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Mark Schiffman - One of the best experts on this subject based on the ideXlab platform.

  • risk of cervical intraepithelial neoplasia 2 or worse by cytology human papillomavirus 16 18 and Colposcopy impression a systematic review and meta analysis
    Obstetrics & Gynecology, 2018
    Co-Authors: Michelle I Silver, Stewart L Massad, Michelle J Khan, Michael A Gold, Rebecca B Perkins, Julia C Gage, Jeffrey C Andrews, Charles K Cooper, Valentin Parvu, Mark Schiffman
    Abstract:

    OBJECTIVE To calculate pooled risk estimates for combinations of cytology result, human papillomavirus (HPV) 16/18 genotype and Colposcopy impression to provide a basis for risk-stratified Colposcopy and biopsy practice. DATA SOURCE A PubMed search was conducted on June 1, 2016, and a ClinicalTrials.gov search was conducted on June 9, 2018, using key words such as "uterine cervical neoplasms," "cervical cancer," "mass screening," "early detection of cancer," and "Colposcopy." METHODS OF STUDY SELECTION Eligible studies must have included colposcopic impression and either cytology results or HPV 16/18 partial genotype results as well as a histologic biopsy diagnosis from adult women. Manuscripts were reviewed for the following: cytology, HPV status, and Colposcopy impression as well as age, number of women, and number of cervical intraepithelial neoplasia (CIN) 2, CIN 3, and cancer cases. Strata were defined by the various combinations of cytology, genotype, and colposcopic impression. TABULATION, INTEGRATION, AND RESULTS Of 340 abstracts identified, nine were eligible for inclusion. Data were also obtained from three unpublished studies, two of which have since been published. We calculated the risk of CIN 2 or worse and CIN 3 or worse based on cytology, Colposcopy, and HPV 16/18 test results. We found similar risk patterns across studies in the lowest risk groups such that risk estimates were similar despite different referral populations and study designs. Women with a normal Colposcopy impression (no acetowhitening), less than high-grade squamous intraepithelial lesion cytology, and HPV 16/18-negative were at low risk of prevalent precancer. Women with at least two of the following: high-grade squamous intraepithelial lesion cytology, HPV16- or HPV18-positive, and high-grade colposcopic impression were at highest risk of prevalent precancer. CONCLUSION Our results support a risk-based approach to Colposcopy and biopsy with modifications of practice at the lowest and highest risk levels.

  • a prospective study of risk based Colposcopy demonstrates improved detection of cervical precancers
    American Journal of Obstetrics and Gynecology, 2018
    Co-Authors: Nicolas Wentzensen, Michelle I Silver, Stewart L Massad, Michael A Gold, Katie M Smith, Joan L Walker, Rosemary E Zuna, Angela Liu, Terence S Dunn, Mark Schiffman
    Abstract:

    Background Sensitivity for detection of precancers at Colposcopy and reassurance provided by a negative Colposcopy are in need of systematic study and improvement. Objective We sought to evaluate whether selecting the appropriate women for multiple targeted cervical biopsies based on screening cytology, human papillomavirus testing, and colposcopic impression could improve accuracy and efficiency of cervical precancer detection. Study Design In all, 690 women aged 18-67 years referred to Colposcopy subsequent to abnormal cervical cancer screening results were included in the study (ClinicalTrials.gov: NCT00339989 ). Up to 4 cervical biopsies were taken during Colposcopy to evaluate the incremental benefit of multiple biopsies. Cervical cytology, human papillomavirus genotyping, and Colposcopy impression were used to establish up to 24 different risk strata. Outcomes for the primary analysis were cervical precancers, which included p16 + cervical intraepithelial neoplasia 2 and all cervical intraepithelial neoplasia 3 that were detected by Colposcopy-guided biopsy during the Colposcopy visit. Later outcomes in women without cervical intraepithelial neoplasia 2 + at baseline were abstracted from electronic medical records. Results The risk of detecting precancer ranged from 2-82% across 24 strata based on Colposcopy impression, cytology, and human papillomavirus genotyping. The risk of precancer in the lowest stratum increased only marginally with multiple biopsies. Women in the highest-risk strata had risks of precancer consistent with immediate treatment. In other risk strata, multiple biopsies substantially improved detection of cervical precancer. Among 361 women with cervical intraepithelial neoplasia Conclusion Risk assessment at the Colposcopy visit makes identification of cervical precancers more effective and efficient. Not finding precancer after a multiple-biopsy protocol provides high reassurance and allows releasing women back to regular screening.

