Learning colposcopy

Colposcopic appearance of normal cervix

Normal cervical epithelium

Original squamous epithelium Columnar epithelium Squamocolumnar junction

Ectropion or ectopy Squamous metaplasia

Features of squamous metaplasia

Transformation zone

Types of transformation zone

Atrophic changes Changes during pregnancy The nulliparous and parous cervix

The colposcopic examination

Indications of colposcopy Description of a colposcope Ancillary instruments for colposcopy Consumables required for colposcopy

Preparation of acetic acid Preparation of Lugol's iodine

Colposcopy setup Steps of a colposcopic examination Inadequate colposcopy Exposing the cervix properly Using the endocervical speculum Colposcopically directed biopsy Endocervical curettage Documentation of colposcopic findings

Detection of infections & benign conditions of cervix

Cervicovaginal inflammation

Vaginal discharge Inflamed cervix

Condyloma and subclinical papillomavirus infection (SPI) The congenital transformation zone (CTZ) Ectropion or ectopy Erosion Cervical polyp Leukoplakia Cervical stenosis Cervical endometriosis Post-treatment consequences

Detection of cervical neoplasias

Identification and documentation of colposcopic abnormalities General assessment Abnormal colposcopy

Grade 1 (minor) changes Grade 2 (major) changes Grade 2 (major) changes (contd.) Non-specific changes Changes suspicious of invasion Miscellaneous changes

Calculating Swede score Diagnosing invasive cancer Diagnosing adenocarcinoma in situ (AIS) and adenocarcinoma Colposcopy procedure – Videos

Treatment of cervical intraepithelial neoplasia Treatment by cryotherapy

Cryosurgical unit Ancillary instruments and consumables Steps Side-effects and complications Post-treatment advice and follow-up Procedure video

Treatment by thermal ablation

The benchtop model The battery-operated model Complications Procedure video

Treatment by LLETZ (LEEP)

Instruments and consumables Steps Direction of cutting: from below upwards Direction of cutting: from one side to the other Side-effects and complications Post treatment advice and follow-up Type 1 excision video Type 2 excision video Type 3 excision video

Treatment by cold-knife conization (CKC)

Instruments Instruments Steps Side effects and complications Procedure video

Cases

Normal

Normal Atrophy Changes in pregnancy

Squamous metaplasia and ectropion

Ectropion Metaplasia

Inflammation and cervicitis

Candidiasis Trichomonas vaginalis Inflammation

Low grade High grade Early and advanced cancers

Squamous cell cancer Adenocarcinoma

Miscellaneous

Cervical polyp Condyloma Congenital transformation zone Leukoplakia Stenosis of cervix

Post treatment

Post-LLETZ Post-cryotherapy Post-radiation changes

Search with IFCPC criteria Search with Swede score criteria

Quiz Foreword Acknowledgement Authors Suggested citation

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Atlas of Colposcopy: Principles and Practice

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Documentation of colposcopic findings

The colposcopic findings should be documented using the nomenclature of the International Federation of Cervical Pathology and Colposcopy (2011 IFCPC nomenclature):

A diagrammatic representation of the colposcopic findings should be made, as shown below:

Draw two concentric circles.
The outer circle represents the boundary of the cervix, and the inner circle represents the external os.
The circle is divided into four quadrants by two perpendicular lines.
Draw the lesion, showing its position in relation to the quadrants and the external os.
The following legends are used as applicable: AW, acetowhite; P, punctation; M, mosaic; AV, abnormal vessels; I, iodine-negative.
The site of biopsy is marked by an “x”.

The Swede score should be calculated based on the following five characteristics:

Swede score (minimum, 0; maximum, 10):

Total score 0–4: normal/CIN1
Total score 5–6: CIN2/CIN3
Total score 7–10: CIN3/cancer.

Finally, a provisional diagnosis should be made from any of the following categories:

normal
condyloma/subclinical papillomavirus infection (SPI)
low-grade squamous intraepithelial lesion (LSIL)
high-grade squamous intraepithelial lesion (HSIL)
adenocarcinoma in situ
squamous cell cancer
adenocarcinoma
other.

The details of how to diagnose these individual conditions are discussed in subsequent sections.

Record the information in the appropriate colposcopy form.