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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Abnormal colposcopic findings – Grade 2 (major) changes

The grade 2 or major changes indicate the presence of high-grade lesions and may include any of the following features.

Dense acetowhite epithelium: A distinct dense and opaque white area after application of acetic acid is suggestive of HSIL (CIN2 or CIN 3). The colour is typically “oyster white” or greyish white. The dense, thick acetowhite area is also known as stearin (fat in its solid form) in the Swede scoring system.

Rapid appearance of acetowhitening: It is important for the colposcopist to note real-time changes while applying acetic acid to the cervix. If the white patch appears within a few seconds of application of acetic acid and persists for a long time, the acetowhite patch is most likely due to CIN2/CIN3 or invasive cancer. In contrast, a white patch that appears slowly and disappears rapidly is usually due to a non-neoplastic condition or low-grade lesion.

Cuffed crypt (gland) opening: A normal crypt opening appears as a black dot surrounded by a thin acetowhite rim in the transformation zone. If the crypt opening is large and the acetowhite rim is dense white and is raised from the surface (like a doughnut), it is called a cuffed crypt opening. Such a cuffed crypt opening is usually located in the dense acetowhite area but may also be isolated. A cuffed crypt opening indicates extension of the neoplasia inside the crypt, which occurs in high-grade lesions only.

Coarse mosaic: In coarse mosaic patterns, the blood vessels are prominent, irregular in calibre, and unevenly spaced. The blood vessels may not be traced completely and are lost in places (“broken” or “open” mosaics). Coarse mosaic is a hallmark of high-grade or invasive lesions. Coarse mosaic patterns are more clearly visible after the effect of the acetic acid wears off.

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