Importance of Colposcopy for screening of Premalignant Lesions of Cervix: An Experience of Tertiary Public Health Hospital in India
Vinita Sarbhai, Mohini Paul, Sangita N Ajmani
Citation Information :
Sarbhai V, Paul M, Ajmani SN. Importance of Colposcopy for screening of Premalignant Lesions of Cervix: An Experience of Tertiary Public Health Hospital in India. Int J Gynecol Endsc 2017; 1 (2):65-68.
Aim: The aim of this article is to correlate the clinical, cytological, and colposcopic findings for detection of premalignant lesions of cervix.
Materials and methods: A total of 100 nonpregnant females attending the gynecology outpatient department (OPD) in Kasturba Hospital, New Delhi, India, were enrolled in the study. Papanicolaou (Pap) smear was done in first OPD visit. Colposcopy was done in these patients and patients with satisfactory colposcopy were subjected to biopsy if any abnormal finding was detected; in those with unsatisfactory colposcopy, endocervical curettage and conization were done. Samples were sent for histopathology examination and findings were correlated.
Results: The Pap smear was evaluated according to Bethesda system, which showed 70 patients had inflammatory smear, 6 had inflammatory with definitive organism, and 14 were abnormal. Out of 14 abnormal smears, 5 cases of atypical squamous cells of uncertain significance (ASCUS), 8 cases of low-grade squamous intraepithelial lesion (LSIL), and 1 case of squamous cell carcinoma (SCC) were noted. Sensitivity of Pap smear for detecting all grades of cervical intraepithelial neoplasia (CIN) was found to be 50%.
On colposcopy, 30% had normal appearance and 38% had miscellaneous findings; 28 patients with abnormal colposcopy finding were graded according to Reid's colposcopy index, and findings showed 26 abnormal and 2 suspected of invasive cancer. Biopsy was done in 32 patients, including abnormal and unsatisfactory colposcopy.
Sensitivity of colposcopy for detecting all grades of CIN and SCC was found to be 92.85%. After combining both Pap smear and colposcopy, detection rate was 100%.
Conclusion: Colposcopy and Pap smear should be done together for early detection of premalignant cervical intraepithelial lesions to reduce the burden of cervical cancer and its associated morbidity and mortality.
Parkin DM, Bray FI, Devesa SS. Cancer burden in the year 2000. The global picture. Eur J Cancer 2001 Oct;37(8):S4-S6.
Luthra UK, Gardner JW. The rising frequency of hysterectomy: its effect on uterine cancer rates. Am J Epidemiol 1977;105: 439-443.
National Cancer Control Programme, Directorate General Health Services, Ministry of Health and Family Welfare, Government of India, New Delhi, 1997.
O’Dowd MJ, Philipp EE. The history of obstetrics and gynecology. Pearl River (NY): Parthenon Publishing Group; 1994. p. 543-570.
Kerkar RA, Kulkarni YV. Screening for cervical cancer: an overview. J Obstet Gynecol India 2006;56:115-122.
Anderson GH, Boys DA, Benedet JL, Le Riche JC, Matisie JP, Suen KC, Worth AJ, Millner A, Bennett OM. Organisation and results of cervical cytology screening program in British Columbia, 1955-85. BMJ 1988 Apr;296(6627):975-978.
Lieu D. The Papanicolaou smear: its value and limitations. J Fam Pract 1996 Apr;42(4):391-399.
Chamberlain J. Reasons that some screening programmes fail to control cervical cancer. In: Hakama M, Miller A, Day N, editors. Screening for cancer of the uterine cervix Lyons, France: IARC; 1986. Vol. 76, p. 161-168.
Coleman DV. Gynecological cytopathology. In: Fox, editor. Haynes and Taylor: obstetrical and gynecology pathology. 4th ed. New York: Churchill; 1986. p. 1392-1422.
Davison JM, Marty JJ. Detecting premalignant cervical lesions. Contribution of screening colposcopy to cytology. J Reprod Med 1994 May;39(5):388-392.
Kierkegaard O, Byrjalsen C, Frandsen KH, Hansen KC, Frydenberg M. Diagnostic accuracy of cytology and colposcopy in cervical squamous intraepithelial lesions. Acta Obstet Gynecol Scand 1994 Sep;73(8):648-651.
