Polarized Light Colposcopy Compared With Standard Colposcopy.

OBJECTIVE: The objective of this study was to determine the potential benefits of polarized light colposcopy compared with standard colposcopy examinations in the evaluation of women with abnormal cervical cytology. MATERIALS AND METHODS: Polarized and standard colposcopy examinations were performed on 330 subjects. Respective images and biopsy annotations were obtained. Sensitivity and specificity; differences in the severity of cervical neoplasia; agreement of colposcopy impression, biopsy intent, and biopsy site; and differences in the number of biopsies were determined using the ROC, Bowker's test of symmetry, kappa statistic, and paired t test, respectively. RESULTS: The sensitivity and specificity for a lesion being seen with nonpolarized light and polarized light colposcopy were 96.8% and 64.5%, and 96.8% and 64.9%, respectively. There was no statistically significant difference in the ROC of the lesion being seen between nonpolarized (80.7) and polarized (80.9) colposcopy. Likewise, there was no statistically significant difference in the ROC of intent to biopsy between nonpolarized (80.2) and polarized colposcopy (78.8). The agreement of cervical histopathology and colposcopy impression for nonpolarized and polarized colposcopy were 0.986 and 0.952, respectively. There was no significant difference between nonpolarized and polarized colposcopy in the mean number of lesions seen or number of sites intended to biopsy. CONCLUSIONS: Polarized light colposcopy was not useful as an adjunct to conventional colposcopy in this study. Further research needs to be performed to determine the overall utility of polarized light colposcopy in clinical practice.

Comparison of knowledge and attitudes toward human papillomavirus, HPV vaccine, pap tests, and cervical cancer between US and Peruvian women.

OBJECTIVES: The purpose of this study was to determine and compare the knowledge and attitudes toward human papillomavirus (HPV), HPV vaccine, Pap tests, and cervical cancer among US and Peruvian women. MATERIALS AND METHODS: A convenience sample of 275 US women in Augusta, GA, and 702 Peruvian women living in or near Cusco, Peru, completed 22- or 21-item questionnaires, respectively. These questionnaires determined their knowledge about HPV, the HPV vaccine, Pap tests, and cervical cancer. Simple logistic regression was used to determine the relationship between location and language on the correct responses. Odds ratios (ORs) and 95% confidence intervals were calculated. RESULTS: US Spanish- (OR = 0.02), Quechua- (OR = 0.05), and Peru Spanish-speaking women (OR = 0.03) were significantly less likely to know that HPV causes cervical cancer compared with US non-Spanish-speaking women. US Spanish- (OR = 10.61, OR = 5.74), Quechua- (OR = 11.08, OR = 9.89), and Peru Spanish-speaking women (OR = 17.25, 14.43) were significantly more likely to be embarrassed and afraid, respectively, to get a Pap test compared with US non-Spanish-speaking women. US Spanish- (OR = 0.11), Quechua- (OR = 0.14), and Peru Spanish-speaking women (OR = 0.11) women were significantly less likely to know the HPV vaccine is safe and effective compared with US non-Spanish-speaking women. CONCLUSIONS: Education must be implemented to address serious misconceptions and worrisome attitudes toward Pap tests and the HPV vaccine to decrease the rate of cervical cancer in Peru and US Spanish-speaking women.

Personal digital assistants used to document compliance of bacterial vaginosis treatment.

OBJECTIVE: The objective of this study was to estimate patient compliance with oral and vaginal metronidazole treatment of bacterial vaginosis using personal digital assistants (PDAs) and paper diaries. GOAL: The goal of this study was to assess a novel compliance documentation approach. STUDY: After each dose of intravaginal or oral metronidazole, 71 subjects recorded the time on a paper diary and answered questions on a PDA. All PDA entries were unknowingly time-date-stamped. Subjects returned for 2- and 6-week posttreatment examinations. Compliance was calculated using a repeated-measures multivariate analysis of variance (ANOVA). RESULTS: Mean patient compliance rates within the oral metronidazole group were greater with the paper diary compared with the PDA (68.3% and 50.0%, respectively, P = 0.001). The observed rate of compliance agreement for PDA versus paper diary was 69.0% (kappa = 0.4). The majority of noncompliant subjects reported they were compliant with the PDA and paper diary. CONCLUSIONS: PDAs could more accurately document true compliance rates and could be reasonable instruments to assess compliance in intravaginal antimicrobial drug or contraceptive trials.

Home study course: Fall 2004.

OBJECTIVE: The Home Study Course is intended for the practicing colposcopist or practitioner who is seeking to develop or enhance his or her colposcopic skills. The goal of the course is to present colposcopic cases that are unusual or instructive in terms of appearance, presentation, or management or that demonstrate new and important knowledge in the area of colposcopy or pathology. Participants may benefit from reading and studying the material or from testing their knowledge by answering the questions. ACCME ACCREDITATION: The American Society for Colposcopy and Cervical Pathology (ASCCP) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The ASCCP designates this continuing medical education activity for 1 credit hour in Category I of the Physician's Recognition Award of the American Medical Association. Credit is available for those who choose to apply. The Home Study Course is planned and produced in accordance with the ACCME's Essential Areas and Elements. DISCLOSURE: Faculty must disclose any significant financial interest or relationship with proprietary entities that may have a direct relationship to the subject matter. For this course, neither author had any such relationship to report.

Patient acceptance of fluorescent and reflective spectroscopy as a replacement test for the pap smear.

OBJECTIVE: To determine women's acceptance of fluorescent and reflective spectroscopy (FRS) as a potential replacement test for the Pap smear. MATERIALS AND METHODS: Women scheduled for a colposcopic examination, or a colposcopic and FRS examination, completed a 22-item questionnaire that included demographic data, medical history, and preference-type questions. Data were compared using chi and Wilcoxon's rank sum tests. RESULTS: Women considered accuracy, comfort, and quick results to be the most important characteristics for new cervical cancer tests. Immediate test results were preferred strongly by both groups (control, 84.5%; scanned, 88.6%). Provided FRS was more accurate than the Pap smear, most women (control, 74.7%; scanned, 68.2%) would rather have FRS if it cost the same as a Pap smear. CONCLUSIONS: Women consider accuracy, comfort, and time critical issues with respect to FRS used as a primary screening test. Acceptance of this new technology will be facilitated by designing equipment accordingly to satisfy the concerns of women.

Women's responses to cervical interrogation by fluorescent and reflective spectroscopy.

OBJECTIVE: To determine women's responses to cervical interrogation by fluorescent and reflective spectroscopy (FRS). MATERIALS AND METHODS: A convenience sample of women scheduled for a colposcopic examination was interrogated by a cervical FRS system. Thereafter, women completed a 24-item questionnaire that assessed their responses to the spectroscopic test. Likert-scale responses were compared among subgroups using the chi test for trend. RESULTS: Most women favored FRS used for locating (97.7%; 170/174) and selectively sampling (96.6%; 168/174) cervical neoplasia. Fewer women (81.0%; 141/174) wanted FRS to replace the Pap smear. Most women were neither nervous (73.6%; 128/174) nor bothered (89.1%; 155/174) by the extra time for the FRS assessment. Women's acceptance was substantiated by 84.9% (146/174) and 90.8% (157/173) wanting their doctor to have and insurance company to pay for FRS, respectively. CONCLUSIONS: Use of FRS as a colposcopic adjunct was supported very favorably by women. Fewer women supported FRS replacing Pap smears. These high rates of approval by women should help the implementation of FRS technology.