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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Treatment by cryotherapy – Steps

Counsel the woman, and obtain informed consent.
Colposcopically re-evaluate the lesion and ensure that:

The lesion is completely ectocervical, with a type 1 TZ.
The lesion does not extend to more than 75% of the cervix.
The lesion can be fully covered by the largest cryotip.
The lesion does not have any features suspicious of cancer.

Remove the colposcope, and use a focusing light for the procedure.
No anaesthesia is required for cryotherapy.
Select a probe with a tip of the appropriate diameter that will cover the lesion completely. Attach the probe to the handle grip (cryogun).
Connect the valve with the pressure gauge to the gas cylinder. The pressure of the gas cylinder should be 40–70 kg/cm² when the gas is flowing (indicator in the green zone).
Wipe the cryotip with saline or lubricant, to ensure adequate thermal contact.
Apply the probe tip firmly to the cervix with the centre of the tip on the external os.
Check that the vaginal walls are not touching the probe tip.
Press the trigger on the handgrip so that gas starts flowing, and start the timer.
Check for the formation of ice at the tip of the probe.

Release the trigger after 3 minutes, when you will see an ice ball formed over the cervix extending 4–5 mm beyond the edge of the tip.
If the ice ball has formed adequately, the probe tip will remain stuck to the cervix.

Wait for 5 minutes for thawing, when the ice will melt and the probe may detach from the cervix.
Reapply the probe at the same place as before, and freeze the cervix for another 3 minutes.
Release the trigger and wait until the ice melts and the probe detaches from the cervix on its own.
The cervix will have a white crater, which indicates that the cervix is properly frozen.

Remove the speculum gently.
Ask the woman to continue lying down for 5 minutes before letting her getting up.
Counsel the woman, and give appropriate follow-up advice.

For additional information, please refer to WHO technical specifications: cryosurgical equipment for the treatment of precancerous cervical lesions and prevention of cervical cancer.