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Atlas of Colposcopy: Principles and Practice

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High grade / CIN2 / CIN3
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  • Age: 52
  • HPV status: Positive


  • Speculum examination

    After normal saline

    After acetic acid

    Examination with endocervical speculum

    Colposcopy report (2011 IFCPC nomenclature):
    / Post-treatment consequence / Endometriosis

    General assessment
  • Adequacy:
  • Squamocolumnar junction visibility:
  • Transformation zone:

  • Normal colposcopic findings
  • Original squamous epithelium:
  • Columnar epithelium:
  • Metaplastic squamous epithelium:
  • Deciduosis in pregnancy:

  • Abnormal colposcopic findings
    General principles
    Position and size
  • Location of the lesion:
  • Location of the lesion by clock position:
  • No. of quadrants:
  • % of cervix:

  • Grade 1 (minor)

    Grade 2 (major)

    Non-specific

    Suspicious for invasion

    Miscellaneous finding



    Swede score:

    Swede score
    0
    1
    2
    Aceto uptake
    Nil or transparentThin, milkyDistinct, stearin
    Margins
    Nil or diffuseSharp but irregular, jagged, satellitesSharp and even, difference in level
    Vessels
    Fine, regularAbsentCoarse or atypical vessels
    Lesion size
    < 5 mm5-15 mm or 2 quadrants>15 mm, 3-4 quadrants, or endocervically undefined
    Iodine uptake
    BrownFaintly or patchy yellowDistinctly yellow
    Final Swede score: Not possible (Iodine uptake missing)



    Case Summary
    Provisional diagnosis: Type 3 transformation zone; high-grade squamous intraepithelial lesion (HSIL).
     
    Management: LLETZ (type 3 excision).
     
    Histopathology: HSIL-CIN2.
     
    Comment: Obtaining a punch biopsy in such a case is quite difficult and unreliable. LLETZ based on colposcopy findings (“see and treat”) is both diagnostic and therapeutic in this case.


      
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