  • evidence based consensus recommendations for Colposcopy practice for cervical cancer prevention in the united states
    Journal of Lower Genital Tract Disease, 2017
    Co-Authors: Nicolas Wentzensen, Mark Schiffman, Alan G Waxman, Christine Conageski, Stewart L Massad, Michelle J Khan, Edward J Mayeaux, Mark H Einstein, Michael A Gold, Barbara S Apgar
    Abstract:

    The American Society for Colposcopy and Cervical Pathology (ASCCP) Colposcopy Standards recommendations address the role of Colposcopy and directed biopsy for cervical cancer prevention in the United States (US). The recommendations were developed by an expert working group appointed by ASCCP's Board of Directors. An extensive literature review was conducted and supplemented by a systematic review and meta-analysis of unpublished data. In addition, a survey of practicing colposcopists was conducted to assess current Colposcopy practice in the US. Recommendations were approved by the working group members, and the final revisions were made based on comments received from the public. The recommendations cover terminology, risk-based Colposcopy, Colposcopy procedures, and Colposcopy adjuncts. The ASCCP Colposcopy Standards recommendations are an important step toward raising the standard of Colposcopy services delivered to women in the US. Because cervical cancer screening programs are currently undergoing important changes that may affect Colposcopy performance, updates to some of the current recommendations may be necessary in the future.

  • asccp Colposcopy standards role of Colposcopy benefits potential harms and terminology for colposcopic practice
    Journal of Lower Genital Tract Disease, 2017
    Co-Authors: Michelle J Khan, Mark Schiffman, Nicolas Wentzensen, Claudia L Werner, Teresa M Darragh, Richard Guido, Cara Mathews, Annabarbara Moscicki, Martha M Mitchell, Stewart L Massad
    Abstract:

    ObjectivesThe American Society for Colposcopy and Cervical Pathology Colposcopy Standards address the role of and approach to Colposcopy and biopsy for cervical cancer prevention in the United States. Working Group 1 was tasked with defining the role of Colposcopy, describing benefits and potential

  • asccp Colposcopy standards risk based Colposcopy practice
    Journal of Lower Genital Tract Disease, 2017
    Co-Authors: Nicolas Wentzensen, Mark Schiffman, Christine Conageski, Michelle I Silver, Michelle J Khan, Michael A Gold, Rebecca B Perkins, Katie M Smith, Julia C Gage, Mark H Einstein
    Abstract:

    ObjectivesThe American Society for Colposcopy and Cervical Pathology (ASCCP) Colposcopy Standards recommendations address the role of and approach to Colposcopy for cervical cancer prevention in the United States.Materials and MethodsThe recommendations were developed by an expert working group appo

Nicolas Wentzensen - One of the best experts on this subject based on the ideXlab platform.

  • a prospective study of risk based Colposcopy demonstrates improved detection of cervical precancers
    American Journal of Obstetrics and Gynecology, 2018
    Co-Authors: Nicolas Wentzensen, Michelle I Silver, Stewart L Massad, Michael A Gold, Katie M Smith, Joan L Walker, Rosemary E Zuna, Angela Liu, Terence S Dunn, Mark Schiffman
    Abstract:

    Background Sensitivity for detection of precancers at Colposcopy and reassurance provided by a negative Colposcopy are in need of systematic study and improvement. Objective We sought to evaluate whether selecting the appropriate women for multiple targeted cervical biopsies based on screening cytology, human papillomavirus testing, and colposcopic impression could improve accuracy and efficiency of cervical precancer detection. Study Design In all, 690 women aged 18-67 years referred to Colposcopy subsequent to abnormal cervical cancer screening results were included in the study (ClinicalTrials.gov: NCT00339989 ). Up to 4 cervical biopsies were taken during Colposcopy to evaluate the incremental benefit of multiple biopsies. Cervical cytology, human papillomavirus genotyping, and Colposcopy impression were used to establish up to 24 different risk strata. Outcomes for the primary analysis were cervical precancers, which included p16 + cervical intraepithelial neoplasia 2 and all cervical intraepithelial neoplasia 3 that were detected by Colposcopy-guided biopsy during the Colposcopy visit. Later outcomes in women without cervical intraepithelial neoplasia 2 + at baseline were abstracted from electronic medical records. Results The risk of detecting precancer ranged from 2-82% across 24 strata based on Colposcopy impression, cytology, and human papillomavirus genotyping. The risk of precancer in the lowest stratum increased only marginally with multiple biopsies. Women in the highest-risk strata had risks of precancer consistent with immediate treatment. In other risk strata, multiple biopsies substantially improved detection of cervical precancer. Among 361 women with cervical intraepithelial neoplasia Conclusion Risk assessment at the Colposcopy visit makes identification of cervical precancers more effective and efficient. Not finding precancer after a multiple-biopsy protocol provides high reassurance and allows releasing women back to regular screening.

