DOCSLIB.ORG

Agreement Between Endocervical Brush and Endocervical Curettage in Patients Undergoing Repeat Endocervical Sampling

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Agreement Between Endocervical Brush and Endocervical Curettage in Patients Undergoing Repeat Endocervical Sampling Agreement Between Endocervical Brush and Endocervical Curettage in Patients Undergoing Repeat Endocervical Sampling Meredith J. Alston MD David W. Doo MD Sara E. Mazzoni MD MPH Elaine H. Stickrath MD Denver Health Medical Center University of Colorado Department of Obstetrics and Gynecology Background • Women with abnormal Pap tests referred for colposcopy frequently require sampling of the endocervix • ASCCP deems both the endocervical brush (ECB) and the endocervical currette (ECC) appropriate means of collecting endocervical samples (1) • Both have advantages and disadvantages, and it is unclear if one modality is superior Background • ECB has good sensitivity for endocervical lesions, it has poor specificity, ranging from 26- 38%2,3 • ECC has an excellent negative predictive value of 99.4% in women who had a satisfactory colposcopy • ECB is better tolerated by the patient, but runs the risk of contamination from the ectocervix • ECC is less likely to obtain an adequate sample Background • The results from the endocervical sample may influence clinical management after colposcopy. • Certain treatment options for high grade squamous intraepithelial neoplasia are available only to women with negative endocervical sampling. ▫ Ablative techniques ▫ Expectant management Background • Over concerns related to potential complications of excisional treatments, as well as over- treatment, there has been a push to re-introduce ablative techniques and, in appropriate clinical circumstances, expectant management, into the routine treatment of patients with cervical cancer precursors (12). Background • At our institution, it is our concern that due to the possibility of contamination from the ectocervix, a positive ECB may not represent a true positive endocervical sample. • We do not use a sleeve • Positive ECBs return for ECC if otherwise a candidate for ablative therapy or expectant management Objective • To describe the agreement between these two modalities of endocervical sampling. • Aid clinicians in: ▫ counseling of patients ▫ interpretation of results ▫ selection of an endocervical sampling method in varied clinical scenarios Methods • IRB approval was obtained through the Colorado Multiple Institutional Review Board • Retrospective cohort study • April 1, 2013-June 15, 201 • ECB and returned for ECC Methods • ECB sampling results ▫ “Low-grade” LSIL ASCUS ▫ “High-grade” HSIL ASC-H • ECC results: negative, LSIL, and HSIL according to LAST terminology(13). Methods • Demographics: ▫ Age ▫ Gravidity ▫ Parity ▫ Insurance ▫ primary language ▫ Contraception ▫ menopausal status ▫ Weight ▫ current drug or tobacco use ▫ history of prior treatment for dysplasia (including type of treatment) Methods • REDCap • Percent agreement between ECB and ECC were calculated based on “low-grade” and “high-grade” classifications • Chi-square and student’s t-test were used to determine differences in dichotomous and continuous variables • Multivariate analyses, using logistic regression modeling, were used to compare outcome measures among the groups • Statistical tests were considered significant at P<0.05. Table 1. Patient Demographics and Clinical Characteristics Mean Age (years) 33.9 ± 10.3 Gravidity 2.27 ± 1.8 Results Parity 1.8 ± 1.5 Primary Language English 56 (70.9%) Spanish 20 (25.3%) Other 3 (3.8%) Insurance Yes 56 (70.9%) No 23 (29.1%) Contraception Method Condoms 7 (8.9%) Depo Provera 4 (5.1%) Implanon/Nexplanon 6 (7.6%) IUD 19 (24.1%) OCPs/Patch/Ring 6 (7.6%) Menopause 7 (8.9%) Sterilization 6 (7.6%) Tobacco Use Yes 14 (17.7%) No 65 (82.3%) Drug Use Yes 2 (2.5%) No 77 (97.5%) History of Prior Treatment Yes 4 (5.1%) No 57 (72.2%) Not Documented 18 (22.8%) Results Results Table 2. Demographic and Clinical Predictors of Agreement Between ECB and ECC Variable Agreement No Agreement P Value n=8 n=71 Mean