Liquid based cytology improves the positive predictive value of glandular smears compared to conventional cytology.

PURPOSE: To investigate whether the introduction of liquid-based cytology (LBC) in an urban setting decreases the diagnosis of glandular neoplasia (grade 6) and improves the positive predictive value (PPV) of cervical cytological screening. METHODS: A retrospective database review was conducted identifying women with cervical cytological abnormalities including glandular neoplasia (grade 6) before and after the introduction of LBC. RESULTS: Following the introduction of LBC the rate of glandular neoplasia (grade 6) referrals fell from 1.08% to 0.69% of all cervical cytological abnormalities. There was a significant reduction in 'abnormal' cytological samples subsequently found to be associated with no invasive or preinvasive disease but no decrease in the number showing preinvasive or invasive disease. A significant decrease in number of patients having a final diagnosis of normal/inflammatory or wart changes was seen in those patients referred during the LBC period (p < 0.01). CONCLUSION: The introduction of LBC in an urban setting decreased cytological glandular neoplasia referrals but not at the expense of missing preinvasive and invasive cancers. It has also increased the PPV of cervical sampling to detect preinvasive and invasive cancer from 59.6% to 76.0%.

Impact of patient counseling on acceptance of the levonorgestrel implant contraceptive in the United Kingdom.

Patient counseling is an important aspect of family planning. Patient choice, compliance, and satisfaction with a contraceptive method depend heavily on the counseling experience. This is especially true in the United Kingdom where contraceptives are provided to patients at no direct cost to them. Women are therefore more likely to choose a contraceptive option based on perceived desirability as opposed to cost. We surveyed physicians from six family planning centers in the United Kingdom who have extensive experience with levonorgestrel contraceptive implants with respect to counseling issues and patient acceptability of levonorgestrel implants. The physicians reported on their experience with 521 women. They acknowledged the need for and importance of counseling, and these centers provided preinsertion counseling 100% of the time. Primary responsibility for counseling was handled by the physician who spent, on average, 19 minutes per patient discussing the advantages and risks of levonorgestrel implants. Physicians felt that the majority of women (82%) accepting levonorgestrel implants had a positive experience. The incidence of bleeding irregularities was consistent with that reported in clinical trials, and this did not substantially affect the postinsertion acceptability of the product. Effective counseling is no doubt responsible for the high level of patient acceptance of these side effects. In a review of the literature, we found counseling to be a significant factor in a woman's tolerance of contraceptive-induced bleeding irregularities, which are frequently experienced with levonorgestrel implants. The results of our survey support the literature findings.