  • asccp Colposcopy standards how do we perform Colposcopy implications for establishing standards
    Journal of Lower Genital Tract Disease, 2017
    Co-Authors: Alan G Waxman, Christine Conageski, Michelle I Silver, Candice Tedeschi, Elizabeth A Stier, Barbara S Apgar, Warner K Huh, Nicolas Wentzensen, Stewart L Massad, Michelle J Khan
    Abstract:

    OBJECTIVES The American Society for Colposcopy and Cervical Pathology (ASCCP) Colposcopy Standards recommendations address the role of and approach to Colposcopy and biopsy for cervical cancer prevention in the United States. The recommendations were developed by an expert working group appointed by ASCCP's Board of Directors. Working group 3 defined Colposcopy procedure guidelines for minimum and comprehensive Colposcopy practice and evaluated the use of Colposcopy adjuncts. MATERIALS AND METHODS The working group performed a systematic literature review to identify best practices in Colposcopy methodology and to evaluate the use of available Colposcopy adjuncts. The literature provided little evidence to support specific elements of the procedure. The working group, therefore, implemented a national survey of current and recent ASCCP members to evaluate common elements of the Colposcopy examination. The findings of this survey were modified by expert consensus from the ASCCP Colposcopy Standards Committee members to create guidelines for performing Colposcopy. The draft recommendations were posted online for public comment and presented at an open session of the International Federation for Cervical Pathology and Colposcopy 2017 World Congress for further comment. All comments were considered in the development of final recommendations. RESULTS Minimum and comprehensive Colposcopy practice guidelines were developed. These guidelines represent recommended practice in all parts of the examination including the following: preColposcopy evaluation, performing the procedure, documentation of findings, biopsy practice, and postprocedure follow-up. CONCLUSIONS These guidelines are intended to serve as a guide to standardize Colposcopy across the United States.

  • evidence based consensus recommendations for Colposcopy practice for cervical cancer prevention in the united states
    Journal of Lower Genital Tract Disease, 2017
    Co-Authors: Nicolas Wentzensen, Mark Schiffman, Alan G Waxman, Christine Conageski, Stewart L Massad, Michelle J Khan, Edward J Mayeaux, Mark H Einstein, Michael A Gold, Barbara S Apgar
    Abstract:

    The American Society for Colposcopy and Cervical Pathology (ASCCP) Colposcopy Standards recommendations address the role of Colposcopy and directed biopsy for cervical cancer prevention in the United States (US). The recommendations were developed by an expert working group appointed by ASCCP's Board of Directors. An extensive literature review was conducted and supplemented by a systematic review and meta-analysis of unpublished data. In addition, a survey of practicing colposcopists was conducted to assess current Colposcopy practice in the US. Recommendations were approved by the working group members, and the final revisions were made based on comments received from the public. The recommendations cover terminology, risk-based Colposcopy, Colposcopy procedures, and Colposcopy adjuncts. The ASCCP Colposcopy Standards recommendations are an important step toward raising the standard of Colposcopy services delivered to women in the US. Because cervical cancer screening programs are currently undergoing important changes that may affect Colposcopy performance, updates to some of the current recommendations may be necessary in the future.

  • asccp Colposcopy standards role of Colposcopy benefits potential harms and terminology for colposcopic practice
    Journal of Lower Genital Tract Disease, 2017
    Co-Authors: Michelle J Khan, Mark Schiffman, Nicolas Wentzensen, Claudia L Werner, Teresa M Darragh, Richard Guido, Cara Mathews, Annabarbara Moscicki, Martha M Mitchell, Stewart L Massad
    Abstract:

    ObjectivesThe American Society for Colposcopy and Cervical Pathology Colposcopy Standards address the role of and approach to Colposcopy and biopsy for cervical cancer prevention in the United States. Working Group 1 was tasked with defining the role of Colposcopy, describing benefits and potential

  • asccp Colposcopy standards Colposcopy quality improvement recommendations for the united states
    Journal of Lower Genital Tract Disease, 2017
    Co-Authors: Edward J Mayeaux, Stewart L Massad, Mark H Einstein, Akiva P Novetsky, David Chelmow, Kim Choma, Francisco A R Garcia, Angela H Liu, Theognosia Papasozomenos, Nicolas Wentzensen
    Abstract:

    Objectives The American Society for Colposcopy and Cervical Pathology (ASCCP) Colposcopy Standards recommendations address the role of and approach to Colposcopy and biopsy for cervical cancer prevention in the United States. The recommendations were developed by an expert working group appointed by ASCCP's Board of Directors. The ASCCP Quality Improvement Working Group developed evidence-based guidelines to promote best practices and reduce errors in Colposcopy and recommended indicators to measure Colposcopy quality. Materials and methods The working group performed a systematic review of existing major society and national guidelines and quality indicators. An initial list of potential quality indicators was developed and refined through successive iterative discussions, and draft quality indicators were proposed. The draft recommendations were then reviewed and commented on by the entire Colposcopy Standards Committee, posted online for public comment, and presented at the International Federation for Cervical Pathology and Colposcopy 2017 World Congress for further comment. All comments were considered, additional adjustments made, and the final recommendations approved by the entire Task Force. Results Eleven quality indicators were selected spanning documentation, biopsy protocols, and time intervals between index screening tests and completion of diagnostic evaluation. Conclusions The proposed quality indicators are intended to serve as a starting point for quality improvement in Colposcopy at a time when Colposcopy volume is decreasing and individual procedures are becoming technically more difficult to perform.