Age (years) 44.3 ± 13.3 32.7 ± 9.3 0.049 Mean Parity 1.5 ± 1.1 1.9 ± 1.6 0.38 Mean weight (pounds) 169 ± 36 156 ± 39 0.37 Primary Language English 5 (62.5%) 51 (71.8%) 0.59 Insured 6 (75.0%) 50 (70.4%) 0.78 Progestin Only Contraception 1 (12.5%) 22 (31.0%) 0.24 Estrogen Contraception 0 6 (8.5%) 1 Menopause 3 (37.5%) 4 (5.6%) 0.02 IUD 0 14 (19.7%) 0.07 Tobacco 2 (25.0%) 12 (16.9%) 0.59 Drugs 0 2 (2.8%) 1 Prior Excision 2 (25.0%) 1 (1.4%) 0.03 Atrophy 1 (12.5%) 7 (9.9%) 1 IUD = Intrauterine Device Discussion • There is poor agreement between ECB and ECC results for both low-grade (7.4%) and high-grade (16%) dysplasia at the time of colposcopy in our patient population using an unsleeved cytobrush. Discussion • Although the ASCCP recommends either cytobrush or curettage for evaluation of the endocervix(15), there has been a significant amount of controversy over which is the preferred method. • Previous studies that have compared the relative sensitivities and specificities of the two methods have produced a wide range of results. Discussion • Our data suggests that ECB collected at the time of colposcopy overestimates the presence of endocervical disease when compared to ECC. We suspect that this may be in a large part due to atypical ectocervical cells adhering to the brush at the time of ECB and thus giving false positive results. Discussion • In our patient population, given the poor agreement between the two modalities, we have elected to perform endocervical sampling with ECC in those patients who may be candidates for expectant management or ablative therapies. References • 1. Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain JM, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. J Low Genit Tract Dis. 2012 Jul;16(3):175–204. • 2. Holmstrom S. A prospective randomized comparison of the endocervical brush and endocervical curette. Obstet Gynecol. 2002 Apr;99(4):S4. • 3. Mogensen ST, Bak M, Dueholm M, Frost L, Knoblauch NO, Praest J, et al. Cytobrush and endocervical curettage in the diagnosis of dysplasia and malignancy of the uterine cervix. Acta Obstet Gynecol Scand. 1997 Jan;76(1):69–73. • 4. Boardman LA, Meinz H, Steinhoff MM, Heber WW, Blume J. A randomized trial of the sleeved cytobrush and the endocervical curette. Obstet Gynecol. 2003 Mar;101(3):426–30. • 5. Weitzman GA, Korhonen MO, Reeves KO, Irwin JF, Carter TS, Kaufman RH. Endocervical brush cytology. An alternative to endocervical curettage? J Reprod Med. 1988 Aug;33(8):677–83. • 6. Andersen W, Frierson H, Barber S, Tabbarah S, Taylor P, Underwood P. Sensitivity and specificity of endocervical curettage and the endocervical brush for the evaluation of the endocervical canal. Am J Obstet Gynecol. 1988 Sep;159(3):702–7. • 7. Klam S, Arseneau J, Mansour N, Franco E, Ferenczy A. Comparison of endocervical curettage and endocervical brushing. Obstet Gynecol. 2000 Jul;96(1):90–4. • 8. Dunn TS, Stevens-Simon C, Moeller LD, Miekle S. Comparing endocervical curettage and endocervical brush at colposcopy. J Low Genit Tract Dis. 2000 Apr;4(2):76–8. • 9. Hoffman MS, Sterghos S, Gordy LW, Gunasekaran S, Cavanagh D. Evaluation of the cervical canal with the endocervical brush. Obstet Gynecol. 1993 Oct;82(4 Pt 1):573–7. • 10. Gosewehr JA, Julian TM, O’Connell BJ. Improving the Cytobrush as an aid in the evaluation of the abnormal Papanicolaou test. Obstet Gynecol. 1991 Sep;78(3 Pt 1):440–3. • 11. Kyrgiou M, Koliopoulos G, Martin-Hirsch P, Arbyn M, Prendiville W, Paraskevaidis E. Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and meta-analysis. Lancet Lond Engl. 2006 Feb 11;367(9509):489–98. • 12. Khan MJ, Smith-McCune KK. Treatment of cervical precancers: back to basics. Obstet Gynecol. 2014 Jun;123(6):1339–43. • 13. Darragh TM, Colgan TJ, Cox JT, Heller DS, Henry MR, Luff RD, et al. The Lower Anogenital Squamous Terminology Standardization Project for HPV-Associated Lesions: Background and Consensus Recommendations From the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology. J Low Genit Tract Dis. 2012 Jul;16(3):205–42. • 14. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009 Apr;42(2):377–81. • 15. Massad LS, Einstein MH, Huh WK, Katki HA, Kinney WK, Schiffman M, et al. