Colposcopy
Today
Dr. Sharda Jain (DGF)
Cervical Cancer Screening
• Concept of cervical cancer screening& down staging
• Why Colposcopy ?
• Uses / Indications
• M...
Cervical Cancer Screening
No. 1 cancer in women
in India.
Cancer Cervix –
a Global Paradox
• Cancer cervix –100% Preventable Disease
WHO
• Cancer cervix –Death by Incompetence
Lanc...
System Failures Leading to
Cervical Cancer Diagnosis
Women do not
come in for
screening
Health care providers
do not scree...
Every HPV + Case does not become cancer
Disease Progression
Natural History of CIN lesions
Ostor 93
Regression % Persistence
%
Progression
to CIS %
Progression
to invasion
%
CIN 1 60...
Accessibility of CERVIX……..
• seen instantly after putting speculum inside the vagina
and becomes apparent.
• The success ...
Indications for COLPOSCOPY….
• Abnormal PAP Smear
• Evaluation & treatment of CIN
• Bleeding- post coital
- Postmenopausal...
Benefits of Colposcopy…….
• Non invasive, no anaethesia for pain
• Helps in precise examination of cervix and TZ
• Guide t...
Pap Smear Abnormalities
• SQUAMOUSE CELL
- Atypical squamouse cells (ASC)
of understand Significance (ASC – US)
Cannot exc...
FIGO Recommendation for management
of abnormal smear
COLPOSCOPY
PROCEDURE
PATIENT POSITION
Lithotomy
Position
Consent
Time
Instruments Need for Colposcopy
• COLPOSCOPY
• Self retaining specula
• Endo Cervical speculum
• Punch biopsy forceps
• Po...
STEPS FOR PERFORMING VIDEO
COLPOSCOPY….
• Normal Inspection after cleaning with normal saline
• Inspection through Green f...
COLPOSCOPY DIRECTED
• Biopsy forceps: Punch biopsy forcep is preferred
• Tissue specimen is sent to Lab for testing furthe...
Endo- Cervical Sampling by Curettage
• ECC is needed if Colposcopy is unsatisfactory
• Initial glandular cell abnormalitie...
SCREENING COLPOSCOPY
PORTABLE COLPOSCOPY
Part of
SEE (VIA & VILI) AND TREAT PROGRAMME
Diagrammatic Representation of
Colposcopy Finding is Must
• Normal
• Ectopy
• Zone of transformation
• Nebothian Cyst
• Pi...
Normal Colposcopy
• Original Squamous epithelium
• Columnar epithelium
• Normal transformation Zone
TZ lies between the
original squamo-columner
junction and the new (or the
present ) squamo-columner
junction. This is a
hi...
Type 2 TZ
• Eversion of
columnar epi
Satisfactory Colposcopy
Adequate Visualization entire
cervical SCJ & transformation Zone
Type – 3 TZ
unsatisfactory Colpos...
NYBOTHIAN
FOLLICLE
Abnormal Colposcopy
NORMAL INSPECTION AFTER CLEANING
WITH NORMAL SALINE….
VIEW WITH GREEN FILTER
• For vascular pattern of cervix.
• This absorbs the red color and makes the
appearance of blood ve...
Iodine Negative
GRADE 3
AW
Dull Oyster White, Grey
Aceto white lesion
• Intensity
• Duration of stay
• speed of Appearance
• speed of disappearance
• margins Relation to SCJ...
Mustard yellow
Vascular Pattern In Abnormal Epithelium…
Mosaic
Fine
Coarse
A typical
Vessels
CorkScrew
Irregular Caliber
Irregular branch...
Punctations
PUNCTATION
MOSAIC
Coarse mosaic
and coarse
punctations
COARSE MOSAIC, ICD
Carcinoma of the Cervix
KERATOSIS
CANCER
SCORING SYSTEM FOR MODIFIED READ INDEX
GRADING SYSTEM OF BURKE AND COWORKER
MISCELLANEOUS
CATEGORY
A Typical Infectious CERVIX….
Thank You
&
Colposcopy Today Practical Approach !! Dr. Sharda Jain , Dr. Jyoti Agarwal dr. Jyoti Bhaskar Lifecare Centre
Colposcopy Today Practical Approach !! Dr. Sharda Jain , Dr. Jyoti Agarwal dr. Jyoti Bhaskar Lifecare Centre
Colposcopy Today Practical Approach !! Dr. Sharda Jain , Dr. Jyoti Agarwal dr. Jyoti Bhaskar Lifecare Centre
Colposcopy Today Practical Approach !! Dr. Sharda Jain , Dr. Jyoti Agarwal dr. Jyoti Bhaskar Lifecare Centre
Colposcopy Today Practical Approach !! Dr. Sharda Jain , Dr. Jyoti Agarwal dr. Jyoti Bhaskar Lifecare Centre
Colposcopy Today Practical Approach !! Dr. Sharda Jain , Dr. Jyoti Agarwal dr. Jyoti Bhaskar Lifecare Centre
Colposcopy Today Practical Approach !! Dr. Sharda Jain , Dr. Jyoti Agarwal dr. Jyoti Bhaskar Lifecare Centre
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Colposcopy Today Practical Approach !! Dr. Sharda Jain , Dr. Jyoti Agarwal dr. Jyoti Bhaskar Lifecare Centre

