2 prof walter culture

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2 prof walter culture

  1. 1. IFCPC Symposium IPV Meeting Berlin September 2011
  2. 2. The new IFCPC Nomenclature
  3. 3. Normal findings
  4. 4. General Assessment • Adequate or not (inflammation, bleeding, fibrosis etc • Squamo-columnar junction visible fully, partially or not • Transformation zone Type is 1 or 2 or 3, as before
  5. 5. Abnormal colposcopic findings general principles • Location of the lesion – Inside or outside the TZ – At which position (Clockface) • Size of the lesion – Percentage of the cervical surface – Number of quadrants
  6. 6. Grade 1 or minor lesions • Thin aceto-white epithelium • Irregular geographical border • Fine mosaic • Fine punctation
  7. 7. Grade 2 or major lesions • Dense aceto-white epitheilium • Rapid aceto uptake • Cuffed crypt openings • Coarse mosaic or punctate vessels • Sharp borders • Inner border sign • Ridge sign
  8. 8. Non specific • Leukoplakia (keratosis, hyperkeratosis), “erosion” • Lugol’s iodine uptake or Schiller’s test – Stained – Unstained – Partially stained
  9. 9. Suspicious for invasion • Atypical vessels • Fragile vessels, irregular surface, exophytic lesion, necrosis, ulcertation (necrosis) tumour or gross neoplasm
  10. 10. Miscellaneous findings • The congenital transformation Zone • Condyloma, polyp, endo or ecto cervical • Inflammation • Stenosis • Congenital anomaly • Post treatment consequences • Endometriosis
  11. 11. The Transformation Zone • Types 1,2 and 3 as before • Now types 1,2 and 3 excision types – So much confusion in terminology in the literature – Dimensions in publications not standard – Little evidence for effect of excision extent
  12. 12. Type I TZ Type II TZ Type III TZ • completely ectocervical • fully visible • can be small or large • has some endocervical component • fully visible • ectocervical component may be small or large • has endocervical component • not fully visible • ectocervical component may be small or large
  13. 13. Excision specimen dimensions
  14. 14. Thickness of specimen Length of specimen Perimeter of specimen The dimensions of the Excised T Z specimen
  15. 15. Thickness = surface to stromal margin Length = endo to ectocervical margin Circumference = A to B of opened specimen Endoce mar Ect Surface Margin Stromal margin A
  16. 16. Proposal for excised TZ dimensions nomenclature • The distance from the surface to the stromal margin is the thickness of the specimen • The distance from the endocervical to ectocervical margin is the length
  17. 17. Proposal to classify TZ excisional treatment • Type 1 Excision (large or small) – Excision of an ectocervical TZ • Type 2 Excision (large or small) – Excision of a type 2 TZ • Type 3 Excision (large or small) – Excision of a type 3 TZ – Excision of suspected CGIN or micro or for a previously incomplete excision
  18. 18. Type 1 Excision •Excision pathway •Upper limit of visibility
  19. 19. •Path of excision •Upper limit of visibility Type 2 Excision
  20. 20. Type 3 Excision •Upper limit visibility •Excision path
  21. 21. Type 3 Excision •Excision path a b Volume and thickness of excised TZ is predictive of premature labour
  22. 22. Conclusion • Simple nomenclature system • Will be adding – Image correlation – Vulvar and vaginal nomenclature • Publication imminent

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