Do all grade I lesions on colposcopy need to be biopsied?

The present study intends to correlate grade I atypical transformation zone (ATZ) on colposcopy with cytology & histology in 51 patients by retrospective data analysis. Indications of colposcopy were inflammatory smears with unhealthy cervix (37/51). Atypical squamous cells of unknown etiology (2/51) & squamous intraepithelial lesions on cytology (12/51). All the patients exhibited grade I lesions on colposcopy & underwent directed biopsy. On histology chronic cervicitis was the commonest finding 70.6% (36/51) & CIN was found in 19.6% (10/51), out of which CIN II-III occurred only in 3.92% (2/51). Overcall rate of colposcopy for grade I lesions was 80.39%. Age, parity, the postcoital or contact bleeding did not correlate with the histological positivity of the lesions. Grade I ATZ with inflammatory smears revealed CIN II-III only in 2.7% (1/37) while with low grade SIL cytology there was no moderate or severe dysplasia. However Grade I lesions in association with high grade SIL exhibited CIN II-III lesions in 16.6% (1/6). Therefore grade I lesions in presence of inflammatory or low grade SIL smears can be observed & biopsied only if the changes persist. However association of high grade SIL with grade I ATZ calls for immediate biopsy.

Comparison of magnified chemiluminescent examination with incandescent light examination and colposcopy for detection of cervical neoplasia.

Magnified Chemiluminescent Examination (MCE) or speculoscopy is a new visual method for detection of cervical neoplasia. It utilizes low magnification and a special "blue-white" chemiluminescent light. The study includes 125 women with unhealthy cervix who were subjected to magnified examination with projected incandescent light (PIL) and chemiluminescent light (MCE). This was followed by colposcopy and directed biopsy from acetowhite areas. Of all 125 subjects, 20 patients showed cervical neoplasia of varying degree on histopathology. MCE could detect 18/20 neoplasias while PIL detected 11/20 cases. Sensitivity of MCE (90%) was significantly superior (P < 0.05) to PIL (55%) in detecting cervical neoplasia. Colposcopy, as compared to MCE, is better than speculoscopy as it facilitates grading of lesions due to higher magnification but antecedent MCE detected the acetowhitening in majority of patients (32/43). However, tendency to "overall" acetowhite lesions was significantly less during MCE when compared with colposcopy. Thus, MCE is a new diagnostic tool which is better than routine incandescent light examination and correlates well with colposcopy.

Fetal Ebstein anomaly--a rare cause of non-immune hydrops.

A rare case of fetal Ebstein anomaly presenting as non-immune hydrops fetalis at 28 weeks of gestation is reported along with its review of literature.