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McGee AE, Alibegashvili T, Elfgren K, Frey B, Grigore M, Heinonen A, Jach R, Jariene K, Kesic V, Küppers V, Kyrgiou M, Leeson S, Louwers J, Mazurec M, Mergui J, Pedro A, Šavrova A, Siegler E, Tabuica U, Trojnarska D, Trzeszcz M, Turyna R, Volodko N, Cruickshank ME. European consensus statement on expert colposcopy. Eur J Obstet Gynecol Reprod Biol 2023; 290:27-37. [PMID: 37716200 DOI: 10.1016/j.ejogrb.2023.08.369] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/07/2023] [Accepted: 08/18/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Following the publication of the European consensus statement on standards for essential colposcopy in 2020, the need for standards relating to more complex and challenging colposcopy practice was recognised. These standards relate to colposcopy undertaken in patients identified through cervical screening and tertiary referrals from colposcopists who undertake standard colposcopy only. This set of recommendations provides a review of the current literature and agreement on care for recognised complex cases. With good uptake of human papillomavirus (HPV) immunisation, we anticipate a marked reduction in cervical disease over the next decade. Still, the expert colposcopist will continue to be vital in managing complex cases, including previous cervical intraepithelial neoplasia (CIN)/complex screening histories and multi-zonal disease. AIMS To provide expert guidance on complex colposcopy cases through published evidence and expert consensus. MATERIAL & METHODS Members of the EFC and ESGO formed a working group to identify topics considered to be the remit of the expert rather than the standard colposcopy service. These were presented at the EFC satellite meeting, Helsinki 2021, for broader discussion and finalisation of the topics. RESULTS & DISCUSSION The agreed standards included colposcopy in pregnancy and post-menopause, investigation and management of glandular abnormalities, persistent high-risk HPV+ with normal/low-grade cytology, colposcopy management of type 3 transformation zones (TZ), high-grade cytology and normal colposcopy, colposcopy adjuncts, follow-up after treatment with CIN next to TZ margins and follow-up after treatment with CIN with persistent HPV+, and more. These standards are under review to create a final paper of consensus standards for dissemination to all EFC and ESGO members.
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Affiliation(s)
- A E McGee
- Aberdeen Centre for Women's Health Research (ACWHR), University of Aberdeen, UK.
| | - T Alibegashvili
- Department of Gynaecology, Georgian National Screening Center, Tbilisi, Georgia
| | - K Elfgren
- Karolinska Institutet, Stockholm, Sweden
| | - B Frey
- Frauenklinik Baselland, Switzerland
| | - M Grigore
- Department of Obstetrics and Gynaecology, University of Medicine and Pharmacy "Grigore T. Popa" Iasi, Romania
| | - A Heinonen
- Department of Obstetrics and Gynecology, University of Helsinki, and Helsinki University Hospital
| | - R Jach
- Institute of Nursing and Obstetrics, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - K Jariene
- Department of Obstetrics and Gynecology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - V Kesic
- Faculty of Medicine, University of Belgrade, Clinic of Obstetrics and Gynaecology, Clinical Center of Serbia, Belgrade, Serbia
| | - V Küppers
- Frauenheilkunde & Geburtshilfe, Zytologisches Labor, Dysplasie-Sprechstunde, Düsseldorf, Germany
| | - M Kyrgiou
- IRDB, MDR & Surgery and Cancer, Faculty of Medicine, Imperial College London, UK
| | - S Leeson
- West London Gynaecological Cancer Centre, Imperial College NHS Trust, UK; Department of Obstetrics and Gynaecology, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Wales, UK
| | - J Louwers
- Diakonessenhuis, Bosboomstraat 1, 3582 KE, Utrecht, the Netherlands
| | - M Mazurec
- Corfamed Woman's Health Center, Kluczborska, Wroclaw, Poland; Department of Pathology and Clinical Cytology, University Hospital in Wroclaw, Poland
| | - J Mergui
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, Paris, France
| | - A Pedro
- Department of Obstetrics and Gynaecology, CUF Sintra Hospital, Sintra, Portugal
| | - A Šavrova
- Gynaecology Centre, North Estonia Medical Centre, Estonia
| | - E Siegler
- The Israeli Society of Colposcopy and Cervical and Vulvar Pathology, Peretz Berenstein St, Haifa, Israel
| | - U Tabuica
- Department of Obstetrics and Gynaecology, State University of Medicine and Pharmacy, Referral Center of Colposcopy, Chisinau, Moldavia
| | - D Trojnarska
- Institute of Nursing and Obstetrics, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - M Trzeszcz
- Corfamed Woman's Health Center, Kluczborska, Wroclaw, Poland; Department of Pathology and Clinical Cytology, University Hospital in Wroclaw, Poland
