***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To assess the influence of high-risk Human Papilloma Virus ( hrHPV ) genotyping on the detection of high- grade disease ( CIN2 + ) using colposcopic impression both with and without electrical impedance spectroscopy ( ZedScan I ) as an adjunct . STUDY DESIGN A prospect i ve cohort of women with a known hrHPV genotype referred to a single colposcopy service . RESULTS 839 women underwent colposcopy and ZedScan I examination . 613 women were referred with abnormal cytology ; 411 ( 67 % ) with low- grade dyskaryosis ( 67 % ) and 202 ( 33 % ) with high- grade dyskaryosis . 187 were referred with persistent hrHPV but negative cytology . 35 were attended for follow up and 4 for a clinical indication . 159 ( 19 % ) women were positive for HPV16 only ; 54 ( 6 % ) with HPV18 only , 443 ( 53 % ) women were positive for hrHPV other types ( HPV O ) . 183 ( 22 % ) were positive for multiple hrHPV genotypes . CIN2 + was present in 170 ( 84.2 % ) of high- grade and 69 ( 16.7 % ) of low- grade cytology referrals . Colposcopy was better at detecting HPV16 associated CIN2 + than that associated with HPV18 or HPV O ( 86.9 % vs 79.7 % , p=0.0191 ) . ZedScan I increased the detection of CIN2 + from 85.6 % to 96 % irrespective of hrHPV genotype status ( p<0.0001 ) . CONCLUSION The use of an electrical impedance spectroscopic device ( ZedScan I ) increases detection of CIN2 + irrespective of hrHPV genotype Abstract After treatment for cervical intraepithelial neoplasia ( CIN ) , in the UK women who are cytology-negative , high-risk ( HR ) human papilloma virus ( HPV ) positive are referred to colposcopy .  This pilot study assessed the incidence of residual/recurrent CIN and the diagnostic accuracy of colposcopy with dynamic spectral imaging ( DSI ) mapping in their detection . This was a prospect i ve service evaluation carried out in a UK National Health Service ( NHS ) colposcopy clinic . All women , referred with negative cytology/HR-HPV positive result following treatment for CIN from March 2013 until November 2014 , who were examined with the DSI digital colposcope were included . We excluded 3 cases because of poor- quality imaging from user errors . Everyday clinical practice was followed . Initial colposcopic impression , DSI map indication , and biopsy site selection s were recorded . CIN2 + was considered the primary outcome and CIN of any grade a secondary outcome . A total of 105 women were included of which 5 ( 4.8 % ) had CIN2 + histology and 24 ( 22.9 % ) had CIN1 . Pre-DSI map colposcopy suggested normal/low grade in all 5 of the CIN2 + cases and DSI suggested high- grade ( HG ) CIN in 4 of the 5 cases . Sensitivity of st and ard colposcopy for CIN2 + was 0 % , improving to 80 % with the incorporation of the DSI map . The CIN burden in this population is higher than previously expected . Colposcopic identification of HG CIN appears to improve significantly with DSI in this cohort leading to refinement in patient management . A larger , multicentric prospect i ve study ( DySIS colposcopy 2 ) is planned to confirm these initial findings OBJECTIVE . A previous study has shown that Dynamic Spectral Imaging ( DSI ) colposcopy increases the sensitivity of the colposcopic examination in women referred with abnormal cytology . In this study we have reanalyzed the performance of DSI and conventional colposcopy for new referral conditions and for low- grade cytology referrals versus high- grade cytology referrals . METHOD . Data from a previous validation trial was used to assess the performance of DSI in different cytology groups : Women referred with BMD ( borderline and mild dyskaryosis ) cytology and women referred with NBMD cytology either hrHPV positive or negative were separately analyzed . Furthermore , we tried to assess the clinical performance by appropriate filtering of patients to replicate two different referral strategies . RESULTS . The sensitivity of DSI and conventional colposcopy  to detect CIN2 + lesions in women referred with BMD cytology is 82 % and 44 % respectively ( p= 0.001 ) and in the NBMD group 77 % and 64 % respectively ( p= 0.24 ) . If the two techniques are combined the sensitivity is 85%.When the conditions of new screening strategies are applied DSI colposcopy has a higher sensitivity to detect CIN2 + than conventional colposcopy . Findings are similar when CIN3 + is used as a threshold . CONCLUSION . We found that in most cases DSI colposcopy has a higher sensitivity than conventional colposcopy , even when referral criteria