Michael A Gold - One of the best experts on this subject based on the ideXlab platform.

  • risk of cervical intraepithelial neoplasia 2 or worse by cytology human papillomavirus 16 18 and Colposcopy impression a systematic review and meta analysis
    Obstetrics & Gynecology, 2018
    Co-Authors: Michelle I Silver, Stewart L Massad, Michelle J Khan, Michael A Gold, Rebecca B Perkins, Julia C Gage, Jeffrey C Andrews, Charles K Cooper, Valentin Parvu, Mark Schiffman
    Abstract:

    OBJECTIVE To calculate pooled risk estimates for combinations of cytology result, human papillomavirus (HPV) 16/18 genotype and Colposcopy impression to provide a basis for risk-stratified Colposcopy and biopsy practice. DATA SOURCE A PubMed search was conducted on June 1, 2016, and a ClinicalTrials.gov search was conducted on June 9, 2018, using key words such as "uterine cervical neoplasms," "cervical cancer," "mass screening," "early detection of cancer," and "Colposcopy." METHODS OF STUDY SELECTION Eligible studies must have included colposcopic impression and either cytology results or HPV 16/18 partial genotype results as well as a histologic biopsy diagnosis from adult women. Manuscripts were reviewed for the following: cytology, HPV status, and Colposcopy impression as well as age, number of women, and number of cervical intraepithelial neoplasia (CIN) 2, CIN 3, and cancer cases. Strata were defined by the various combinations of cytology, genotype, and colposcopic impression. TABULATION, INTEGRATION, AND RESULTS Of 340 abstracts identified, nine were eligible for inclusion. Data were also obtained from three unpublished studies, two of which have since been published. We calculated the risk of CIN 2 or worse and CIN 3 or worse based on cytology, Colposcopy, and HPV 16/18 test results. We found similar risk patterns across studies in the lowest risk groups such that risk estimates were similar despite different referral populations and study designs. Women with a normal Colposcopy impression (no acetowhitening), less than high-grade squamous intraepithelial lesion cytology, and HPV 16/18-negative were at low risk of prevalent precancer. Women with at least two of the following: high-grade squamous intraepithelial lesion cytology, HPV16- or HPV18-positive, and high-grade colposcopic impression were at highest risk of prevalent precancer. CONCLUSION Our results support a risk-based approach to Colposcopy and biopsy with modifications of practice at the lowest and highest risk levels.

  • a prospective study of risk based Colposcopy demonstrates improved detection of cervical precancers
    American Journal of Obstetrics and Gynecology, 2018
    Co-Authors: Nicolas Wentzensen, Michelle I Silver, Stewart L Massad, Michael A Gold, Katie M Smith, Joan L Walker, Rosemary E Zuna, Angela Liu, Terence S Dunn, Mark Schiffman
    Abstract:

    Background Sensitivity for detection of precancers at Colposcopy and reassurance provided by a negative Colposcopy are in need of systematic study and improvement. Objective We sought to evaluate whether selecting the appropriate women for multiple targeted cervical biopsies based on screening cytology, human papillomavirus testing, and colposcopic impression could improve accuracy and efficiency of cervical precancer detection. Study Design In all, 690 women aged 18-67 years referred to Colposcopy subsequent to abnormal cervical cancer screening results were included in the study (ClinicalTrials.gov: NCT00339989 ). Up to 4 cervical biopsies were taken during Colposcopy to evaluate the incremental benefit of multiple biopsies. Cervical cytology, human papillomavirus genotyping, and Colposcopy impression were used to establish up to 24 different risk strata. Outcomes for the primary analysis were cervical precancers, which included p16 + cervical intraepithelial neoplasia 2 and all cervical intraepithelial neoplasia 3 that were detected by Colposcopy-guided biopsy during the Colposcopy visit. Later outcomes in women without cervical intraepithelial neoplasia 2 + at baseline were abstracted from electronic medical records. Results The risk of detecting precancer ranged from 2-82% across 24 strata based on Colposcopy impression, cytology, and human papillomavirus genotyping. The risk of precancer in the lowest stratum increased only marginally with multiple biopsies. Women in the highest-risk strata had risks of precancer consistent with immediate treatment. In other risk strata, multiple biopsies substantially improved detection of cervical precancer. Among 361 women with cervical intraepithelial neoplasia Conclusion Risk assessment at the Colposcopy visit makes identification of cervical precancers more effective and efficient. Not finding precancer after a multiple-biopsy protocol provides high reassurance and allows releasing women back to regular screening.

