Review: Optical Micrometer Resolution Scanning for Non-invasive Grading of Precancer in the Human Uterine Cervix

Management of cervical precancer is archetypal for other cancer prevention programmes but has to consider diagnostic and logistic challenges. Numerous optical tools are emerging for non-destructive near real-time early diagnosis of precancerous lesions of the cervix. Non-destructive, real-time imaging modalities have reached pre-commercial status, but high resolution mapping tools are not yet introduced in clinical settings. The NCBI PubMed web page was searched using the keywords ‘CIN diagnosis’ and the combinations of ‘cervix {confocal, optical coherence tomography, ftir, infrared, Raman, vibrational, spectroscopy}’. Suitable titles were identified and their relevant references followed. Challenges in precancer management are discussed. The following tools capable of non-destructive high resolution mapping in a clinical environment were selected: confocal microscopy, optical coherence tomography, IR spectroscopy, and Raman spectroscopy. Findings on the clinical performance of these techniques are put into context in order to assist the reader in judging the likely performance of these methods as diagnostic tools. Rationale for carrying out research under the prospect of the HPV vaccine is given.

Colposcopic diagnosis and treatment of cervical dysplasia at a single clinic visit. Experience of low-voltage diathermy loop in 1000 patients

In a study of 1000 women referred over 20 months with abnormal smears and in whom the entire transformation zone could be seen the aim was to test the feasibility of colposcopic assessment and treatment at one visit to the clinic. 897 women needed only one visit. This was achieved by using a modification of the large loop diathermy excision technique and by careful attention to the timing of the clinic visit. 103 required further visits, for the following reasons: incomplete excision on histology and/or subsequently abnormal smear (85), secondary haemorrhage (6), microinvasion or invasive carcinoma (9), biopsy specimens unusable (3). Further treatment was given in 4.1% of the cervical dysplasias. All patients treated in a single visit preferred this approach to the alternative of colposcopic assessment and biopsy followed, after histological examination, by local ablation by laser, excision by loop biopsy technique, or cone biopsy.

Combined synchronous abdomino-vaginal operation in management of recurrent urinary stress incontinence

A synchronous combined abdomino-vaginal repair operation is described which enables adequate mobilisation and subsequent fixation of the urethro-vesical junction with accurate insertion of supporting stitches. This procedure is of great value in the management of patients with previous failed anterior colporrhaphy for stress incontinence.

Cytologic features of a mixed mesodermal tumor of the uterus demonstrated by cells obtained with the mi-mark endometrial sampler

A case is reported of a 68-year-old woman with a malignant mixed mesodermal tumor of the uterus. Prior to diagnostic curettage and hysterectomy, cells were obtained with the Mi-Mark Endometrial Sampler. Cellular features are described in detail.

Diagnostic accuracy of the MiMark endometrial cell sampler in 101 patients with postmenopausal bleeding

The efficacy of the MiMark endometrial cell sampler in the cytological assessment of endometrium was evaluated in 101 patients with postmenopausal bleeding. The apparatus was successful in daignosing all but one of the endometrial carcinomas in the series. Reports of its accuracy in diagnosing endometrial hyperplasia and other endometrial pathology cannot be substantiated.

Hypoxic stillbirth due to entangled intrauterine catheter

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Starch granulomatosis of the peritoneum

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