If the problems of the subjective nature of colposcopy could be avoided, colposcopy could be a non-invasive method of allowing women to remain under safe surveillance whilst avoiding having tissue biopsies taken. This thesis presents an evaluation of different methods to identify a high risk group from women with mild dyskaryosis in the context of a prospective randomised trial. Chapter 1 describes the historical background to the management of low grade cytological abnormalities and the changes brought about by the introduction of colposcopy. This is used to put into context the current dilemma regarding the management of mild dyskaryosis. The role of human papillomavirus in the development of cervical neoplasia will be discussed with a literature review of current evidence to support its use as a secondary screening tool for cervical disease. Chapter 2 describes the design of this prospective randomised controlled trial including patient recruitment and randomisation and the trial protocol. Chapter 3 presents the histopathological outcome for each trial arm and evaluates the use of semi-quantitative HPV 16 detection with the current use of cytological surveillance as a method of secondary screening. Chapter 4 presents the results of a pilot study to compare the efficiency of a commercial HPV detection kit, hybrid capture, with semi-quantitative HPV 16 detection by polymerase chain reaction for women with mild dyskaryosis. Chapter 5 compares the value of objective measurement of colposcopic features of cervical intraepithelial neoplasia on digitised colposcopic images with subjective colposcopic assessment and comments on image digitising in the surveillance of women with mild dyskaryosis. Chapter 6 presents the socio-demographic data on the trial women and evaluates the ability of high risk behaviour to identify a high risk group from those women with mild dyskaryosis. Chapter 7 summarises the results of this trial and presents the main conclusions.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:484132 |
| Date | January 1999 |
| Creators | Cruickshank, Margaret Eleanor |
| Publisher | University of Aberdeen |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
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