  • evidence based consensus recommendations for Colposcopy practice for cervical cancer prevention in the united states
    Journal of Lower Genital Tract Disease, 2017
    Co-Authors: Nicolas Wentzensen, Mark Schiffman, Alan G Waxman, Christine Conageski, Stewart L Massad, Michelle J Khan, Edward J Mayeaux, Mark H Einstein, Michael A Gold, Barbara S Apgar
    Abstract:

    The American Society for Colposcopy and Cervical Pathology (ASCCP) Colposcopy Standards recommendations address the role of Colposcopy and directed biopsy for cervical cancer prevention in the United States (US). The recommendations were developed by an expert working group appointed by ASCCP's Board of Directors. An extensive literature review was conducted and supplemented by a systematic review and meta-analysis of unpublished data. In addition, a survey of practicing colposcopists was conducted to assess current Colposcopy practice in the US. Recommendations were approved by the working group members, and the final revisions were made based on comments received from the public. The recommendations cover terminology, risk-based Colposcopy, Colposcopy procedures, and Colposcopy adjuncts. The ASCCP Colposcopy Standards recommendations are an important step toward raising the standard of Colposcopy services delivered to women in the US. Because cervical cancer screening programs are currently undergoing important changes that may affect Colposcopy performance, updates to some of the current recommendations may be necessary in the future.

  • asccp Colposcopy standards risk based Colposcopy practice
    Journal of Lower Genital Tract Disease, 2017
    Co-Authors: Nicolas Wentzensen, Mark Schiffman, Christine Conageski, Michelle I Silver, Michelle J Khan, Michael A Gold, Rebecca B Perkins, Katie M Smith, Julia C Gage, Mark H Einstein
    Abstract:

    ObjectivesThe American Society for Colposcopy and Cervical Pathology (ASCCP) Colposcopy Standards recommendations address the role of and approach to Colposcopy for cervical cancer prevention in the United States.Materials and MethodsThe recommendations were developed by an expert working group appo

  • optical detection of high grade cervical intraepithelial neoplasia in vivo results of a 604 patient study
    American Journal of Obstetrics and Gynecology, 2004
    Co-Authors: Warner K Huh, Michael A Gold, Richard Guido, Francisco A R Garcia, Ramon M Cestero, Kathleen Mcintyreseltman, Diane M Harper, Louis Burke, Stephen T Sum, Ross F Flewelling
    Abstract:

    Abstract Objective The purpose of this study was to assess the in vivo optical detection of high-grade cervical intraepithelial neoplasia (2/3+) on the whole cervix with a noncontact, spectroscopic device. Study design Cervical scanning devices collected intrinsic fluorescence and broadband white light spectra and video images from 604 women during routine Colposcopy examinations at 6 clinical centers. A statistically significant dataset was developed of intrinsic fluorescence and white light-induced cervical tissue spectra that was correlated to expert histopathologic determination. On the basis of a retrospective analysis of the acquired data, a classification algorithm was developed, validated, and optimized. Results Intrinsic fluorescence, backscattered white light, and video imaging each contribute complementary information to diagnostic algorithms for high-grade cervical neoplasia. More than 10,000 measurements that were made on colposcopically identified tissue from>500 subjects were the basis for algorithm training and testing. Algorithm performance demonstrated a sensitivity of approximately 90%. This performance was confirmed by various training methods. With the use of a multivariate classification algorithm, optical detection is predicted to detect 33% more high-grade cervical intraepithelial neoplasia (2/3+) than Colposcopy alone. Conclusion Full cervix optical interrogation for the detection of high-grade cervical intraepithelial neoplasia is feasible and appears capable of detecting more high-grade cervical intraepithelial neoplasia than Colposcopy alone. With the use of this classification algorithm, a multisite, randomized controlled trial is underway that compares the combination of optical detection and Colposcopy versus Colposcopy alone.

Stewart L Massad - One of the best experts on this subject based on the ideXlab platform.

  • risk of cervical intraepithelial neoplasia 2 or worse by cytology human papillomavirus 16 18 and Colposcopy impression a systematic review and meta analysis
    Obstetrics & Gynecology, 2018
    Co-Authors: Michelle I Silver, Stewart L Massad, Michelle J Khan, Michael A Gold, Rebecca B Perkins, Julia C Gage, Jeffrey C Andrews, Charles K Cooper, Valentin Parvu, Mark Schiffman
    Abstract:

