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COLPOSCOPY:
technical execution and results
What is Colposcopy ?
A colposcopy is a procedure that allows a physician to examine a vulva, vagina and cervix. This is executed by a colposcope, an instrument that shines the cervix and magnifies the tissue being inspected.
This methodical, devised in the 1924 from the German gynecologist Hans Hinselmann, was made to evidence the most premature shapes of carcinoma of the uterine cervix, in a still symptomless stage and invisibile without help. Subsequently, with the knowledge's evolution of the natural history of the cervicocarcinoma, the Colposcopy tried to study all the stages of the precancerouse lesions (dysplasias), lesions with possible evolution from normality until frankly neoplastic condition.
When a Pap-test marks the presence of atypical cells, for example a Dysplasia or C.I.N. ( Cervical Intraepithelial Neoplasia), the Colposcopy has to estimate the vaginal walls and the uterine cervix, eventually to confirm the existence of atypical images, their exact localization and extension.
Localization of the lesions is indispensable to execute one or more biopsies under colposcopic guide that they will carry to a precise hystological diagnosis. The Colposcopy has an important role in supplying indications about the adapted modality of surgical treatment in single case.
Colposcopy: technical execution
- Direct colposcopic observation
- Colposcopic observation after acetic acid application
- Colposcopic observation after application of iodine solution of Lugol (Shiller test)
Colposcopy: report and classification
The aim of Colposcopy is to estimate the squamous epithelium of the uterine cervix and of the vaginal walls, and the cylindrical or glandular epithelium of the endocervix (where is possible), and the squamocolumnar junction (point of passage between two epithelia). Considered that the dysplastic lesions more frequently are localized in proximity of the junction, it is of extreme importance the appraisal of this last one. In fact it defined unsatisfactory the colposcopic examination that does not succeed to estimate the squamocolumnar junction. That can happen not necessarily for pathological reasons; as an example it can happen in the woman in postmenopause (for effect of a narrowing of the neck), or in the woman that have never delivery, or in the woman that have had surgical operations (to es. conization) on the neck of the uterus, with consequent scar. Estimated the junction, on observe the characteristics of the esocervical squamous epithelium and therefore the cylindrical epithelium in the beginning of the cervical channel (at least where it is possible). On these superficial ones the presence of eventual images is observed that can be in relation to dysplasic lesions or viral kind. In fact they are often associated to the dysplasic lesions of the meaningful images of possible viral infections, due to the HPV (Human Papilloma Virus or virus of the condylomas). The localization of such lesions is an indispensable premise tu execute an aimed biopsy (when necessary) and in order to estimate the more opportune modalities of treatment. In order to concur an interpretation homogeneity, the results of the colposcopic examination are described by a classification currently shared from all gynecologist (Classification Barcelona 2002), and brought back on an appropriate card that comprises also a design of the neck of the uterus, on which to represent with an appropriate image the result of the examination.
IFCPC COLPOSCOPIC CLASSIFICATION (Barcelona 2002)
I. Normal colposcopic findings.
Original squamous epithelium
Columnar epithelium
The transformation zone
II. Abnormal colposcopic findings
Acetowhite epithelium (flat or dense)
Punctation (fine or coarse)
Mosaic (fine or coarse)
Iodine Negativity
Atypical Vessels
III. Colposcopic findings suggestive of invasive cancer
Irregular surface. Erosion or Ulceration
Dense Acetowhite Change.
Wide Irregular Punctation and Mosaic.
Abnormal Vessels.
IV. Unsatisfactory colposcopy
An unsatisfactory colposcopy examination occurs when the squamocolumnar junction cannot be visualised. It may also occur if
associated trauma, inflammation, or atrophy preclude a full colposcopic assessment, or when the cervix is not
visible.
V. Miscellaneous findings
Condylomata
Keratosis
Erosion
Inflammation
Atrophy
Deciduosis
Polyps
I. Normal colposcopic findings.
Original squamous epithelium
Columnar epithelium
The transformation zone
II. Abnormal colposcopic findings
Acetowhite epithelium (flat or dense)
Punctation (fine or coarse)
Mosaic (fine or coarse)
Iodine Negativity
Atypical Vessels
III. Colposcopic findings suggestive of invasive cancer
Irregular surface. Erosion or Ulceration
Dense Acetowhite Change.
Wide Irregular Punctation and Mosaic.
Abnormal Vessels.
IV. Unsatisfactory colposcopy
An unsatisfactory colposcopy examination occurs when the squamocolumnar junction cannot be visualised. It may also occur if
associated trauma, inflammation, or atrophy preclude a full colposcopic assessment, or when the cervix is not
visible.
V. Miscellaneous findings
Condylomata
Keratosis
Erosion
Inflammation
Atrophy
Deciduosis
Polyps
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