), the
Arbeitsgemeinschaft für Kolposkopie und Zervixpathologie
(AGKOL – Swiss Society of Colposcopy and Cervical Pathology) and the
Arbeitsgemeinschaft für Kolposkopie und Zervixpathologie
(AGCPC – German Society of Colposcopy and Cervical Pathology) accepted the validity of the 2011 IFCPC nomenclature and recommended its use in general clinical practice across German-speaking countries. The revised nomenclature was devised so that examiners can evaluate colposcopic criteria according to a specific scheme. At the start of the examination, the examiner must assess whether the colposcopy is representative or not. 1. Can the examination be classed as adequate or inadequate (reasons must be given)? 2. How would you describe the visibility of the squamocolumnar junction and categorize the transformation zone? Below we discuss some aspects of this general assessment as outlined in the nomenclature which were found to require further clarification for general practice.
To examine psychosomatic aspects of vulvodynia (VD) in comparison with the chronic pelvic pain syndrome (CPPS).
Sixty-seven VD patients and 97 CPPS patients were examined with psychological tests ...(Freiburg Personality Inventory, Giessen Test) and compared with a control group of 34 healthy women. Sociodemographic data and psychoanalytic diagnoses were collected for 36 VD patients and 106 CPPS patients (inpatients). Descriptive statistics, chi 2 test and multivariant analyses were used.
CPPS patients had significantly higher somatization than VD patients (P < .004). Both CPPS and VD patients, as inpatients, were significantly more depressive than the control group. In milder forms of VD, the patients (outpatients) exhibited no depression. The incidences of sexual abuse and severe psychological disturbances were significantly higher in the CPPS group (P < .01).
VD and CPPS are two, distinct psychosomatic gynecologic syndromes and indicate psychosomatically oriented therapy.
Zielsetzung:
Maligne und prämaligne Läsionen der Vulva zeigen während der letzten Dekaden eine steigende Inzidenz in Deutschland. Während das differenzierte VIN häufig HPV-unabhängig entsteht, ist ...das häufigere undifferenzierte VIN meist HPV-induziert. Prämaligne und maligne Läsionen wurden auf auf HPV-Infektion und -Typ untersucht, um den Anteil an HPV-induzierten Läsionen zu bestimmen.
Materialien:
Von 1997 bis 2012 wurden die klinischen Daten von 599 Patientinnen erhoben und anhand der Läsion selektiert.
Methoden:
Es wurden 433 VIN und 81 PEC hinsichtlich Histopathologie, HPV-Infektion, Patientinnenalter und Lokalisation untersucht.
Ergebnisse:
Unter 433 VIN fanden sich 16 (3,7%) low-risk-Infektionen, 330 (76,2%) high-risk-Infektionen und 44 (10,2%) Mischinfektionen, 43 (9,9%) waren HPV-negativ. Die häufigsten HPV-Typen waren 16 (82,1%) und 33 (8,2%).
Unter 81 PEC fanden sich 7 (8,6%) low-risk-Infektionen, 30 (37%) high-risk-Infektionen und 7 (8,6%) Mischinfektionen, 37 (45,7%) waren HPV-negativ. Die häufigsten HPV-Typen waren 16 (59,1%), 33 und 6 (jeweils 13,6%). Das Durchschnittsalter der 81 Fälle war 52,8 Jahre. 50 (61,7%) Patientinnen waren jünger als 56 Jahre. Bei den unter 56-Jährigen waren 44% HPV-negativ, über 56 48,4%.
Zusammenfassung:
Über 50% der Karzinome waren HPV-positiv, sowohl über, als auch unter 56 Jahren. Weiterhin waren 90,1% der VIN HPV-positiv, dies unterstreicht die Rolle von HPV, insbesondere HPV-16. Weiterhin gilt VIN gemeinhin als Präkanzerose, somit zeigt sich großes Präventionspotential. Das Durchschnittsalter von 52,8 Jahren der Krebspatientinnen unterstreicht die Tendenz zu jüngeren Patientinnen in Deutschland mit invasiven Karzinomen (Hampl et al., Obstet Gynecol 2008).
Inadequate hygiene, aggressive cleansing, and chafing skin folds, as well as urine, feces, and sweat may trigger irritative contact dermatitis in the anogenital area. Serious recommendations for ...protection of the skin toward irritants include hygienic aspects and the use of appropriate skin care. Furthermore, preventing an accumulation of irritants on unprotected skin is mandatory. An intraindividual comparison study with 30 participants (17 female, 13 male; age: 44.2±8.3 years) was performed to evaluate the properties of a newly developed water-in-oil (W/O) balm on artificial sodium dodecyl sulfate-damaged epidermal barrier. The balm was applied 14 days twice daily, and transepidermal water loss and erythema were investigated. A significant improvement of both parameters after 12 days and even after 21 days could be confirmed. Two major clinical trials were performed to evaluate the safety and efficacy regarding protective and regenerative properties of the W/O balm on irritated skin in the anogenital area. Therefore, 29 children were enrolled (14 male, 15 female, age: 15.5±7.8 months) in an open-labeled 4-week clinical study. The balm was used in the area under disposable diapers at least after diaper change or if required. Furthermore, in a second open, multicenter study, 43 women (mean age: 46.2±16.9) with predisposition to skin irritation in the outer anogenital region were included. The product was applied for 4 weeks 1-2 times daily. In both studies, skin tolerability, applicability, scent, spreadability, and removability of the balm were evaluated by participants and practitioners predominantly as good or even very good, also skin hydration, protection, and regeneration were judged positively. The studies confirmed that the newly developed W/O balm exhibits excellent tolerability and is easy to remove. At the same time, excellent properties with respect to efficacy regarding regeneration and protection could be observed, without any undesired effects at any time.
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