    OBJECTIVE To calculate pooled risk estimates for combinations of cytology result, human papillomavirus (HPV) 16/18 genotype and Colposcopy impression to provide a basis for risk-stratified Colposcopy and biopsy practice. DATA SOURCE A PubMed search was conducted on June 1, 2016, and a ClinicalTrials.gov search was conducted on June 9, 2018, using key words such as "uterine cervical neoplasms," "cervical cancer," "mass screening," "early detection of cancer," and "Colposcopy." METHODS OF STUDY SELECTION Eligible studies must have included colposcopic impression and either cytology results or HPV 16/18 partial genotype results as well as a histologic biopsy diagnosis from adult women. Manuscripts were reviewed for the following: cytology, HPV status, and Colposcopy impression as well as age, number of women, and number of cervical intraepithelial neoplasia (CIN) 2, CIN 3, and cancer cases. Strata were defined by the various combinations of cytology, genotype, and colposcopic impression. TABULATION, INTEGRATION, AND RESULTS Of 340 abstracts identified, nine were eligible for inclusion. Data were also obtained from three unpublished studies, two of which have since been published. We calculated the risk of CIN 2 or worse and CIN 3 or worse based on cytology, Colposcopy, and HPV 16/18 test results. We found similar risk patterns across studies in the lowest risk groups such that risk estimates were similar despite different referral populations and study designs. Women with a normal Colposcopy impression (no acetowhitening), less than high-grade squamous intraepithelial lesion cytology, and HPV 16/18-negative were at low risk of prevalent precancer. Women with at least two of the following: high-grade squamous intraepithelial lesion cytology, HPV16- or HPV18-positive, and high-grade colposcopic impression were at highest risk of prevalent precancer. CONCLUSION Our results support a risk-based approach to Colposcopy and biopsy with modifications of practice at the lowest and highest risk levels.

  • a prospective study of risk based Colposcopy demonstrates improved detection of cervical precancers
    American Journal of Obstetrics and Gynecology, 2018
    Co-Authors: Nicolas Wentzensen, Michelle I Silver, Stewart L Massad, Michael A Gold, Katie M Smith, Joan L Walker, Rosemary E Zuna, Angela Liu, Terence S Dunn, Mark Schiffman
    Abstract:

    Background Sensitivity for detection of precancers at Colposcopy and reassurance provided by a negative Colposcopy are in need of systematic study and improvement. Objective We sought to evaluate whether selecting the appropriate women for multiple targeted cervical biopsies based on screening cytology, human papillomavirus testing, and colposcopic impression could improve accuracy and efficiency of cervical precancer detection. Study Design In all, 690 women aged 18-67 years referred to Colposcopy subsequent to abnormal cervical cancer screening results were included in the study (ClinicalTrials.gov: NCT00339989 ). Up to 4 cervical biopsies were taken during Colposcopy to evaluate the incremental benefit of multiple biopsies. Cervical cytology, human papillomavirus genotyping, and Colposcopy impression were used to establish up to 24 different risk strata. Outcomes for the primary analysis were cervical precancers, which included p16 + cervical intraepithelial neoplasia 2 and all cervical intraepithelial neoplasia 3 that were detected by Colposcopy-guided biopsy during the Colposcopy visit. Later outcomes in women without cervical intraepithelial neoplasia 2 + at baseline were abstracted from electronic medical records. Results The risk of detecting precancer ranged from 2-82% across 24 strata based on Colposcopy impression, cytology, and human papillomavirus genotyping. The risk of precancer in the lowest stratum increased only marginally with multiple biopsies. Women in the highest-risk strata had risks of precancer consistent with immediate treatment. In other risk strata, multiple biopsies substantially improved detection of cervical precancer. Among 361 women with cervical intraepithelial neoplasia Conclusion Risk assessment at the Colposcopy visit makes identification of cervical precancers more effective and efficient. Not finding precancer after a multiple-biopsy protocol provides high reassurance and allows releasing women back to regular screening.

  • asccp Colposcopy standards how do we perform Colposcopy implications for establishing standards
    Journal of Lower Genital Tract Disease, 2017
    Co-Authors: Alan G Waxman, Christine Conageski, Michelle I Silver, Candice Tedeschi, Elizabeth A Stier, Barbara S Apgar, Warner K Huh, Nicolas Wentzensen, Stewart L Massad, Michelle J Khan
    Abstract:

    OBJECTIVES The American Society for Colposcopy and Cervical Pathology (ASCCP) Colposcopy Standards recommendations address the role of and approach to Colposcopy and biopsy for cervical cancer prevention in the United States. The recommendations were developed by an expert working group appointed by ASCCP's Board of Directors. Working group 3 defined Colposcopy procedure guidelines for minimum and comprehensive Colposcopy practice and evaluated the use of Colposcopy adjuncts. MATERIALS AND METHODS The working group performed a systematic literature review to identify best practices in Colposcopy methodology and to evaluate the use of available Colposcopy adjuncts. The literature provided little evidence to support specific elements of the procedure. The working group, therefore, implemented a national survey of current and recent ASCCP members to evaluate common elements of the Colposcopy examination. The findings of this survey were modified by expert consensus from the ASCCP Colposcopy Standards Committee members to create guidelines for performing Colposcopy. The draft recommendations were posted online for public comment and presented at an open session of the International Federation for Cervical Pathology and Colposcopy 2017 World Congress for further comment. All comments were considered in the development of final recommendations. RESULTS Minimum and comprehensive Colposcopy practice guidelines were developed. These guidelines represent recommended practice in all parts of the examination including the following: preColposcopy evaluation, performing the procedure, documentation of findings, biopsy practice, and postprocedure follow-up. CONCLUSIONS These guidelines are intended to serve as a guide to standardize Colposcopy across the United States.