Sankaranarayanan R, Chatterji R, Shastri SS, Wesley RS, Basu P, Mahe C, Muwonge R, Seigneurin D, Somanathan T, Roy C, et al. Accuracy of human papillomavirus testing in primary screening of cervical neoplasia: results from a multicenter study in India. Int J Cancer 2004 Nov;112(2):341-347.
Gilmour DT, Das S, Flowerdew G. Rates of urinary tract injury from gynecologic surgery and the role of intraoperative cystoscopy. Obstet Gynecol 2006 Jun;107(6):1366-1372.
Ibeanu OA, Chesson RR, Echols KT, Nieves M, Busangu F, Nolan TE. Urinary tract injury during hysterectomy based on universal cystoscopy. Obstet Gynecol 2009 Jan;113(1):6-10.
Badenoch DF, Tiptaft RC, Thakar DR, Fowler CG, Blandy JP. Early repair of accidental injury to the ureter or bladder following gynaecological surgery. Br J Urol 1987 Jun;59(6):516-518.
Ferro A, David B, Donald G. Intraoperative and postoperative morbidity associated with cystoscopy performed in patients undergoing gynecologic surgery. Am J Obstet Gynecol 2003 Aug;189(2):354-357.
Visco AG, Taber KH, Weidner AC, Barber MD, Nyers ER. Costeffectiveness of universal cystoscopy to identify ureteral injury at hysterectomy. Obstet Gynecol 2001 May;97(5 Pt 1):685-692.
ACOG Committee Opinion. Number 372. The role of cystourethroscopy in the generalist obstetrician-gynecologist practice. Obstet Gynecol 2007 Jul;110(1):221-224.
Chi AM, Curran DS, Morgan DM, Fenner DE, Swenson CW. Universal cystoscopy after benign hysterectomy: examining the effects of an institutional policy. Obstet Gynecol 2016 Feb;127(2):369-375.
Farrell SA, Baskett TF, Baydock S. The use of intraoperative cystoscopy by general gynaecologists in Canada. J Obstet Gynaecol Can 2009 Jan;31(1):48-53.
Coates KW, Kuehl TJ, Bachofen CG, Shull BL. Analysis of surgical complications and patient outcomes in a residency training program. Am J Obstet Gynecol 2001 Jan;184(7): 1380-1385.
Esteve JL, Acosta R, Pérez Y, Campos R, Hernández AV, Texidó CS. Treatment of uterine myoma with 5 or 10 mg mifepristone daily during 6 months, post-treatment evolution over 12 months: double-blind randomised clinical trial. Eur J Obstet Gynecol Reprod Biol 2012 Apr;161(2):202-208.
Eisinger SH, Fiscella J, Bonfiglio T, Meldrum S, Fiscella K. Open-label study of ultra low-dose mifepristone for the treatment of uterine leiomyomata. Eur J Obstet Gynecol Reprod Biol 2009 Oct;146(2):215-218.
Miller CE, Davies S, Johnston M. Laparoscopic myomectomy with uterine reconstruction is a safe surgical procedure. Presented at the 27th Annual Meeting of the American Association of Gynecologic Laparoscopists. Atlanta, GA. 1998.
Anitha V, Rajesh P, Shanmugam M, Priya BM, Prabhu S, Shivakumar V. Comparative evaluation of natural Curcumin and synthetic chlorhexidine in the management of chronic periodontitis as a local drug delivery: a clinical and microbiological study. Indian J Dent Res 2015 Jan-Feb;26(1):53-56.
Raja N, Murthykumar K, Ashwin KS, Kumar N, Priyadharshini R. Effects of natural products on oral health: a review. Asian J Pharm Clin Res 2014;7(5):279-282.
Manifar S, Obwaller A, Gharehgozloo A, Boorboor Shirazi Kordi HR, Akhondzadeh S. Curcumin gel in the treatment of minor aphthous ulcer: a randomized, placebo – controlled trial. J Med Plants 2012;11(41):40-45.
Deshmukh RA, Bagewadi AS. Comparison of effectiveness of Curcumin with triamcinolone acetonide in the gel form in treatment of minor recurrent aphthous stomatitis: a randomized clinical trial. Int J Pharm Investig 2014 Jul;4(3):138-141.
Rai B, Kaur J, Jacobs R, Singh J. Possible action mechanism for Curcumin in pre-cancerous lesions based on serum and salivary markers of oxidative stress. J Oral Sci 2010;52(2):251-260.
Agarwal N, Singh D, Sinha A, Srivastava S, Prasad RK, Singh G. Evaluation of efficacy of turmeric in management of oral submuocus fibrosis. J Indian Acad Oral Med Radiol 2014;26(3):260-263.