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis. 2013 Apr;17(5 Suppl 1):S1–27. • Thank you! Are Women With Abnormal Pap Smears Being Discharged from Colposcopy Too Soon? Rachel Kupets MD, MSc, Anna Kone PHD, Julia Gao, Li Wang Ontario Cervical Screening Program, Cancer Care Ontario Verbal Disclosure •No Disclosures Introduction • Research has found that more than half of women referred for abnormal cervical cytology are exited from colposcopy with out undergoing treatment • Concern that lesions may have been missed in untreated women who may continue to be at elevated risk of developing cervical cancer • Mcredie et al. published that 50% of women with untreated CIN III progressed into invasive cancer • Concern whether colposcopy has adequately excluded high grade cervical dysplasia Kupets, R et al, J Obstet Gynaecol Can. 2014 Dec;36(12):1079-84. McCredie MR, et al Lancet Oncol. 2008 May;9(5):425-34. doi: 10.1016/S1470-2045(08)70103-7 Objective • To determine
Load more

Recommended publications
  • 2021 – the Following CPT Codes Are Approved for Billing Through Women’S Way
    WHAT’S COVERED – 2021 Women’s Way CPT Code Medicare Part B Rate List Effective January 1, 2021 For questions, call the Women’s Way State Office 800-280-5512 or 701-328-2389 • CPT codes that are specifically not covered are 77061, 77062 and 87623 • Reimbursement for treatment services is not allowed. (See note on page 8). • CPT code 99201 has been removed from What’s Covered List • New CPT codes are in bold font. 2021 – The following CPT codes are approved for billing through Women’s Way. Description of Services CPT $ Rate Office Visits New patient; medically appropriate history/exam; straightforward decision making; 15-29 minutes 99202 72.19 New patient; medically appropriate history/exam; low level decision making; 30-44 minutes 99203 110.77 New patient; medically appropriate history/exam; moderate level decision making; 45-59 minutes 99204 165.36 New patient; medically appropriate history/exam; high level decision making; 60-74 minutes. 99205 218.21 Established patient; evaluation and management, may not require presence of physician; 99211 22.83 presenting problems are minimal Established patient; medically appropriate history/exam, straightforward decision making; 10-19 99212 55.88 minutes Established patient; medically appropriate history/exam, low level decision making; 20-29 minutes 99213 90.48 Established patient; medically appropriate history/exam, moderate level decision making; 30-39 99214 128.42 minutes Established patient; comprehensive history exam, high complex decision making; 40-54 minutes 99215 128.42 Initial comprehensive
    [Show full text]
  • RELATIVE VALUE UNITS (RVUS) and RELATED INFORMATION—Continued
    Federal Register / Vol. 68, No. 158 / Friday, August 15, 2003 / Proposed Rules 49129 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued Physician Non- Mal- Non- 1 CPT/ Facility Facility 2 MOD Status Description work facility PE practice acility Global HCPCS RVUs RVUs PE RVUs RVUs total total 42720 ....... ........... A Drainage of throat ab- 5.42 5.24 3.93 0.39 11.05 9.74 010 scess. 42725 ....... ........... A Drainage of throat ab- 10.72 N/A 8.26 0.80 N/A 19.78 090 scess. 42800 ....... ........... A Biopsy of throat ................ 1.39 2.35 1.45 0.10 3.84 2.94 010 42802 ....... ........... A Biopsy of throat ................ 1.54 3.17 1.62 0.11 4.82 3.27 010 42804 ....... ........... A Biopsy of upper nose/ 1.24 3.16 1.54 0.09 4.49 2.87 010 throat. 42806 ....... ........... A Biopsy of upper nose/ 1.58 3.17 1.66 0.12 4.87 3.36 010 throat. 42808 ....... ........... A Excise pharynx lesion ...... 2.30 3.31 1.99 0.17 5.78 4.46 010 42809 ....... ........... A Remove pharynx foreign 1.81 2.46 1.40 0.13 4.40 3.34 010 body. 42810 ....... ........... A Excision of neck cyst ........ 3.25 5.05 3.53 0.25 8.55 7.03 090 42815 ....... ........... A Excision of neck cyst ........ 7.07 N/A 5.63 0.53 N/A 13.23 090 42820 ....... ........... A Remove tonsils and ade- 3.91 N/A 3.63 0.28 N/A 7.82 090 noids.