  • evidence based consensus recommendations for Colposcopy practice for cervical cancer prevention in the united states
    Journal of Lower Genital Tract Disease, 2017
    Co-Authors: Nicolas Wentzensen, Mark Schiffman, Alan G Waxman, Christine Conageski, Stewart L Massad, Michelle J Khan, Edward J Mayeaux, Mark H Einstein, Michael A Gold, Barbara S Apgar
    Abstract:

    The American Society for Colposcopy and Cervical Pathology (ASCCP) Colposcopy Standards recommendations address the role of Colposcopy and directed biopsy for cervical cancer prevention in the United States (US). The recommendations were developed by an expert working group appointed by ASCCP's Board of Directors. An extensive literature review was conducted and supplemented by a systematic review and meta-analysis of unpublished data. In addition, a survey of practicing colposcopists was conducted to assess current Colposcopy practice in the US. Recommendations were approved by the working group members, and the final revisions were made based on comments received from the public. The recommendations cover terminology, risk-based Colposcopy, Colposcopy procedures, and Colposcopy adjuncts. The ASCCP Colposcopy Standards recommendations are an important step toward raising the standard of Colposcopy services delivered to women in the US. Because cervical cancer screening programs are currently undergoing important changes that may affect Colposcopy performance, updates to some of the current recommendations may be necessary in the future.

  • asccp Colposcopy standards role of Colposcopy benefits potential harms and terminology for colposcopic practice
    Journal of Lower Genital Tract Disease, 2017
    Co-Authors: Michelle J Khan, Mark Schiffman, Nicolas Wentzensen, Claudia L Werner, Teresa M Darragh, Richard Guido, Cara Mathews, Annabarbara Moscicki, Martha M Mitchell, Stewart L Massad
    Abstract:

    ObjectivesThe American Society for Colposcopy and Cervical Pathology Colposcopy Standards address the role of and approach to Colposcopy and biopsy for cervical cancer prevention in the United States. Working Group 1 was tasked with defining the role of Colposcopy, describing benefits and potential

Michelle J Khan - One of the best experts on this subject based on the ideXlab platform.

  • risk of cervical intraepithelial neoplasia 2 or worse by cytology human papillomavirus 16 18 and Colposcopy impression a systematic review and meta analysis
    Obstetrics & Gynecology, 2018
    Co-Authors: Michelle I Silver, Stewart L Massad, Michelle J Khan, Michael A Gold, Rebecca B Perkins, Julia C Gage, Jeffrey C Andrews, Charles K Cooper, Valentin Parvu, Mark Schiffman
    Abstract:

    OBJECTIVE To calculate pooled risk estimates for combinations of cytology result, human papillomavirus (HPV) 16/18 genotype and Colposcopy impression to provide a basis for risk-stratified Colposcopy and biopsy practice. DATA SOURCE A PubMed search was conducted on June 1, 2016, and a ClinicalTrials.gov search was conducted on June 9, 2018, using key words such as "uterine cervical neoplasms," "cervical cancer," "mass screening," "early detection of cancer," and "Colposcopy." METHODS OF STUDY SELECTION Eligible studies must have included colposcopic impression and either cytology results or HPV 16/18 partial genotype results as well as a histologic biopsy diagnosis from adult women. Manuscripts were reviewed for the following: cytology, HPV status, and Colposcopy impression as well as age, number of women, and number of cervical intraepithelial neoplasia (CIN) 2, CIN 3, and cancer cases. Strata were defined by the various combinations of cytology, genotype, and colposcopic impression. TABULATION, INTEGRATION, AND RESULTS Of 340 abstracts identified, nine were eligible for inclusion. Data were also obtained from three unpublished studies, two of which have since been published. We calculated the risk of CIN 2 or worse and CIN 3 or worse based on cytology, Colposcopy, and HPV 16/18 test results. We found similar risk patterns across studies in the lowest risk groups such that risk estimates were similar despite different referral populations and study designs. Women with a normal Colposcopy impression (no acetowhitening), less than high-grade squamous intraepithelial lesion cytology, and HPV 16/18-negative were at low risk of prevalent precancer. Women with at least two of the following: high-grade squamous intraepithelial lesion cytology, HPV16- or HPV18-positive, and high-grade colposcopic impression were at highest risk of prevalent precancer. CONCLUSION Our results support a risk-based approach to Colposcopy and biopsy with modifications of practice at the lowest and highest risk levels.

