Colposcopy to evaluate abnormal cervical cytology in 2008

  • Dana M. Chase
    Division of Gynecologic Oncology, Chao Family Comprehensive Cancer Center, University of California, Irvine, Medical Center, Orange, CA
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  • Marlene Kalouyan
    Division of Gynecologic Oncology, Chao Family Comprehensive Cancer Center, University of California, Irvine, Medical Center, Orange, CA
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  • Philip J. DiSaia
    Reprints: Philip J. DiSaia, MD, Division Director, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine, Medical Center, 101 The City Dr. South, Bldg. 56, Room 275, Orange, CA 92868
    Division of Gynecologic Oncology, Chao Family Comprehensive Cancer Center, University of California, Irvine, Medical Center, Orange, CA
    Search for articles by this author
      The rates of cervical cancer in the United States are low in comparison with developing nations. Whereas the Papanicolaou smear has performed well in terms of dectecting both precursors of squamous cell carcinoma and squamous cell carcinoma of the cervix, this test has been less successful at identifying those women with the highest-risk premalignant disease. The use of human papillomavirus testing has also contributed to the improved sensitivity of screening for cervical cancer. In light of this, the colposcopy clinic retains high referral rates yet has poor diagnostic accuracy. Unfortunately, patients are triaged to follow-up for abnormal Papanicolaou smears based on algorithms that rely on the less evidence-based techniques of colposcopy. Therefore, the need to improve the specificity of colposcopic-guided biopsy remains. The colposcopic procedure is highlighted in this review and evaluated in terms of current literature on technique, the colposcopic impression, cervical biopsy, and methods proposed to enhance appreciation of the highest-risk lesions. By outlining certain flaws in technique and discussing the proposal of new tests to supplement the current standard of care, this review aimed to highlight the need for future research to maintain sensitivity but improve the specificity of colposcopy.

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