    [Show full text]
  • Obstetrics and Gyneclogy
    3/28/2016 Obstetrics and Gynecology Presented by: Peggy Stilley, CPC, CPC-I, CPMA, CPB, COBGC Objectives • Procedures • Pregnancy • Payments • Patient Relationships 1 3/28/2016 Female Genital Anatomy Terminology and Abbreviations • Endometriosis • Neoplasm • BUS • TAH/BSO • G3P2 2 3/28/2016 Procedures • Hysterectomy • Prolapse repairs • IUDs • Colposcopy Hysterectomy • Approach • Open • Vaginal • Total Laparoscopic • Laparoscopic assisted • Extent • Total • Subtotal • Supracervical • Diagnosis 3 3/28/2016 CPT Codes • Abdominal 58150 – • With or without removal tubes/ovaries 58240 • Some additional services • Vaginal 58260-58270 • Size of uterus < 250 grams, > 250 grams 58275-58294 • Additional services CPT Codes • LAVH 58541-58544 • Detach uterus , cervix, and structures through the scope 58548-58554 • Uterus removed thru the vagina • TLH • Detach structures laparoscopically entire 58570- 58573 uterus, cervix, bodies • Removed thru the vagina or abdomen • LSH • Detaching structures through the scope, 58541 – 58544 leaving the cervix • Morcellating – removing abdominally 4 3/28/2016 Hysterectomy Additional procedures performed • Tubes & Ovaries removed • Enterocele repair • Repairs for incontinence • Marshall-Marchetti-Krantz • Colporrhaphy • Colpo-urethropexy • Urethral Sling • TVT, TOT 5 3/28/2016 Procedures • 57288 Sling • 57240 Anterior Repair • 57250 Posterior Repair • +57267 Add on code for mesh/graft • 57260 Combo of A&P • 57425 Laparoscopic Colpopexy • 57280 Colpopexy, Abdominal approach • 57282 Colpopexy, vaginal approach Example 1 PREOPERATIVE DIAGNOSES: 1. Menorrhagia unresponsive to medical treatment with resulting chronic blood loss anemia POSTOPERATIVE DIAGNOSES: 1. Menorrhagia 2. Blood loss anemia TITLE OF SURGERY: Total abdominal hysterectomy ANESTHESIA: GENERAL ENDOTRACHEAL ANESTHESIA. INDICATIONS: The patient is a lovely 52-year-old female who presented with menorrhagia that is non- responsive to medical treatment.
