Colposcopy normal

Objective

• Determines the presence of invasive cancer

• Localizes the squamocolumnar junction

• Identifies the most severe disease for biopsy

• Evaluates the extent of disease

What to Look?

Evaluation

Instrumentation

Curette

Colposcope:

• Stereoscopic binocular microscope

• Magnification: 8x to 40x

• Generally panoramic view at 10x

• Green filter -> to highlight vascular pattern

• Kevorkian-Younge biopsy forceps

• Endocervical curette

• Endocervical brush

• Cytology brush

• Silver nitrate stick

• Monsel's solution

Kevorkian

1. Evaluate entire lesion

• Can you follow the entire lesion?
• Does it go past the SCJ and into the endocervix?
• Does it move into the vagina

2. Evaluate entire SCJ

• Is it obscured by prior treatments?
• Does it recede into the endocevix?

Proper evaluation of both lesion and the SCJ is an adequate for colposcopy

scj

Introduction

Post-Menopausal Colposcopy

Unsatisfactory result

Hormonal changes

Indication

History

Esterogen treatment will cause enough ectropion of endocervical cells to result in satisfactory examination

Lines of Treatment

Transformation zone can't be visualized

• Post-coital bleeding

• Unexplained vaginal bleeding

• Positive screening test by Cervicography or Speculoscopy

• Abnormal Pap test suggesting cervical dysplasia

• Positive high risk HPV DNA in ASC-US triage

• Was pioneered in Germany by dr. Hinselmann (1920's)

• His work identified several atypical appearances that still used today:

- Leukoplakia

- Punctation

- Felderung (mosaicism)

• Today colposcopy has been accepted as a diagnostic tool in evaluating abnormal pap test

• LEEP

• Cryotherapy

• Laser

• Cone biopsy

• Hysterectomy

Normal Vascular Pattern

Colposcopy in Pregnancy

Normal Colposcopy

Normal Histology

• Incidence of cervical cancer varies from 1 to 15 cases per 10,000 pregnancies

• Mean age of diagnosis: 34 years

NIH/ASCCP Guidelines for Management of Women with Cervical Cytological Abnormalities

NIH Recommendation

• In the absence of invasive disease, additional colposcopic and cytological examinations are recommended, with biopsy only if the appearance of the lesion worsens or cytology suggests invasive cancer.

• Unless invasive cancer is identified, treatment is unacceptable.

• A diagnostic excisional procedure is recommended only if invasion is suspected.

• Re-evaluation with cytology and colposcopy is recommended no sooner than 6 weeks postpartum.

• It is preferred that the colposcopic evaluation of pregnant women with HSIL be conducted by clinicians who are experienced in the evaluation of colposcopic changes induced by pregnancy.

• Biopsy of lesions suspicious for high-grade disease or cancer is preferred; biopsy of other lesions is acceptable.

• Endocervical curettage is unacceptable in pregnant women.

• Since unsatisfactory colposcopy may become satisfactory as the pregnancy progresses, it is recommended that women with an unsatisfactory colposcopy undergo a repeat colposcopic examination in 6-12 weeks.

Chadwick sign

Large transformation zone with active squamous metaplasia

Increased vascularity, stromal edema, and stromal hypertrophy, cause marked enlargement of the cervix

LSIL in pregnancy

HSIL in pregnancy

• Pregnancy triggers very active squamous metaplasia which shows an exaggerated acetowhite change in response to acetic acid.

• Increased vascularity and stromal edema can cause a decrease in acetowhitening but an exaggeration of vascular patterns.

Normal Colposcopy

dr. Sigit Purbadi, SpOG(K)