Das DA, Balan A, Sreelatha KT. Comparative Study of the efficacy of Curcumin and turmeric oil as chemopreventive agents in oral submucous fibrosis. A clinical and histopathological evaluation. J Indian Acad Oral Med Radiol 2010;22(2):88-92.
Wu CN, Madden E, Lozada NF, Silverman SJ. High dose curcuminoids are efficacious in the reduction in symptoms and signs of oral lichen planus. J Am Acad Dermatol 2012 May; 66(5):752-760.
Wilken R, Veena MS, Wang MB, Srivatsan ES. Curcumin: a review of anti-cancer properties and therapeutic activity in head and neck squamous cell carcinoma. Mol Cancer 2011 Feb 7;10:12.
Perrone D, Ardito F, Giannatempo G, Dioguardi M, Troiano G, Lo Russo L, De Lillo A, Laino L, Lo Muzio L. Biological and therapeutic activities, and anticancer properties of Curcumin. Exp Ther Med 2015 Nov; 10(5):1615-1623.
Schwartz J, Shklar G, Reid S, Trickler D. Prevention of experimental oral cancer by extracts of spirulina-dunaliella algae. Nutr Cancer 1988;11(2);127-134.
Patil S, Al-Zarea BK, Maheshwari S, Sahu R. Comparative evaluation of natural antioxidants spirulina and aloe vera for the treatment of oral submucous fibrosis. J Oral Biol Craniofac Res 2015 Jan-Apr;5(1):11-15.
Feng Z, Weinberg A. Role of bacteria in health and disease of periodontal tissues. Periodontol 2000 2006;40:50-76.
Shetty P, Shenai P, Chatra L, Rao PK. Efficacy of spirulina as an antioxidant adjuvant to corticosteroid injection in management of oral submucous fibrosis. Indian J Dent Res 2013 May-Jun;24(3):347-350.
Mulk BS, Deshpande P, Velpula N, Chappidi V, Chintamaneni RL, Goyal S. Spirulina and pentoxyfilline. a novel approach for treatment of oral submucous fibrosis. J Clin Diagn Res 2013 Dec;7(12):3048-3050.
Gupta SC, Yadav YC. “Misi” an etiological factor in oral submucous fibrosis. Indian J Otolaryngol 1978 Mar;30(1):5-6.
Schwartz J. Atrophia idiopathica (tropica) mucosae oris. Demonstrated at the Eleventh International Dental Congress, London; 1952 (cited by Sirsat and Khanolkar, Indian J Med Sci 1962;16:189-197).
Joshi SG. Submucous fibrosis of the palate and pillars. Indian J Otolaryngol 1953;4(1):1-4.
Yoithapprabhunath TR, Maheswaran T, Dineshshankar J, Anusushanth A, Sindhuja P, Sitra G. Pathogenesis and therapeutic intervention of oral submucous fibrosis. J Pharm Bioallied Sci 2013 Jun;5(Suppl 1):S85-S88.
Arakeri G, Brennan PA. Oral submucous fibrosis: an overview of the aetiology, pathogenesis, classification, and principles of management. Br J Oral Maxillofac Surg 2013 Oct;51(7):587-593.
van der Waal I. Potentially malignant disorders of the oral and oropharyngeal mucosa; terminology, classification and present concepts of management. Oral Oncol 2009 Apr- May;45(4-5):317-323.
Tilakaratne WM, Ekanayaka RP, Warnakulasuriya S. Oral submucous fibrosis: a historical perspective and a review on etiology and pathogenesis. Oral Surg Oral Med Oral Pathol Oral Radiol 2016 Aug;122(2):178-191.
Singh BP, Mittal N, Sharma V, Palani. Evaluation of role of oxitard capsules in the treatment of oral submucous fibrosis. Antiseptic 2009 Oct;106(10):503-507.
Patil S, Khandelwal S, Maheshwari S. Comparative efficacy of newer antioxidants spirulina and lycopene for the treatment of oral submucous fibrosis. Clin Cancer Investig J 2014 Nov- Dec;3(6):482-486.
Xie Q, Bedran-Russo AK, Wu CD. In vitro remineralization effects of grape seed extract on artificial root caries. J Dent 2008 Nov;36(11):900-906.
Vinitha M, Balal M. In vitro anticandidal activity of cinnamomum vernum. J Med Sci 2008;8(4):425-428.