    [Show full text]
  • 2019 Reimbursement Schedule IMPORTANT INFORMATION REGARDING REIMBURSEMENT by the CARE for YOURSELF PROGRAM 1
    Iowa Department of Public Health Effective on or after Date of Service 01.01.2019 Division of Health Promotion Chronic Disease Prevention Iowa Care for Yourself Program 2019 Reimbursement Schedule IMPORTANT INFORMATION REGARDING REIMBURSEMENT BY THE CARE FOR YOURSELF PROGRAM 1. If a Pap test is performed, the collection of the Pap (CPT codes 99000, Q0091 & Q0111) is included in the office visit reimbursement. The woman is not to be billed for the collection or handling of the specimen. 2. These amounts apply when service is performed for the purpose of this program. Rates listed for services include all incidental charges related to the procedure; additional amounts may not be billed to the client. 3. Federal funding can not be used to reimburse for treatment of breast cancer, cervical intraepithelial neoplasia or cervical cancer. CPT Description End RATE Code OFFICE VISITS Notes 26 TC Total 99201 New Patient Visit; problem focused 3 42.90 99202 New Patient Visit; expanded problem focused 3 72.00 99203 New Patient Visit; detailed, low complexity 3 102.01 99204 New Patient Visit; comprehensive history, exam, moderate complexity 1 155.82 99205 New Patient Visit; comprehensive history, exam, high complexity 1,3 196.16 99211 Established Patient Visit, may not require presence of physician 21.35 99212 Established Patient Visit, problem focused 3,4 42.42 99213 Established Patient Visit, expanded problem focused 3,4 70.35 99214 Established Patient Visit, comprehensive moderate complexity 3,4 103.31 99215 Established Patient Visit, comprehensive high complexity 3,4 138.47 99385 New Patient Visit (18 - 39 y.o) - paid at 99203 rate 2 102.01 99386 New Patient Visit (40 - 64 y.o.) - paid at 99203 rate 2 102.01 99387 New Patient Visit (65+ y.o.) - paid at 99203 rate 2 102.01 99395 Established Patient Visit (18 - 39 y.o.) - paid at 99213 rate 2 70.35 99396 Established Patient Visit (40 - 64 y.o.) - paid at 99213 rate 2,3,4 70.35 99397 Established Patient Visit (65+ y.o.) - paid at 99213 rate 2 70.35 G0101 Cancer screening; pelvic and breast exam included.
    [Show full text]
  • 2012 Updated Consensus Guidelines for Managing Abnormal Cervical
    2012 Updated Consensus Guidelines for the Management of Abnormal Cervical Cancer Screening Tests and Cancer Precursors L. Stewart Massad, MD, Mark H. Einstein, MD, Warner K. Huh, MD, Hormuzd A. Katki, PhD, Walter K. Kinney, MD, Mark Schiffman, MD, Diane Solomon, MD, Nicolas Wentzensen, MD, and Herschel W. Lawson, MD, for the 2012 ASCCP Consensus Guidelines Conference From Washington University School of Medicine, St. Louis, Missouri; Albert Einstein College of Medicine, New York, New York; University of Alabama School of Medicine, Birmingham, Alabama; Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland; The Permanente Medical Group, Sacramento, California; and Emory University School of Medicine, Atlanta, Georgia h ABSTRACT: A group of 47 experts representing 23 Kaiser Permanente Northern California Medical Care Plan professional societies, national and international health provided evidence on risk after abnormal tests. Where data organizations, and federal agencies met in Bethesda, MD, were available, guidelines prescribed similar management September 14Y15, 2012, to revise the 2006 American Society for women with similar risks forCIN3,AIS,andcancer.Most for Colposcopy and Cervical Pathology Consensus Guidelines. prior guidelines were reaffirmed. Examples of updates in- The group’s goal was to provide revised evidence-based clude: Human papillomavirusYnegative atypical squamous consensus guidelines for managing women with abnormal cells of undetermined significance results are followed with cervical cancer screening tests, cervical intraepithelial neo- co-testing at 3 years before return to routine screening and plasia (CIN) and adenocarcinoma in situ (AIS) following are not sufficient for exiting women from screening at age adoption of cervical cancer screening guidelines incorporat- 65 years; women aged 21Y24 years need less invasive man- ing longer screening intervals and co-testing.