are changed . Unlike conventional colposcopy , the sensitivity of colposcopy with DSI in low- grade cytology referrals was found similar to the sensitivity in high- grade cytology referrals . This suggests that a baseline colposcopy sensitivity may be possible with the adjunctive use of the DSI map , irrespective of referral cytology The objective of this study was to assess the performance of cervical impedance spectroscopy in the detection of cervical intraepithelial neoplasia ( CIN ) using the new MKIII impedance probe . A prospect i ve observational study recruited women referred to colposcopy with an abnormal Papanicolaou smear . A pencil probe incorporating four gold electrodes was used to measure electrical impedance spectra from cervical epithelium . Colposcopy examinations , including probe positioning , were video recorded to allow for correlation between results obtained from colposcopic impression , histopathologic examination of colposcopic punch biopsies , and impedance measurements . Cervical impedance – derived parameters R , S , R/S , C , and Fc were assessed to see if significant difference in values obtained in CIN and normal epithelium existed . The performance of the probe in identifying women with CIN was also assessed . One hundred seventy-six women were recruited and 1168 points analyzed . Parameters R , S , and Fc showed significant separation of CIN or squamous intraepithelial lesion ( SIL ) from squamous , mature metaplastic , and columnar epithelium . Sensitivities of 74 % and specificity of 53 % can be achieved in identifying CIN 2/3 ( High- grade SIL ) in screened women . We conclude that cervical impedance spectrometry provides a potentially promising real-time screening tool for CIN with similar sensitivity and specificity to currently used screening tests . Further research is ongoing to develop the probe for potential clinical use Objective To explore the association between preterm delivery and treatment at colposcopy .  Design Retrospective- prospect i ve cohort study using record linkage . Setting 12 National Health Service hospitals in Engl and . Participants Women who had a cervical histology sample taken between 1987 and 2009 . These women were linked by hospital episode statistics to hospital obstetric records between 1998 and 2009 for the whole of Engl and to identify singleton live births between 20 - 43 gestational weeks before or after cervical histology . Main outcome measures Proportion of preterm births ( < 37 weeks ) ; the relative risk for the strength of association between preterm births and treatment for cervical intraepithelial neoplasia . Results 18 441 singleton births occurred : 4176 before histology and 14 265 after histology . Of the singleton births after histology , 9.0 % ( n=1284 ) were preterm compared with 6.7 % of all births in Engl and over the same period ( excess risk 2.3 per 100 births , 95 % confidence interval 1.8 % to 2.8 % ) . Among first births after histology , the adjusted relative risk associated with previous treatment was 1.19 ( 95 % confidence interval 1.01 to 1.41 ) ; among first births before histology the relative risk associated with subsequent treatment was 1.47 ( 1.05 to 2.05 ) . Combining these , the relative risk associated with treatment adjusted for timing relative to histology was 0.91 ( 0.66 to 1.26 ) corresponding to an absolute difference of −0.25 ( −2.61 to 2.11 ) per 100 singleton births . Among 372 women who gave birth both before and after treatment , there were 30 preterm births after treatment and 32 before treatment ( relative risk 0.94 , 0.62 to 1.43 ) . Conclusion The risk of preterm delivery in women treated by colposcopy  in Engl and was substantially less than that in many other studies , predominantly from Nordic countries . The increased risk may be a consequence of confounding and not caused by treatment . Although this study is reassuring for large loop excision of the transformation zone overall , it is possible that deep conisation or repeated treatment leads to an increased risk of preterm delivery OBJECTIVE To evaluate the efficacy of an electrical impedance probe ( Epitheliometer ) in the diagnosis of high grade cervical intraepithelial neoplasia ( CIN ) in women referred with cervical smear abnormalities and to assess the effect of acetic acid ( AA ) and tissue boundaries on the measurements . METHODS A prospect i ve observational study was undertaken in the colposcopy clinic . One hundred and sixty-five women , either with a clinical indication or abnormal cervical cytology , were