Colposcopy of patients with cytologic inflammatory epithelial changes.

Of 3,308 cervical cytologies performed at a university health service between September 1986 and September 1987, 371 were reported as showing inflammatory epithelial changes (IECs). Colposcopy was offered to all patients with this diagnosis and was actually performed on 200 (54%). Of these women, 44 had an atypical transformation zone; of the 33 who were biopsied, 23 had histologic diagnoses ranging from human papillomavirus (HPV) infection (4 cases) to grade III cervical intraepithelial neoplasia (CIN; 4 cases). Most biopsies showed CIN I. In our clinic, the 95% confidence limits for the histologic diagnosis of HPV or CIN in women with a cytologic diagnosis of IEC are 8.5% to 23.5%. Colposcopic examination of women with IEC may be able to detect patients with CIN who are missed by standard cytologic screening. Concerns about a potential bias from false-positive histology reports must be resolved before such an approach can be recommended.

Improving the sensitivity of cervical cytologic screening. A comparison of duplicate smears and colposcopic examination of patients with cytologic inflammatory epithelial changes.

During a ten-month period, 264 cervical cytologic specimens were submitted in duplicate to two separate cytology laboratories. An attempt was made to perform colposcopy on all 45 patients reported as having an abnormality by either laboratory. All but one patient with a cytologic diagnosis of cervical intraepithelial neoplasia (CIN) underwent colposcopy, as did 68% of the patients with a diagnosis of nondysplastic atypia (inflammatory epithelial changes [IEC]). Five cases of histologically verified CIN were found by colposcopic study of patients with a cytologic diagnosis of CIN; two additional cases were found by colposcopic study of patients with a cytologic diagnosis of IEC. On the assumption that patients not colposcoped were not systematically different from the others with IEC, the screening sensitivities for both laboratories and for cytology followed by colposcopy of IEC cases were estimated. A statistically significant improvement in screening sensitivity was achieved by colposcopic examination of patients with IEC. This conclusion was tempered by a Bayesian analysis that suggested that some of the apparent improved sensitivity could be due to falsely positive biopsy reports. Despite potential benefits, it is premature to recommend universal colposcopic examination of patients with cytologic reports of inflammatory epithelial changes.

Inflammatory epithelial changes and nonviral cervicovaginal pathogens.

To assess the relationship between inflammatory epithelial changes (IECs) and cervicovaginal infection, 249 women with cytologic diagnoses of IEC were studied. The findings showed a Chlamydia infection in 15.7% of the cases, Monilia in 38.1%, Trichomonas in 1.6% and a lateral vaginal wall pH of greater than 5.5 in 29.7%. These results were compared with those for 211 controls drawn from the same population; women with abnormal cytologic reports were excluded from the control group. The controls had a prevalence of yeast and trichomoniasis no different from that of the IEC group. In contrast, the prevalence of chlamydial infection (7.6%) and pH greater than 5.5 (10.7%) were significantly lower in the controls than in the IEC cases. Chlamydia was found in 30.2% of 43 women with an atypical transformation zone, equally distributed between women whose biopsies were normal and those whose biopsies showed cervical intraepithelial neoplasia. The traditional guidelines of treating cases with cytologic diagnoses of IEC prior to obtaining a repeat smear may need reevaluation in the light of these findings.