    [Show full text]
  • Services Not Requiring Prior Authorization for PSN Specialists
    For PSN Specialists, these office-based services require no Prior Authorization. effective 02/07/2020 "Notification" is required for EmblemHealth Cohort 2 patients - see website for details MEDICAL SPECIALTIES SURGICAL SPECIALTIES Allergy & Immunology Surgery - Breast Audiology Surgery - Colorectal Cardiovascular Disease Surgery - General Dermatology & Dermatopathology Surgery - Hand Endocrinology Surgery Head & Neck Gastroenterology Surgery - GYN Oncology Hematology & Oncology Surgery - Orthopedics Infectious Disease Surgery - Plastic and Reconstructive Nephrology Surgery - Vascular Neurology Surgery - Urology Obstetrics & Gynecology Ophthalmology Surgery - Breast Otolaryngology (ENT) 10021 FNA BX W/O IMG GDN 1ST LES Pain Management 10022 FNA W/IMAGE Podiatry 76642 ULTRASOUND BREAST LIMITED Pulmonary Disease Rheumatology Surgery - Colorectal 10060 DRAINAGE OF SKIN ABSCESS Allergy & Immunology 12021 CLOSURE OF SPLIT WOUND 31231 NASAL ENDOSCOPY, DX 43235 UPPR GI ENDOSCOPY, DIAGNOSIS 94010 BREATHING CAPACITY TEST 44386 ENDOSCOPY, BOWEL POUCH/BIOP 94016 REVIEW PATIENT SPIROMETRY 44388 COLONOSCOPY THRU STOMA SPX 94060 EVALUATION OF WHEEZING 45300 PROCTOSIGMOIDOSCOPY DX 94150 VITAL CAPACITY TEST 45303 PROCTOSIGMOIDOSCOPY DILATE 94200 LUNG FUNCTION TEST (MBC/MVV) 45330 DIAGNOSTIC SIGMOIDOSCOPY 94640 AIRWAY INHALATION TREATMENT 45331 SIGMOIDOSCOPY AND BIOPSY 94664 EVALUATE PT USE OF INHALER 45378 DIAGNOSTIC COLONOSCOPY 94726 PULM FUNCT TST PLETHYSMOGRAP 45379 COLONOSCOPY W/FB REMOVAL 94727 PULM FUNCTION TEST BY GAS 45380 COLONOSCOPY AND BIOPSY
    [Show full text]
  • SJH Procedures
    SJH Procedures - Gynecology and Gynecology Oncology Services New Name Old Name CPT Code Service ABLATION, LESION, CERVIX AND VULVA, USING CO2 LASER LASER VAPORIZATION CERVIX/VULVA W CO2 LASER 56501 Destruction of lesion(s), vulva; simple (eg, laser surgery, Gynecology electrosurgery, cryosurgery, chemosurgery) 56515 Destruction of lesion(s), vulva; extensive (eg, laser surgery, Gynecology electrosurgery, cryosurgery, chemosurgery) 57513 Cautery of cervix; laser ablation Gynecology BIOPSY OR EXCISION, LESION, FACE AND NECK EXCISION/BIOPSY (MASS/LESION/LIPOMA/CYST) FACE/NECK General, Gynecology, Plastics, ENT, Maxillofacial BIOPSY OR EXCISION, LESION, FACE AND NECK, 2 OR MORE EXCISE/BIOPSY (MASS/LESION/LIPOMA/CYST) MULTIPLE FACE/NECK 11102 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); General, Gynecology, single lesion Aesthetics, Urology, Maxillofacial, ENT, Thoracic, Vascular, Cardiovascular, Plastics, Orthopedics 11103 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); General, Gynecology, each separate/additional lesion (list separately in addition to Aesthetics, Urology, code for primary procedure) Maxillofacial, ENT, Thoracic, Vascular, Cardiovascular, Plastics, Orthopedics 11104 Punch biopsy of skin (including simple closure, when General, Gynecology, performed); single lesion Aesthetics, Urology, Maxillofacial, ENT, Thoracic, Vascular, Cardiovascular, Plastics, Orthopedics 11105 Punch biopsy of skin (including simple closure, when General, Gynecology, performed); each separate/additional lesion
    [Show full text]
  • Cervical Cancer
    Cervical Cancer Overview Each year, about 15,000 women in the United States learn they have cervical cancer. Cervical cancer is one of the most common types to affect a woman’s reproductive organs. Most cases of cervical cancer are caused by the human papillomavirus (HPV). Before cervical cancer appears, the cells of the cervix go through precancerous changes known as dysplasia. It is these abnormal cell changes that an annual Pap test can help to detect. For some women, these changes may go away without any treatment. More often, they need to be treated to keep them from changing into cancer. Because so many women do have Pap tests annually, deaths from cervical cancer have decreased greatly and are now rare in the United States. Chances of successfully treating cervical cancer are highest when detected early. Need-to-Know Anatomy The cervix is part of the female reproductive system. It is the narrow, lower end of the uterus. It is a hollow, pear-shaped organ where a fetus grows. It is about one inch around and connects the vagina (birth canal) to the uterus. During a woman’s menstrual period, blood flows from the uterus through the cervix to the vagina. The cervix also produces mucus that helps sperm move from the vagina into the uterus. Sperm travel through the cervix to fertilize a woman’s egg during conception. During pregnancy, the cervix is tightly closed to help keep the baby inside the uterus. During childbirth, the cervix opens or dilates to allow the baby to pass through the vagina.
