1. Colposcopy
Today
Dr. Sharda Jain (DGF)

2. Cervical Cancer Screening
• Concept of cervical cancer screening& down staging
• Why Colposcopy ?
• Uses / Indications
• Method of Colposcopy
• Normal Colposcopy
• Abnormal; Colposcopy

3. Cervical Cancer Screening
No. 1 cancer in women
in India.

4. Cancer Cervix –
a Global Paradox
• Cancer cervix –100% Preventable Disease
WHO
• Cancer cervix –Death by Incompetence
Lancet
• Cancer cervix – The Unmet Challenge

5. System Failures Leading to
Cervical Cancer Diagnosis
Women do not
come in for
screening
Health care providers
do not screen women
at visits
Colposcopy for
abnormal screen
not done
Patient does not get
appropriate therapy
Patient gets cervical
cancer
Courtesy of Connie Trimble, MD, Johns Hopkins University School of Medicine, Baltimore, MD

6. Every HPV + Case does not become cancer

7. Disease Progression

8. Natural History of CIN lesions
Ostor 93
Regression % Persistence
%
Progression
to CIS %
Progression
to invasion
%
CIN 1 60 30 11 1
CIN 2 40 30 22 5
CIN 3 30 <60 - Over 12

10. Accessibility of CERVIX……..
• seen instantly after putting speculum inside the vagina
and becomes apparent.
• The success of colposcopy lies in visualising the
cervical epithelia in the region of transformation zone
in its entirely.

11. Indications for COLPOSCOPY….
• Abnormal PAP Smear
• Evaluation & treatment of CIN
• Bleeding- post coital
- Postmenopausal
- Menorrhagia
• Persistent vaginal discharge
• Long standing foul smelling vaginal discharge
• Unhealthy Cervix
• HPV positive / external vulval warts
• Evaluation of sexual assault Victims

12. Benefits of Colposcopy…….
• Non invasive, no anaethesia for pain
• Helps in precise examination of cervix and TZ
• Guide to locate the biopsy, improve accuracy of
early diagnosis
• Reduce over-treatment
• Easy for follow up
• This is an outpatient procedure
• It takes only a few minutes

13. Pap Smear Abnormalities
• SQUAMOUSE CELL
- Atypical squamouse cells (ASC)
of understand Significance (ASC – US)
Cannot exclude HSIL (ASC- H)
- Low – grade squamouse intraepithelial lesion (LSIL)
- High – grade squamouse intraepithelial lesion (HSIL)
• GLANDULAR CELL
Atypical glandular cells (AGC)
Endocervical adenocarcinoma in situ (AIS)
Adenocarcinoma
Solomon , 2002

15. FIGO Recommendation for management
of abnormal smear

16. COLPOSCOPY
PROCEDURE

17. PATIENT POSITION
Lithotomy
Position
Consent
Time

19. Instruments Need for Colposcopy
• COLPOSCOPY
• Self retaining specula
• Endo Cervical speculum
• Punch biopsy forceps
• Polyp forceps
• Poly forceps
• Diathermy loop
• Ayre’s spatula
• Cotton tipped applicators
• Tampon
• Normal saline
• 2% acetic acid
• Lugol’s iodine
• Cytology fixative – 95% alcohol
• 10% formalin
Endo Cervical curette, Speculum
Cervical Biopsy forceps

20. STEPS FOR PERFORMING VIDEO
COLPOSCOPY….
• Normal Inspection after cleaning with normal saline
• Inspection through Green filter
• Inspection after application of Acetic Acid 3%
White Vinegar
• Inspection after application of Lugols Iodine
Stains mature sqa epi- dark Brown
• Examination of Vagina
• Directed Biopsy.

21. COLPOSCOPY DIRECTED
• Biopsy forceps: Punch biopsy forcep is preferred
• Tissue specimen is sent to Lab for testing further.

22. Endo- Cervical Sampling by Curettage
• ECC is needed if Colposcopy is unsatisfactory
• Initial glandular cell abnormalities
• Ablative treatment if plan

24. SCREENING COLPOSCOPY
PORTABLE COLPOSCOPY
Part of
SEE (VIA & VILI) AND TREAT PROGRAMME

26. Diagrammatic Representation of
Colposcopy Finding is Must
• Normal
• Ectopy
• Zone of transformation
• Nebothian Cyst
• Picture
• Leukoplakia
• Punatation
• Mosaic
• Atypical
transformation Zone
• Erosion vera
• Atypical Vessels
ODELLS DIAGRAM Hammomds

27. Normal Colposcopy
• Original Squamous epithelium
• Columnar epithelium
• Normal transformation Zone

29. TZ lies between the
original squamo-columner
junction and the new (or the
present ) squamo-columner
junction. This is a
highly active zone of
metaplastic tissues
in which the single layered
columnar epithelium is
transformed by metaplastic
cellular divisions into
multilayered squamous
epithelium.

30. Type 2 TZ
• Eversion of
columnar epi

31. Satisfactory Colposcopy
Adequate Visualization entire
cervical SCJ & transformation Zone
Type – 3 TZ
unsatisfactory Colposcopy

32. NYBOTHIAN
FOLLICLE

33. Abnormal Colposcopy

34. NORMAL INSPECTION AFTER CLEANING
WITH NORMAL SALINE….

35. VIEW WITH GREEN FILTER
• For vascular pattern of cervix.
• This absorbs the red color and makes the
appearance of blood vessels black
• Black blood vessels can be viewed clearly.

36. Iodine Negative

37. GRADE 3
AW
Dull Oyster White, Grey

38. Aceto white lesion
• Intensity
• Duration of stay
• speed of Appearance
• speed of disappearance
• margins Relation to SCJ
Inside TZ/ outside TZ

39. Mustard yellow

40. Vascular Pattern In Abnormal Epithelium…
Mosaic
Fine
Coarse
A typical
Vessels
CorkScrew
Irregular Caliber
Irregular branching
Punctuations
Fine
Coarse

41. Punctations

42. PUNCTATION

43. MOSAIC

44. Coarse mosaic
and coarse
punctations

45. COARSE MOSAIC, ICD

46. Carcinoma of the Cervix

47. KERATOSIS
CANCER

49. SCORING SYSTEM FOR MODIFIED READ INDEX

50. GRADING SYSTEM OF BURKE AND COWORKER

51. MISCELLANEOUS
CATEGORY

52. A Typical Infectious CERVIX….

53. Thank You
&