Atlas of Colposcopy: Principles and Practice

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High grade / CIN2 / CIN3
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  • Age: 34
  • HPV status: Positive

  • Speculum examination

    After normal saline

    After normal saline with green filter

    After acetic acid

    After acetic acid

    After acetic acid with higher magnification

    After acetic acid

    After Lugol’s iodine

    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)


    Suspicious for invasion

    Miscellaneous finding

    Swede score:

    Swede score
    Aceto uptake
    Nil or transparentThin, milkyDistinct, stearin
    Nil or diffuseSharp but irregular, jagged, satellitesSharp and even, difference in level
    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: 9

    Case Summary
    Provisional diagnosis: Type 1 transformation zone; high-grade squamous intraepithelial lesion (HSIL) in pregnancy.
    Management: Multiple punch biopsies obtained from the posterior lip and also from the extension of the lesion to the vaginal wall.
    Histopathology: HSIL-CIN3.
    Comment: The posterior lip had a large high-grade lesion that extended to the vagina. Biopsies were obtained to exclude invasive cancer. The anterior lip had a thin acetowhite area with indistinct margin that suggests metaplastic changes. The patient had LLETZ 2 months after normal delivery. The lesion was less extensive at that time. Sometimes apparently high-grade lesions in pregnancy may resolve completely after delivery. A repeat colposcopy 2–3 months after delivery is essential before making any decision about treatment.

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