    [Show full text]
  • Coding for Obstetrics and Gynecology
    Coding for Obstetrics and Gynecology Marie Mindeman Director-CPT Coding and Regulatory Affairs Overview • Anatomy and Physiology Review of Systems • Coding Visit Screenings for Path & Lab Results • CPT Coding for Common Gynecologic Procedures • Prenatal Care • Obstetrical Triage • Ultrasound Readings • Practical Case Scenarios Major Female Reproductive Structures • Ovaries • Fallopian Tubes • Uterus • Vagina Ovaries • Found on either side of the uterus, below and behind the fallopian tubes – Anchored to the uterus below the fallopian tubes via the ligament of ovary and suspensory ligaments • Form eggs for reproductive purposes • Part of the endocrine system – Secrete estrogens and progesterones • Subanatomical structures – Epoophorone – Follicle – Corpus Albicans – Corpus Luteum Ovaries-Subanatomical structures – Epoophorone – Follicle – Corpus Albicans – Corpus Luteum Fallopian Tubes (Oviducts) • Ducts for ovaries • Not attached to ovaries • Attached to the uppermost angles of the uterus Fallopian Tubes-Subanatomical Structures • Distal segment – Infundibulum – Fimbriae-fringe-like structures at the end of the infundibulum • Medial segment-Ampulla • Medial proximal-Isthmus-narrowed opening just prior to entry to uterine myometrium • Proximal segment-within uterine myometrium Uterus • Composed of – Body of the uterus • Fundus- – most superior portion of the uterus- – Rounded prominence above the fallopian tubes – Cervix • Endocervical Canal –extension from uterus to the vagina- “neck” of the uterus • Internal Os-termination at uterus
    [Show full text]
  • Reliability of Endocervical Curettage in the Diagnosis of High-Grade Cervical Neoplasia and Cervical Cancer in Selected Patients
    ANTICANCER RESEARCH 35: 4183-4190 (2015) Reliability of Endocervical Curettage in the Diagnosis of High-grade Cervical Neoplasia and Cervical Cancer in Selected Patients CHERIF AKLADIOS1, LISE LECOINTRE1, EMMANUELLE BAULON1, VERONIQUE THOMA1, GERLINDE AVEROUS2, MURIEL FENDER3, FRANÇOIS LEFEBVRE4 and JEAN-JACQUES BALDAUF1 Departments of 1Obstetrics and Gynecology, 2Pathology, University Hospital of Hautepierre, Strasbourg, France; 3EVE Association, Graffenstaden, France; 4Methodology and Biostatistics Sector, Public Health Department, Strasbourg University Hospitals, Strasbourg, France Abstract. Aim: To analyze the reliability of endocervical involvement, represents a real difficulty for the colposcopist curettage (ECC) in the diagnosis of high-grade cervical trying to achieve complete visualization, as well as accurate intraepithelial neoplasia and cervical cancer, and to identify sampling by directed biopsy. In such cases, for many risk factors associated with diagnostic underestimation. colposcopists endocervical curettage (ECC) increases the Materials and Methods: A retrospective study was carried-out reliability of the examination and reduces the risk of an involving 445 patients who underwent ECC for: endocervical occult cancer (2-4). Many authors refer to situations where lesion incompletely visible on colposcopy or inaccessible to only EEC helped establish the diagnosis of cancer, either by biopsy; atypical glandular cells on smear, or discrepancy immediate analysis of the curetted sample or secondarily to between colposcopic impression
    [Show full text]
  • Distribution of Cervical Intraepithelial Neoplasia on the Cervix in Chinese Women: Pooled Analysis of 19 Population Based Screening Studies Yu-Qian Zhao1, Irene J
