Management guidelines for women with normal colposcopy after low grade cervical abnormalities: population study.

OBJECTIVES: To develop an evidence based protocol for the follow up of women with low grade cervical abnormalities for whom treatment is not immediately indicated. DESIGN: Population outcome study. SETTING: Colposcopy clinic of an inner city teaching hospital. PARTICIPANTS: 566 women with low grade cytological abnormalities who were not treated at a first visit to the colposcopy clinic, followed up for a total of 881 years. MAIN OUTCOME MEASURES: Resolution of abnormalities, persistence of disease, and treated disease. RESULTS: Abnormalities resolved in 306 (54.1%) women, whereas 138 (24.4%) had persistent disease and 122 (21.5%) were subsequently treated. Colposcopic opinion, smear test results, age, smoking history, and number of pregnancies were all significantly related to outcome. Logistic regression analysis produced a model that correctly identified 70% of women whose abnormalities resolved. Only 23 of 295 women (7.8%) with a normal cervix on colposcopy and a smear without dyskaryosis at a first visit were treated by the end of the observation period. CONCLUSIONS: Women referred with low grade cytological abnormalities who have a normal cervix on colposcopy and a negative or borderline repeat smear test result may be discharged from the colposcopy clinic. We propose a follow up protocol that could safely avoid unnecessary visits to a clinic.

The Pipelle endometrial suction curette: how useful is it in clinical practice?

The Pipelle endometrial sampler is gaining popularity as an alternative to formal dilatation and curettage (D&C). This study demonstrates that the Pipelle reduces the number of D&Cs required to assess the endometrium by 65%. This has significant benefits in terms of patient safety and cost. If an inadequate sample is obtained, which occurs most commonly in the postmenopausal patient, there may be a temptation to ascribe this to the presence of an atrophic endometrium. This study, however, finds a significant chance of an underlying carcinoma in these cases. Thus whereas the Pipelle sampler has clinical usefulness when a sample sufficient for histological analysis is obtained, an equivocal result must lead to further investigation.