recruited into the study . A pencil type probe was used to record  impedance spectra  from 12 points on the cervix before and after the application of 5 % AA . Spectra were also recorded from tissue boundaries . Colposcopic examinations , including probe positioning , were video recorded to allow for correlations between histopathological diagnosis of colposcopically directed biopsies , colposcopic impression and the diagnosis based on impedance measurements . RESULTS Receiver operating characteristic ( ROC ) curves were derived . The areas under the curves ( AUCs ) to discriminate original squamous from high grade CIN were 0.80 ( pre AA ) and 0.79 ( post AA ) . Comparison of these curves showed no significant difference , indicating that application of AA does not produce a large change in spectra . The probe could distinguish tissue boundaries from homogeneous tissue points . CONCLUSION The Epitheliometer has the potential to be used as an adjunct to colposcopy in the diagnosis of high grade CIN . It has the advantage of real time results , decreasing the need for diagnostic cervical biopsies , and facilitates a wider use of the ' see and treat ' policy without the risk of overtreatment The sensitivity of conventional colposcopy for the detection of high‐ grade cervical lesions ( cervical intraepithelial neoplasia stage 2 or above ; CIN2 + ) is poor . We aim ed to investigate if a Dynamic Spectral Imaging System ( DySIS ) can enhance or replace conventional colposcopy in clinical practice . From 3 December 2013 to 29 January 2014 a total of 239 women were included . All women were referred to the Department of Obstetrics and Gynecology , Aarhus , Denmark because of an abnormal cytology result . Every woman had three to five cervical punch biopsies taken ; two biopsies were taken following DySIS recommendations . Subsequent biopsies were taken following the clinician 's assessment or r and omly . DySIS allowed detection of five CIN2 + cases ( 7.4 % ) that would not have been detected otherwise , but it failed to detect 46 of CIN2 + cases ( 67.6 % ) . The sensitivity and specificity of DySIS for detecting CIN2 + was 32.4 and 83.0 % , respectively . DySIS colposcopy  seemed inferior to  conventional colposcopy  in detecting high‐ grade lesions and can not replace conventional colposcopy with r and om biopsies Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND Testing for human papillomavirus ( HPV ) DNA is reportedly more sensitive than cytology for the detection of high- grade cervical intraepithelial neoplasia ( CIN ) . The effectiveness of HPV testing in primary cervical screening was assessed in the ARTISTIC trial , which was done over two screening rounds approximately 3 years apart ( 2001 - 03 and 2004 - 07 ) by comparing liquid-based cytology ( LBC ) combined with HPV testing against LBC alone . METHODS Women aged 20 - 64 years who were undergoing routine screening as part of the English National Health Service Cervical Screening Programme in Greater Manchester were r and omly assigned ( between July , 2001 , and September , 2003 ) in a ratio of 3:1 to either combined LBC and HPV testing in which the results were revealed and acted on , or to combined LBC and HPV testing where the HPV result was concealed from the patient and investigator . The primary outcome was the detection rate of cervical intraepithelial neoplasia grade 3 or worse ( CIN3 + ) in the second screening round , analysed by intention to treat . This trial is registered with the International St and ard R and omised Controlled Trial Number IS RCT N25417821 . FINDING 
    Output:
    
The base-case cost-effectiveness results showed that adjunctive DySISmap routinely dominated st and ard colposcopy ( it was less costly and more effective ) .
ZedScan also dominated colposcopy alone for high- grade referrals in see- and -treat clinics .
The use of adjunctive DySIS  increases the sensitivity for detecting CIN 2 + , so it increases the number of high- grade CIN cases that are detected .
However , it also reduces specificity , so that more women with no or low- grade CIN will be incorrectly judged as possibly having high- grade CIN .
The evidence for ZedScan was limited , but it appears to increase sensitivity and decrease specificity compared with colposcopy alone .
The cost-effectiveness of both adjunctive technologies compared with st and ard colposcopy , under both the HPV triage and primary screening algorithms , appears to be favourable when compared with the conventional thresholds used to determine value in the NHS .