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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
Home
Atlas of Colposcopy: Principles and Practice
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Quiz
Age:
54
HPV status:
Positive
After normal saline
After acetic acid
Visualization of the SCJ
After acetic acid with green filter
After Lugol’s iodine
Colposcopy report (2011 IFCPC nomenclature):
IFCPC nomenclature:
- General assessment:
Adequacy:
----
Adequate
Inadequate
Squamo-columnar junction visibility:
----
Completely visible
Partially visible
Not visible
Transformation zone:
----
Type 1
Type 2
Type 3
- Normal colposcopic findings:
Original squamous epithelium:
----
Mature
Atrophic
Columnar epithelium:
----
Ectopy absent
Ectopy present
Metaplastic squamous epithelium:
----
Nabothian cysts
Crypt (gland) openings
Nabothian cysts and Crypt (gland) openings
Deciduosis in pregnancy:
----
Not applicable
No
Yes
- Abnormal colposcopy findings:
- General principles:
- Position and size:
Location of the lesion:
----
Inside the T-zone
Outside the T-zone
Inside and outside the T-zone
On polyp
Location of the lesion by clock position:
----
01 o'clock
02 o'clock
02-06 o'clock
03 o'clock
03-07 o'clock
03-08 o'clock
03-09 o'clock
03-10 o'clock
04 o'clock
04-06 o'clock
04-07 o'clock
04-08 o?clock
04-09 o'clock
04-10 o'clock
05 o'clock
05-08 o'clock
06 & 08 o'clock
06 o'clock
06-08 o'clock
07 o'clock
07-04 o'clock
07-09 o'clock
07-10 o'clock
08 o'clock
08-02 o'clock
09 o'clock
10 o'clock
10-02 o'clock
11 o'clock
11-01 o?clock
11-02 o?clock
11-12 o'clock
12 o'clock
12-01 o'clock
All around
Endocervical
Inside canal
on polyp
No of quadrants:
----
1
2
3
4
On polyp
Inside canal
% cervix:
----
< 25%
25-50%
50-75%
> 75%
Inside canal
On polyp
- Grade 1 (minor):
Thin acetowhite epithelium:
----
Not applicable
No
Yes
Irregular border:
----
Not applicable
No
Yes
Geographic border:
----
Not applicable
No
Yes
Fine mosaic:
----
Not applicable
No
Yes
Fine punctation:
----
Not applicable
No
Yes
- Grade 2 (major):
Dense acetowhite epithelium:
----
Not applicable
No
Yes
Rapid appearance of acetowhite:
----
Not applicable
No
Yes
Cuffed crypt (gland) openings:
----
Not applicable
No
Yes
Coarse mosaic:
----
Not applicable
No
Yes
Coarse punctuation:
----
Not applicable
No
Yes
Sharp border:
----
Not applicable
No
Yes
Inner border sign:
----
Not applicable
No
Yes
Ridge sign:
----
Not applicable
No
Yes
Rag sign:
----
Not applicable
No
Yes
- Non specific:
Leukoplakia:
----
Not applicable
No
Yes
Erosion:
----
Not applicable
No
Yes
Lugol iodine:
----
Not applicable
No
Iodine (non-stained)
Iodine (stained)
- Suspicious for invasion:
Atypical vessels:
----
Not applicable
No
Yes
Fragile vessels:
----
Not applicable
No
Yes
Irregular surface:
----
Not applicable
No
Yes
Exophytic lesions:
----
Not applicable
No
Yes
Necrosis:
----
Not applicable
No
Yes
Ulceration (necrotic):
----
Not applicable
No
Yes
Tumor, gross neoplasm:
----
Not applicable
No
Yes
Miscellaneous finding:
Congenital transformation zone:
----
Not applicable
No
Yes
Condyloma:
----
Not applicable
No
Yes
Polyp:
----
Not applicable
No
Yes
Inflammation:
----
Not applicable
No
Yes
Stenosis:
----
Not applicable
No
Yes
Congenital anomaly:
----
Not applicable
No
Yes
Post treatment consequence:
----
Not applicable
No
Yes
Endometriosis:
----
Not applicable
No
Yes
Swede Score Search Criteria:
Aceto uptake score:
----
0 - Nil or transparent
1 - Thin, milky
2 - Distinct, stearin
Margins score:
----
0 - Nil or diffuse
1 - Sharp but irregular, jagged, satellites
2 - Sharp & even, difference in level
Vessels score:
----
0 - Fine, regular
1 - Absent
2 - Coarse or atypical vessels
Lesion size score:
----
0 - < 5 mm
1 - 5-15 mm or 2 quadrants
2 - >15 mm, 3-4 quadrants, or endocervically undefined
Iodine uptake score:
----
0 - Brown
1 - Faintly or patchy yellow
2 - Distinctly yellow
Final Swede score:
----
00
01
02
03
04
05
06
07
08
09
10
99
Case summary:
Provisional diagnosis:
----
Early and advanced cancers - Adenocarcinoma
Early and advanced cancers - Squamous cell cancer
Ectropion
High grade / CIN 2-3
High grade / CIN2-3
Inflammation - Candidiasis
Inflammation - other
Inflammation - Trichomonas vaginalis
Low grade / CIN 1
Low grade / CIN1
Metaplasia
Miscellaneous - Cervical polyp
Miscellaneous - Condyloma
Miscellaneous - Congenital transformation zone
Miscellaneous - Leukoplakia
Miscellaneous - Stenosis of cervix
Normal
Normal - Atrophy
Normal - with pregnancy induced change
Post-treatment
Management:
----
LLETZ
Multiple punch biopsy
Punch biopsy
Punch biopsy and cryotherapy
Punch biopsy or LLETZ
Repeat colposcopy 2 months after delivery
Repeat HPV test/colposcopy after 1 year
Routine screening after 5 years
Syndromic management of infection and routine screening after 5 years.
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