Definition used in the consensus guidelines ASCCP +24 organizations 2013
Colposcopy
Colposcopy is the examination of the cervix , vagina and, in some instances the vulva, with the colposcope after the application of a 3--5% acetic solution coupled with obtaining colposcopically – directed biopsies of all lesions suspected of representing neoplasia
3. Colposcopy
Colposcopy is the examination of the
cervix , vagina and, in some instances
the vulva, with the colposcope after the
application of a 3--5% acetic solution
coupled with obtaining colposcopically
– directed biopsies of all lesions
suspected of representing neoplasia .
4. Endocervical Sampling
Includes obtaining a specimen
for either histopathological
evaluation using an
endocervical curette or a
cytobrush or for cytological
evaluation using a cytobrush
5. Endocervical assessment
Is the process of evaluating the
endocervical canal for the
presence of neoplasia using
either a colposcope or
endocervical sampling
6. Diagnostic excisional procedure
Is the process of obtaining a speciman
from the transformation zone and
endocervical canal for
histopathological evaluation and
includes laser conization, cold – knife
conization, loop electrosurgical
excision procedure (leep), and loop
electrosurgical conization
7. Adequate colposcopy
Indicates that the entire
squamocolumner junction and
the margin of any visible lesion
can be visualized with the
colposcope .
8. Endometrial sampling
Include obtaining a specimen
for histopathological evaluation
using an endometrial aspiration
or biopsy device a “dilatation
and curettage oh hysteroscopy
15. Indications for COLPOSCOPY….
• Abnormal PAP Smear
• Persistent vaginal discharge
• Long standing foul smelling vaginal
discharge
• Unhealthy Cervix
• Bleeding- post coital/ Postmenopausal
• HPV positive / external vulval warts
• Post treatment follow up
16. Basic Satisfactory Requirements of
Colposcopic Exam
Adequate Visualization
Entire TZ Zone seen
Abnormal areas seen in entirety
Endocervical Canal free of Dysplasia
No Evidence of Invasive Cancer
Abnormal Areas Biopsied
ECC Completed (Non-Pregnant patients)
17. Colposcopy - Objectives
Determines the presence of invasive cancer
Localizes the squamocolumnar junction
Identifies the most severe disease for biopsy
Evaluates the extent of disease
18. Accesibility of CERVIX……..
• seen instantly after putting speculum inside the vagina
and becomes apparent.
• The success of colposcopy lies in visualising the
cervical epithelia in the region of transformation zone
in its entirely.
19. Benefits of Colposcopy…….
• Non invasive, no anaethesia for pain
• Helps in precise examination of cervix and
TZ
• Guide to locate the biopsy, improve accuracy
of early diagnosis
• Reduce over-treatment
• Easy for follow up
• This is an outpatient procedure
• It takes only a few minutes
24. TZ lies between the original squamo-columner junction
and the new (or the present ) squamo-columner junction.
This is a highly active zone of metaplastic tissues in
which the single layered columnar epithelium is transformed
by metaplastic cellular divisions into multilayered squamous
epithelium.
34. STEPS FOR PERFORMING VIDEO
COLPOSCOPY….
• Normal Inspection after cleaning with
normal saline
• Inspection through Green filter
• Inspection after application of acetic acid
• Inspection after application of lugols Iodine
• Examination of Vagina
• Directed Biopsy.
35. NORMAL INSPECTION AFTER CLEANING
WITH NORMAL SALINE….
• To make the tissues and vascular details
more clear.
36. VIEW WITH GREEN FILTER
• For vascular pattern of cervix.
• This absorbs the red color and makes the
appearance of blood vessels black
• Black blood vessels can be viewed clearly.
37.
38. ACETIC ACID TEST
• Coagulation of cell protein seen an interval of 1 mint.
• If white layer is very thick (opaque) that area becomes
area of concern.
• The impact of acetic acid fades away normally in 1-3 mints,
So repeated application is recommended for proper
visualization of pathological lesions.
39. Aceto white lesion
• Intensity
• Duration of stay
• speed of Appearance
• speed of disappearance
• margins Relation to SCJ
Inside TZ/ outside TZ
40. Grading of Colposcopy Findings….
• Grade I: Flat acetowhite epithelium, snow white,
regular pattern of fine calibre vessels . CIN I , HPV
• Grade II: Flat but whiter acetowhite epithelium, gray
white, irregular blood vessel often coarse. CIN I to
carcinoma-in-situ.
• Grade-III dull oyster white, gray acetowhite
epithelium with irregular surface contour and
irregular coarse and coiled blood vessel. Carcinoma-
in-situ early invasive carcinoma.
47. LUGOL’S
IODINE TEST
• Rich glycogen area appears dark brown
• Areas which do not stain are considered iodine negative
and needs attention.
• Iodine doesn’t stain columnar, immature matalplastic,
regenerating squamous epithelium after surgical trauma,
intra epithelial neoplasia and invasive carcinoma.
• Staining is superficial and fades off in 8-10 mints.
60. IMMATURE METAPLASIA
Step I = Loss of tranlucency,
Grape like configuration +
Step II = Loss of grape like
configuration
Step III = villus pattern is lossed
69. EXAMINATION OF VAGINA
& BIOPSY
• The vault of vagina should be carefully
examined for evidence of vaginitis,
leucoplakia and any growth while
withdrawing the speculum
• Colposcopy directed biopsy should be
taken whenever necessary
70. COLPOSCOPY DIRECTED
• Biopsy forceps: Punch biopsy forcep is preferred
• Tissue specimen is sent to Lab for testing further.