Aneja KR, Joshi R. “Antimicrobial activity of Amomum subulatum and Elettaria cardamomum against dental caries causing microorganisms. Ethnobotan Leaflets 2009 Jul;13: 840-849.
Arweiler NB, Donos N, Netuschil L, Reich E, Sculean A. Clinical and antibacterial effect of tea tree oil—a pilot study. Clin Oral Investig 2000 Jun;4(2):70-73.
Soukoulis S, Hirsch R. The effects of a tea tree oil-containing gel on plaque and chronic gingivitis. Aust Dent J 2004 Jun;49(2):78-83.
Michie CA, Cooper E. Frankincense and myrrh as remedies in children. J R Soc Med 1991 Oct;84(10):602-605.
Greene DA. Gold, frankincense, myrrh, and medicine. N C Med J 1993 Dec;54(12):620-622.
Bonifait L, Grenier D. Cranberry polyphenols: potential benefits for dental caries and periodontal disease. J Can Dent Assoc 2010;76:a130.
Bodet C, Grenier D, Chandad F, Ofek I, Steinberg D, Weiss EI. Potential oral health benefits of cranberry. Crit Rev Food Sci Nutr 2008 Aug;48(7):672-680.
Weiss EI, Kozlovsky A, Steinberg D, Lev-Dor R, Bar Ness Greenstein R, Feldman M, Sharon N, Ofek I. A high molecular mass cranberry constituent reduces mutans streptococci level in saliva and inhibits in vitro adhesion to hydroxyapatite. FEMS Microbiol Lett 2004 Mar;232(1):89-92.
Abdul Sattar BA, Hassan AM, Hassan AS. In vitro antimicrobial activity of thymus vulgaris, origanum vulgare and rosmarinus officinalis against dental caries pathogens. Ibn Al-Haitham J Pure Appl Sci 2012 Jan;25(2):1-7.
Huang MT, Ho CT, Wang ZY, Ferraro T, Lou YR, Stauber K, Ma W, Georgiadis C, Laskin JD, Conney AH. Inhibition of skin tumorigenesis by rosemary and its constituents carnosol and ursolic acid. Cancer Res. 1994 Feb;54(3):701-708.
Bernardes WA, Lucarini R, Tozatti MG, Souza MG, Silva ML, Filho AA, Martins CH, Crotti AE, Pauletti PM, Groppo M, et al. Antimicrobial activity of tosmarinus officinalis against oral pathogens: relevance of carnosic acid and carnosol. Chem Biodivers 2010 Jul;7(7):1835-1840.
Parolia A, Thomas MS, Kundabala M, Mohan M. Propolis and its potential uses in oral health. Int J Med Sci 2010 Jul;2(7): 210-215.
Oncag O, Cogulu D, Uzel A, Sorkun K. Efficacy of propolis as an intracanal medicament against Enerococcus faecalis. Gen Dent 2006 Sep-Oct:54(5):319-322.
Martin MP, Pileggi R. A quantitative analysis of propolis: a promising new storage media following avulsion. Dent Traumatol 2004 Apr:20(2):85-89.
Carbajal D, Casaco A, Arruzazabala L, Gonzalez R, Tolon Z. Pharmacological study of Cymbopogon citratus leaves. J Ethnopharmacol 1989 Feb;25(1):103-107.
Sanches NR, Cortez DAG, Schiavini MS, Nakamura CV, Filho BPD. An evaluation of antibacterial activities of Psidium guajava. Braz Arch Biol Technol 2005 May;48(3):4229-4230.
Sanda KA, Grema HA, Geidam YA, Bukar-Kolo YM. Pharmacological aspects of Psidium guajava: an update. Int J Pharmacol 2011 May;7:316-324.
Menezes SM, Cordeiro LN, Viana GS. Punica grantum (pomegranate) extract is active against dental plaque. J Herb Pharmacother 2006;6(2):79-92.
Vasconcelos LC, Sampaio FC, Sampaio MC, Pereira Mdo S, Higino JS, Peixoto MH. Minimum inhibitory concentration of adherence of punica granatum linn (pomegranate) gel against S. mutans, S. mitis and C albicans. Braz Dent J 2006;17(3): 223-227.
Prasad D, Kunnaiah R. Punica granatum: a review on its potential role in treating periodontal disease. J Indian Soc Periodontol 2014 Jul;18(4):428-432.