    Zhao et al. BMC Cancer (2015) 15:485 DOI 10.1186/s12885-015-1494-4 RESEARCH ARTICLE Open Access Distribution of cervical intraepithelial neoplasia on the cervix in Chinese women: pooled analysis of 19 population based screening studies Yu-qian Zhao1, Irene J. Chang1,2, Fang-hui Zhao1, Shang-ying Hu1, Jennifer S. Smith3, Xun Zhang4, Shu-min Li5, Ping Bai5, Wen-hua Zhang5 and You-lin Qiao1* Abstract Background: Controversy remains whether a pattern of cervical intraepithelial neoplasia exists on the cervix. Our study aims at determining if the prevalence of histologically proven lesions differs by cervical four-quadrant location or by 12 o'clock surface locations of diagnosis. Methods: We conducted a retrospective, histopathological study of 19 different population based cervical cancer screening studies from 1999 to 2010 by Cancer Hospital of Chinese Academy of Medical Sciences. The Institutional Review Board for human research subjects at CHCAMS approved all of the studies. During the colposcopy procedure, participant received either 4-quadrant biopsy or directed biopsy with/without endocervical curettage. Data of all samples were stratified by the methods of sampling. Kruskal-Wallis test was used to determine overall distribution of normal/CIN1, CIN2 and CIN3+ on the cervix. Results: In total, 53,088 cervical samples were included in distribution analysis. 66.9 % samples were obtained by random biopsy, 16.1 % were by directed biopsy, and 17.0 % were by endocervical curettage. 95.9%of the biopsied samples were diagnosed as normal/CIN1, 2.0 % were CIN2, and 2.1 % were CIN3 + . CIN2 and CIN3+ were most 2 often found in quadrants 2 and 3 (χKW = 46.6540, p < 0.0001) and at the 4- and 7-o'clock positions by directed biopsy (ORCIN2 = 2.572, 1.689, ORCIN3+ = 3.481, 1.678, respectively), and at the 5-, 6-, 7-, 9- and 12-o’clock positions by random biopsy.
    [Show full text]
  • Cervical Mucosal Block Effectively Reduces the Pain and Cramping from Cryosurgery
    ORIGINAL RESEARCH]_____________________________ Cervical Mucosal Block Effectively Reduces the Pain and Cramping from Cryosurgery Diane M. Harder, MD, MPH, and Janet L. Cobb, MPH, MSN Lebanon, New Hampshire BACKGROUND. Cryosurgery is an effective treatment for squamous intraepithelial lesions, but causes pain and cramping regardless of the particular method of cryosurgery used. The purpose of our study was to determine how effective a four-quadrant cervical mucosal block is in reducing the pain and cramping of cryosurgery. METHODS. Of the 112 women presenting for cryosurgery at the teaching clinics of the University of Missouri- Kansas City School of Medicine at Truman Medical Center-East between September 1995 and September 1996, 87 completed the study. The first 39 women were given the standard treatment of no block with the cryosurgery procedure. The subsequent 48 women were given a four-quadrant submucosal block of 1 % lidocaine with 1:100,000 epinephrine 5 minutes before cryosurgery. The intensity of pain and cramping of each part of the pro­ cedure was measured on 100-mm visual analog scales. RESULTS. The pain and cramping of cryosurgery were significantly reduced (P <.05) with the mucosal block for all measured parts of the cryosurgery procedure, including pain of the first freeze (39 mm vs 12 mm), cramping of the first freeze (49 mm vs 13 mm), pain of the second freeze (24 mm vs 12 mm), cramping of the second freeze (32 mm vs 18 mm), pain of the total composite procedure (44 mm vs 28 mm), and cramping of the total compos­ ite procedure (51 mm vs 21 mm).
    [Show full text]