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Atlas of colposcopy – principles and practice
Cervical cancer is preventable. A combination of vaccination against human papillomavirus (HPV) and early detection and treatment after screening should lead to this cancer becoming a rarity among women in all parts of the world in the decades to come, if these life-saving preventive interventions are implemented.
Colposcopy is an important component of cervical cancer screening as a triaging investigation of screen-positive women. Colposcopy permits magnified visual inspection of the cervical and vaginal mucosa to detect cervical cancer precursor lesions such as cervical intraepithelial neoplasia (CIN) and subclinical cervical cancer, leading to early detection and prevention of cervical cancer, while avoiding false-positive and false-negative outcomes. It facilitates the treatment of cervical precancerous lesions under colposcopic control.
The performance of high-quality and safe colposcopy to ensure accurate diagnosis of lesions requires providers that are well trained and highly informed about the indications, applications, limitations, and pitfalls of colposcopy, supported by good-quality equipment and histopathology services. The atlas entitled Atlas of Colposcopy – Principles and Practice was developed in the context of the cervical cancer screening research studies of the International Agency for Research on Cancer (IARC) and the related provision of technical support for regional and national scale-up of cervical cancer screening programmes. The atlas is valuable in providing a highly comprehensive and interactive digital manual with illustrative clinical pictures and line diagrams of the normal anatomy and physiological and pathophysiological states of the uterine cervical mucosa, and a range of readily detectable colposcopic abnormalities, including inflammatory, precancerous, and early cancerous lesions and congenital anomalies. The atlas addresses the demanding task of covering all aspects of colposcopy education, practice, and quality assurance.
In the past two decades, there has been enormous progress in the understanding of the etiology and pathogenesis of cervical cancer, with important applications in the prevention and early detection of cervical cancer and in the practice of colposcopy. As a result, many women around the world are screened using visual inspection with acetic acid (VIA) or HPV testing, as well as by cytology. Irrespective of the type of screening test used, colposcopy, if it is available in health services, remains the best method to direct biopsies to assess the severity of clinical disease and to inform subsequent management of detected lesions.
Expertise in performing satisfactory, safe, and accurate colposcopic examinations requires high competence in the technical, interpretive, and cognitive aspects, and the capability to integrate colposcopic findings into management practice. The competencies needed are manifold and include: basic theoretical knowledge of the instrumentation, the anatomy and pathophysiology of the cervix, the natural history and manifestations of transient and persistent HPV infections, the natural history of cervical neoplasia, the cytological and histopathological aspects of metaplasia, dysplasia, and cancer, and colposcopic indications and procedures; the ability to recognize the normal and abnormal cervix by visualization and interpretation of the colposcopic appearances of normal, inflammatory, and neoplastic conditions; skills in directing biopsies and managing colposcopic abnormalities; treatment of CIN and adenocarcinoma in situ under colposcopic control; skills in avoiding and controlling bleeding and other complications; and communication skills. This atlas provides a valuable learning tool for obtaining the requisite core knowledge, acquiring the necessary skills for the visual recognition and interpretation of colposcopy findings, and developing the personal and professional attributes required for competence in colposcopy.
The atlas is a rich repository of annotated photographs and illustrations covering almost all aspects of common and rare colposcopic abnormalities. It is a useful addition to the training tools and hands-on training in colposcopy in structured training courses or under the tutorship of experienced and competent expert trainers. The information and illustrations in this atlas have immense potential to be directly useful in the training of nurses, postgraduate students, non-specialist doctors, and gynaecologists in colposcopy, as well as in the day-to-day clinical practice of experienced colposcopists. In this context, I believe that this atlas will find its place among the resources that will contribute to cervical cancer control worldwide.
Dr Christopher P. Wild
Director, International Agency for Research on Cancer