Sauvaire Y, Petit P, Baissac Y, Ribes G. Chemistry and pharmacology of fenugreek. In: Herbs, botanicals and teas. Mazza G, Oomah BD, editors. Lancaster, Pennsylvania: Technomic Pub. Co; 2000. p. 107-129.
Acharya SN, Basu SK, Thomas JE. Methods for the improvement of plant medicinal properties with particular reference to fenugreek (Trigonella foenum-graecum L.). In: Acharya SN, Thomas JE, editors. Advances in medicinal plant research. Kerala, India: Research Signpost; 2007b p. 491-412.
Al-Habori M, Raman A. Pharmacological properties in fenugreek. - In: Petropoulos GA, editor. The genus trigonella. 1st ed. London and New York: Taylor and Francis 2002. p. 163-182.
Saini P, Al-Shibani N, Sun J, Zhang W, Song F, Gregson KS, Windsor LJ. Effects of calendula officinalis on human gingival fibroblasts. Homeopathy 2012 Apr;101(2):92-98.
Khairnar MS, Pawar B, Marawar PPA. Evaluation of calendula officinalis as an anti-plaque and anti-gingivitis agent. J Indian Soc Periodontol 2013 Nov-Dec;17(6):741-747.
Chakraborthy GS. Antimicrobial activity of leaf extract of calendula officinalis Linn. J Herb Med Toxicol 2008 Jun;2(2):65–66.
Zilda CG, Claudia MR, Sandra RF. Antifungal activity of the essential oil from calendula officinalis L growing in Brazil. Braz J Microbiol 2008;39(1):61-63.
Bussadori SK, Castro LC, Galvão AC. Papain gel: a new chemo-mechanical caries removal agent. J Clin Pediatr Dent 2005 Winter;30(2):115-119.
Bertassoni LE, Marshall GW. Papain-gel degrades intact nonmineralized type I collagen fibrils. Scanning 2009 Nov- Dec;31(6):253-258.
Moon SE, Kim HY, Cha JD. Synergistic effect between clove oil and its major compounds and antibiotics against oral bacteria. Arch Oral Biol 2011 Sep;56(9):907-916.
Pinto E, Vale-Silva L, Cavaleiro C, Salgueiro L. Antifungal activity of the clove essential oil from Syzygium aromaticumon, candida, aspergillus and dermatophyte species. J Med Microbiol 2009 Nov;58(Pt 11):1454-1462.
Olajide OA, Makinde JM, Awe SO. Evaluation of the pharmacological properties of nutmeg oil in rats and mice. Pharma Biol 2000;38(5):385-390.
Thanoon SZ, Al-Refai AS, Kamal A. Antibacterial effect and healing potential of nutmeg oil for chemically induced oral ulcerations in rabbits. Zanco J Med Sci 2013;17(2): 393-399.
Mitwally MF, Casper RF. Use of an aromatase inhibitor for induction of ovulation in patients with an inadequate response to clomiphene citrate. Fertil Steril 2001;75:305-09.
Sammour A, Bijan MM, Tan SL, Tulandi T. Prospective randomised trial comparing the effects of letrazole (LE) and clomiphene citrate (CC) on follicular development, endometrial thickness and pregnancy rate in patients undergoing superovulation prior to intrauterine insemination (IUI). Fertil Steril 2001;76(Suppl 1):S110.
Mitwally MF, Casper RF. Single-dose administration of an aromatase inhibitor for ovarian stimulation. Fertil Steril 2005;83:229-31.
Fisher SA, Reid RL, Van Vugt DA, Casper RF. A randomized double-blind comparison of the effects of clomiphene citrate and the aromatase inhibitor letrozole on ovulatory function in normal women. Fertil Steril 2002;78:280-85.
Fatemi HM, Kalibianakis E, Tournaye H, Camus M, Van Steirteghem AC, Devroey P. Clomiphene citrate vs letrozole for ovarian stimulation: A pilot study. Reprod Biomed Online 2003;7:543-46.
Hu Y, Cortvrindt R, Smitz J. Effects of aromatase inhibition on in vitro follicle and oocyte development analyzed by early preantral mouse follicle culture. Mol Reprod Dev 2002;61: 549-59.
Shetty G, Krishnamurthy H, Krishnamurthy HN, Bhatnagar S, Moudgal NR. Effect of estrogen deprivation on the reproductive physiology of male and female primates. J Steroid Biochem Mol Biol 1997;61:157-66.
