Colposcopy Today Practical Approach !! Dr. Sharda Jain , Dr. Jyoti Agarwal dr. Jyoti Bhaskar Lifecare Centre

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  • 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
  • 9. 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.
  • 10. 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
  • 11. 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
  • 12. 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
  • 13. FIGO Recommendation for management of abnormal smear
  • 14. COLPOSCOPY PROCEDURE
  • 15. PATIENT POSITION Lithotomy Position Consent Time
  • 16. 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
  • 17. 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.
  • 18. COLPOSCOPY DIRECTED • Biopsy forceps: Punch biopsy forcep is preferred • Tissue specimen is sent to Lab for testing further.
  • 19. Endo- Cervical Sampling by Curettage • ECC is needed if Colposcopy is unsatisfactory • Initial glandular cell abnormalities • Ablative treatment if plan
  • 20. SCREENING COLPOSCOPY PORTABLE COLPOSCOPY Part of SEE (VIA & VILI) AND TREAT PROGRAMME
  • 21. 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
  • 22. Normal Colposcopy • Original Squamous epithelium • Columnar epithelium • Normal transformation Zone
  • 23. 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.
  • 24. Type 2 TZ • Eversion of columnar epi
  • 25. Satisfactory Colposcopy Adequate Visualization entire cervical SCJ & transformation Zone Type – 3 TZ unsatisfactory Colposcopy
  • 26. NYBOTHIAN FOLLICLE
  • 27. Abnormal Colposcopy
  • 28. NORMAL INSPECTION AFTER CLEANING WITH NORMAL SALINE….
  • 29. 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.
  • 30. Iodine Negative
  • 31. GRADE 3 AW Dull Oyster White, Grey
  • 32. Aceto white lesion • Intensity • Duration of stay • speed of Appearance • speed of disappearance • margins Relation to SCJ Inside TZ/ outside TZ
  • 33. Mustard yellow
  • 34. Vascular Pattern In Abnormal Epithelium… Mosaic Fine Coarse A typical Vessels CorkScrew Irregular Caliber Irregular branching Punctuations Fine Coarse
  • 35. Punctations
  • 36. PUNCTATION
  • 37. MOSAIC
  • 38. Coarse mosaic and coarse punctations
  • 39. COARSE MOSAIC, ICD
  • 40. Carcinoma of the Cervix
  • 41. KERATOSIS CANCER
  • 42. SCORING SYSTEM FOR MODIFIED READ INDEX
  • 43. GRADING SYSTEM OF BURKE AND COWORKER
  • 44. MISCELLANEOUS CATEGORY
  • 45. A Typical Infectious CERVIX….
  • 46. Thank You &