| | - R Turyna
- Institute for the Care of Mother and Child, Prague 4, Czech Republic; Third Faculty of Medicine, Charles University, Prague 10, Czech Republic; Institute of Postgraduate Education in Health Care - IPVZ, Prague 10, Czech Republic
| | - N Volodko
- Department of Oncology and Radiology, Danylo Halytsky Lviv national medical university, Lviv, Ukraine
| | - M E Cruickshank
- Aberdeen Centre for Women's Health Research (ACWHR), University of Aberdeen, UK
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Niu J, Cheng M, Hong Z, Ling J, Di W, Gu L, Qiu L. The effect of 5-Aminolaevulinic Acid Photodynamic Therapy versus CO 2 laser in the Treatment of Cervical Low-grade Squamous Intraepithelial Lesions with High-Risk HPV Infection: A non-randomized, controlled pilot study. Photodiagnosis Photodyn Ther 2021; 36:102548. [PMID: 34562648 DOI: 10.1016/j.pdpdt.2021.102548] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/01/2021] [Accepted: 09/20/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND There are insufficient studies comparing the efficacy of 5-aminolaevulinic acid (ALA) photodynamic therapy (PDT) against CO2 laser therapy in the treatment of cervical low-grade squamous intraepithelial lesion (LSIL) with high-risk human papillomavirus (HR-HPV), especially for long-term efficacy. METHODS Patients with cervical LSIL and HR-HPV infection were divided into two treatment groups based on their own choice. All patients had a follow-up test including HPV testing, cytology and colposcopy at 4-6 months and 12 months after the treatment. RESULTS (1) Among 277 patients, 176 patients received 5-ALA PDT and 101 patients received CO2 laser therapy. (2) 4-6 months after treatment, there was no significant difference between two groups in the complete remission (CR) rates of cervical LSIL and the clearance rate of HR-HPV infection. (3) 12 months after treatment, compared with the CO2 laser group, the CR rates of cervical LSIL in the 5-ALA PDT group was significantly higher than the CO2 laser group. There was no statistical difference in the clearance rate of HR-HPV infection between the two groups. (4) 12 months after treatment, the recurrence rate of cervical lesions and the reinfection rate of HR-HPV infection in 5-ALA PDT group were significantly lower than those in CO2 laser group. CONCLUSION The effect of 5-ALA PDT is similar to CO2 laser at 4-6 months. The long-term efficacy of 5-ALA PDT appears better than CO2 laser. As a non-invasive treatment, 5-ALA PDT is a highly effective therapeutic procedure for cervical LSIL with HR-HPV infection.
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Affiliation(s)
- Jiaxin Niu
- Department of Obstetrics and Gynecology, Renji Hospital, Shanghai Jiaotong University School of Medicine; Shanghai Key Laboratory of Gynecologic Oncology, Renji Hospital, Shanghai Jiaotong University School of Medicine
| | - Mengxing Cheng
- Department of Obstetrics and Gynecology, Renji Hospital, Shanghai Jiaotong University School of Medicine; Shanghai Key Laboratory of Gynecologic Oncology, Renji Hospital, Shanghai Jiaotong University School of Medicine
| | - Zubei Hong
- Department of Obstetrics and Gynecology, Renji Hospital, Shanghai Jiaotong University School of Medicine; Shanghai Key Laboratory of Gynecologic Oncology, Renji Hospital, Shanghai Jiaotong University School of Medicine
| | - Jiayan Ling
- Department of Obstetrics and Gynecology, Renji Hospital, Shanghai Jiaotong University School of Medicine
| | - Wen Di
- Department of Obstetrics and Gynecology, Renji Hospital, Shanghai Jiaotong University School of Medicine; Shanghai Key Laboratory of Gynecologic Oncology, Renji Hospital, Shanghai Jiaotong University School of Medicine; State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine
| | - Liying Gu
- Department of Obstetrics and Gynecology, Renji Hospital, Shanghai Jiaotong University School of Medicine; Shanghai Key Laboratory of Gynecologic Oncology, Renji Hospital, Shanghai Jiaotong University School of Medicine.
| | - Lihua Qiu
- Department of Obstetrics and Gynecology, Renji Hospital, Shanghai Jiaotong University School of Medicine; Shanghai Key Laboratory of Gynecologic Oncology, Renji Hospital, Shanghai Jiaotong University School of Medicine; State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine.
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Affiliation(s)
- Wen-Ling Lee
- Department of Medicine, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC
- Department of Nursing, Oriental Institute of Technology, New Taipei City, Taiwan, ROC
| | - Fa-Kung Lee
- Department of Obstetrics and Gynecology, Cathy General Hospital, Taipei, Taiwan, ROC
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, ROC
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