Atlas of Colposcopy: Principles and Practice

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Changes suspicious of invasion  

Any of the following features will indicate possible malignant disease. They invariably coexist with grade 2 changes.

  • Atypical vessels: Atypical vessels associated with invasive cancers have bizarre shapes, no definite branching patterns, and unequal thickness along the stem.

  • Fragile vessels: Atypical vessels often have thin, shiny walls and bleed easily on contact.

  • Irregular surface: An irregular or uneven surface of the lesion (molehill-like appearance) indicates invasive change.

  • Exophytic lesion: A thick, raised acetowhite area with an irregular surface suggests invasive cancer.

  • Necrosis or ulceration: A necrotic or ulcerated lesion that bleeds on contact is suspicious of invasive cancer. The necrosed or ulcerated area may not be acetowhite, because the epithelium is often peeled off the surface.

  • Tumour or gross neoplasm:: The presence of an obvious growth on the cervix is always suspicious of cancer, especially if there are abnormal blood vessels and the lesion becomes densely white after application of acetic acid.

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