  • asccp Colposcopy standards how do we perform Colposcopy implications for establishing standards
    Journal of Lower Genital Tract Disease, 2017
    Co-Authors: Alan G Waxman, Christine Conageski, Michelle I Silver, Candice Tedeschi, Elizabeth A Stier, Barbara S Apgar, Warner K Huh, Nicolas Wentzensen, Stewart L Massad, Michelle J Khan
    Abstract:

    OBJECTIVES The American Society for Colposcopy and Cervical Pathology (ASCCP) Colposcopy Standards recommendations address the role of and approach to Colposcopy and biopsy for cervical cancer prevention in the United States. The recommendations were developed by an expert working group appointed by ASCCP's Board of Directors. Working group 3 defined Colposcopy procedure guidelines for minimum and comprehensive Colposcopy practice and evaluated the use of Colposcopy adjuncts. MATERIALS AND METHODS The working group performed a systematic literature review to identify best practices in Colposcopy methodology and to evaluate the use of available Colposcopy adjuncts. The literature provided little evidence to support specific elements of the procedure. The working group, therefore, implemented a national survey of current and recent ASCCP members to evaluate common elements of the Colposcopy examination. The findings of this survey were modified by expert consensus from the ASCCP Colposcopy Standards Committee members to create guidelines for performing Colposcopy. The draft recommendations were posted online for public comment and presented at an open session of the International Federation for Cervical Pathology and Colposcopy 2017 World Congress for further comment. All comments were considered in the development of final recommendations. RESULTS Minimum and comprehensive Colposcopy practice guidelines were developed. These guidelines represent recommended practice in all parts of the examination including the following: preColposcopy evaluation, performing the procedure, documentation of findings, biopsy practice, and postprocedure follow-up. CONCLUSIONS These guidelines are intended to serve as a guide to standardize Colposcopy across the United States.

  • evidence based consensus recommendations for Colposcopy practice for cervical cancer prevention in the united states
    Journal of Lower Genital Tract Disease, 2017
    Co-Authors: Nicolas Wentzensen, Mark Schiffman, Alan G Waxman, Christine Conageski, Stewart L Massad, Michelle J Khan, Edward J Mayeaux, Mark H Einstein, Michael A Gold, Barbara S Apgar
    Abstract:

    The American Society for Colposcopy and Cervical Pathology (ASCCP) Colposcopy Standards recommendations address the role of Colposcopy and directed biopsy for cervical cancer prevention in the United States (US). The recommendations were developed by an expert working group appointed by ASCCP's Board of Directors. An extensive literature review was conducted and supplemented by a systematic review and meta-analysis of unpublished data. In addition, a survey of practicing colposcopists was conducted to assess current Colposcopy practice in the US. Recommendations were approved by the working group members, and the final revisions were made based on comments received from the public. The recommendations cover terminology, risk-based Colposcopy, Colposcopy procedures, and Colposcopy adjuncts. The ASCCP Colposcopy Standards recommendations are an important step toward raising the standard of Colposcopy services delivered to women in the US. Because cervical cancer screening programs are currently undergoing important changes that may affect Colposcopy performance, updates to some of the current recommendations may be necessary in the future.

  • asccp Colposcopy standards role of Colposcopy benefits potential harms and terminology for colposcopic practice
    Journal of Lower Genital Tract Disease, 2017
    Co-Authors: Michelle J Khan, Mark Schiffman, Nicolas Wentzensen, Claudia L Werner, Teresa M Darragh, Richard Guido, Cara Mathews, Annabarbara Moscicki, Martha M Mitchell, Stewart L Massad
    Abstract:

    ObjectivesThe American Society for Colposcopy and Cervical Pathology Colposcopy Standards address the role of and approach to Colposcopy and biopsy for cervical cancer prevention in the United States. Working Group 1 was tasked with defining the role of Colposcopy, describing benefits and potential

  • asccp Colposcopy standards risk based Colposcopy practice
    Journal of Lower Genital Tract Disease, 2017
    Co-Authors: Nicolas Wentzensen, Mark Schiffman, Christine Conageski, Michelle I Silver, Michelle J Khan, Michael A Gold, Rebecca B Perkins, Katie M Smith, Julia C Gage, Mark H Einstein
    Abstract:

    ObjectivesThe American Society for Colposcopy and Cervical Pathology (ASCCP) Colposcopy Standards recommendations address the role of and approach to Colposcopy for cervical cancer prevention in the United States.Materials and MethodsThe recommendations were developed by an expert working group appo