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

  1. 1. Colposcopy Today Dr. Sharda Jain (DGF)
  2. 2. Cervical Cancer Screening • Concept of cervical cancer screening& down staging • Why Colposcopy ? • Uses / Indications • Method of Colposcopy • Normal Colposcopy • Abnormal; Colposcopy
  3. 3. Cervical Cancer Screening No. 1 cancer in women in India.
  4. 4. Cancer Cervix – a Global Paradox • Cancer cervix –100% Preventable Disease WHO • Cancer cervix –Death by Incompetence Lancet • Cancer cervix – The Unmet Challenge
  5. 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. 6. Every HPV + Case does not become cancer
  7. 7. Disease Progression
  8. 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. 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. 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. 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. 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. 13. FIGO Recommendation for management of abnormal smear
  14. 14. COLPOSCOPY PROCEDURE
  15. 15. PATIENT POSITION Lithotomy Position Consent Time
  16. 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. 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. 18. COLPOSCOPY DIRECTED • Biopsy forceps: Punch biopsy forcep is preferred • Tissue specimen is sent to Lab for testing further.
  19. 19. Endo- Cervical Sampling by Curettage • ECC is needed if Colposcopy is unsatisfactory • Initial glandular cell abnormalities • Ablative treatment if plan
  20. 20. SCREENING COLPOSCOPY PORTABLE COLPOSCOPY Part of SEE (VIA & VILI) AND TREAT PROGRAMME
  21. 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. 22. Normal Colposcopy • Original Squamous epithelium • Columnar epithelium • Normal transformation Zone
  23. 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. 24. Type 2 TZ • Eversion of columnar epi
  25. 25. Satisfactory Colposcopy Adequate Visualization entire cervical SCJ & transformation Zone Type – 3 TZ unsatisfactory Colposcopy
  26. 26. NYBOTHIAN FOLLICLE
  27. 27. Abnormal Colposcopy
  28. 28. NORMAL INSPECTION AFTER CLEANING WITH NORMAL SALINE….
  29. 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. 30. Iodine Negative
  31. 31. GRADE 3 AW Dull Oyster White, Grey
  32. 32. Aceto white lesion • Intensity • Duration of stay • speed of Appearance • speed of disappearance • margins Relation to SCJ Inside TZ/ outside TZ
  33. 33. Mustard yellow
  34. 34. Vascular Pattern In Abnormal Epithelium… Mosaic Fine Coarse A typical Vessels CorkScrew Irregular Caliber Irregular branching Punctuations Fine Coarse
  35. 35. Punctations
  36. 36. PUNCTATION
  37. 37. MOSAIC
  38. 38. Coarse mosaic and coarse punctations
  39. 39. COARSE MOSAIC, ICD
  40. 40. Carcinoma of the Cervix
  41. 41. KERATOSIS CANCER
  42. 42. SCORING SYSTEM FOR MODIFIED READ INDEX
  43. 43. GRADING SYSTEM OF BURKE AND COWORKER
  44. 44. MISCELLANEOUS CATEGORY
  45. 45. A Typical Infectious CERVIX….
  46. 46. Thank You &

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