Mitwally MF, Casper RF. Aromatase inhibition reduces gonadotrophin dose required for controlled ovarian stimulation in women with unexplained infertility. Hum Reprod 2003;18:1588-97.
Mitwally MF, Casper RF. Aromatase inhibition improves ovarian response to follicle-stimulating hormone in poor responders. Fertil Steril 2002;77:776-80.
Goswami SK, Das T, Chattopadhyay R, Sawhney V, Kumar J, Chaudhury K, Chakravarty BN, Kabir SN. A randomized single blind controlled trial of letrozole as a low-cost IVF protocol in women with poor ovarian response: A preliminary report. Hum Reprod 2004;19:2031-35.
Newkirk KM, Chandler HL, Parent AE, et al. Ultraviolet radiation-induced corneal degeneration in 129 mice. Toxicol Pathol 2007;35:819-26.
Pettenati MJ, Sweatt AJ, Lantz P, et al. The human cornea has a high incidence of acquired chromosome abnormalities. Hum Genet 1997;101:26-29.
Snibson GR. Collagen cross-linking: A new treatment paradigm in corneal disease—a review. Clin Experiment Ophthalmol 2010;38:141-53.
Spoerl E, Raiskup-Wolf F, Kuhlisch E, Pillunat LE. Cigarette smoking is negatively associated with keratoconus. J Refract Surg 2008;24:S737-40.
Rabinowitz YS, Nesburn AB, McDonnell PJ. Videokeratography of the fellow eye in unilateral keratoconus. Ophthalmology 1993;100:181-86.
Goodrich DW, Lee WH. The molecular genetics of retinoblastoma. Cancer Surv 1990;9:529-54.
Moodaley LC, Woodward EG, Liu CS, Buckley RJ. Life expectancy in keratoconus. Br J Ophthalmol 1992;76:590-91.
Honein MA, Dawson AL, Petersen EE, Jones AM, Lee EH, Yazdy MM, Ahmad N, Macdonald J, Evert N, Bingham A, et al. Birth defects among fetuses and infants of US women with evidence of possible Zika virus infection during pregnancy. JAMA 2017 Jan 3;317(1):59-68.
Chervenak FA, Jeanty P, Cantraine F, Chitkara U, Venus I, Berkowitz RL, Hobbins JC. The diagnosis of fetal microcephaly. Am J Obstet Gynecol 1984 Jul 1;149(5):512-517.
Papageorghiou AT, Thilaganathan B, Bilardo CM, Ngu A, Malinger G, Herrera M, Salomon LJ, Riley LE, Copel JA. ISUOG Interim Guidance on ultrasound for Zika virus infection in pregnancy: information for healthcare professionals. Ultrasound Obstet Gynecol 2016 Apr;47(4):530-532.
Chibueze EC, Parsons AJ, Lopes KD, Yo T, Swa T, Nagata C, Horita N, Morisaki N, Balogun OO, Dagvadorj A, et al. Diagnostic accuracy of ultrasound scanning for prenatal microcephaly in the context of Zika virus infection: a systematic review and meta-analysis. Sci Rep 2017 May 23;7(1):2310.
Cordeiro MT. Zika virus: laboratory diagnosis. In: Zika in focus. Springer International Publishing; 2017. pp. 59-62.
Mlakar J, Korva M, Tul N, Popović M, Poljšak-Prijatelj M, Mraz J, Kolenc M, Resman Rus K, Vesnaver Vipotnik T, Fabjan Vodušek V, et al. Zika virus associated with microcephaly. N Engl J Med 2016 Mar 10;374(10):951-958.
Zare Mehrjardi M, Keshavarz E, Poretti A, Hazin AN. Neuroimaging findings of Zika virus infection: a review article. Jpn J Radiol 2016 Dec;34(12):765-770.
Oliveira Melo AS, Malinger G, Ximenes R, Szejnfeld PO, Alves Sampaio S, Bispo de Filippis AM. Zika virus intrauterine infection causes fetal brain abnormality and microcephaly: tip of the iceberg? Ultrasound Obstet Gynecol 2016 Jan;47(1):6-7.
Brasil P, Pereira JP Jr, Moreira ME, Ribeiro Nogueira RM, Damasceno L, Wakimoto M, Rabello RS, Valderramos SG, Halai UA, Salles TS, et al. Zika virus infection in pregnant women in Rio de Janeiro. N Engl J Med 2016 Dec 15;375(24):2321-2334.