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An Introduction to Colposcopy Grothuesmann
The document provides an overview of colposcopy as a secondary cervical cancer prevention method, detailing indications for the procedure, steps in conducting an examination, and classifications of transformation zones. It outlines the colposcopic signs, terminology, and the importance of teamwork in therapy following findings. Additionally, it emphasizes the need for standardized training in maternal health and gynecology services to enhance care for women.
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An Introduction to Colposcopy Grothuesmann
- 1. An Introduction toColposcopy Dr Dirk Grothuesmann http://dg-maternalhealth.de/
- 2. Secondary Cervix CancerPrevention • Secondary prevention means stop the progression of disease once it has already started (stop progression) • Cytological screening Pap-Test • Visual screening Colposcopy • +/- HPV-Testing
- 3. Indication for Colposcopy •Abnormal Pap smear • Treatment and follow up of CIN • Bleeding • post-coital • Postmenopausal • Menorrhagia • Persist vagina discharge • Unhealthy cervix • HPV pos / external vulva warts
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- 6. Transformation Zone • TheNormal TZ is located between the old SCJ and the colposcopically-visible, new SCJ • Dynamic Area • Carcinogenic factors (HPV, carcinogenic Substances e.g. Smoking) are incorporated into vulnerable immature metaplastic Epithelia
- 7. Classification of TransformationZone Bornstein J et al., 2011
- 8. Transformation Zone TZ I TZII TZ III Sellors JW and Sankaranarayanan R, 2003
- 9. Steps in theColposcopic Examination • Obtain a relevant medical history • Explain the procedure to the woman • Obtain informed consent • Speculum and obtain specimens for lab examination, HPV Test, PAP if necessary • Apply normal saline solution • Apply 5% acetic acid • Apply Lugol’s iodine solution • Perform cervical biopsies, if necessary Schneider A, 2013
- 10. 2011 IFCPC Nomenclature ofColposcopy Normal Findings
- 11. 2011 IFCPC Nomenclature ofColposcopy Abnormal Findings MINOR MAJOR Suspicious For CA
- 12. 2011 IFCPC Nomenclature ofColposcopy Normal Findings Squamous/Columnar Epithelium Gland Openings, TZ I Nabothian Cyst, Squamous Epithelium TZ II
- 13. 2011 IFCPC Nomenclature ofColposcopy Minor Abnormal Findings Acetowhite Epethilum 3 o’ clock, HPV + Punctuation Mosaic Acetowhite
- 14. Minor abnormal Findings AbnormalFindings (Normal vascular Pattern) Sellors and Sankaranarayanan , 2003,
- 15. Minor abnormal Findings AbnormalFindings (Normal vascular Pattern) Normally vessel patterns of the cervical epithelium over a Nabothian Cyst
- 16. Major abnormal Findings InnerBorder sign Rag sign Major abnormal Findings CIN suspect
- 17. Major abnormal Findings Prominentgland opening Ridge sign Major abnormal Findings CIN suspect
- 18. Findings suspicious forInvasion Atypical vascular Patterns C A N C E R
- 19. 2011 IFCPC Nomenclature ofColposcopy Miscellaneous finding
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- 21. Miscellaneous Findings Polyp endocervical Inflammation Trichomoniasis Polyp,Inflammation IFCPC, IFCPC Nomenclature 2011
- 22. The modified ReidColposcopic Index Colposcopic signs • Color • Lesion margin/surface configuration • Vessels • Iodine staining Zero point 0ne point Two point Reid and Scalzi, 1985
- 23. Line Diagrams ofCervix Hammond’s graph: (A) Cervical Canal, (B) Portio vaginalis of Cervix – Transformation Zone, (C) Portio vaginalis outside of Transformation Zone, (D) Vaginal Vault Odell’s diagram enables to mark individually diagnosed Findings I II
- 24. Colposcopy - consequentTherapy = Teamwork
- 26. Literature Bornstein J etal., 2011 Colposcopic Terminology of the International Federation for Cervical Pathology and Colposcopy, American College of Obstetricians and Gynecologist, VOL. 120, (1), 166 – 172, from http://jgcs21.umin.jp/colposcopy_02.pdf IFCPC, IFCPC Nomenclature 2011, from http://www.ifcpc.org/en/healthcare-professionals/resource-material/2011-ifcpc-nomenclature Massad L S et al., 2012 Updated Consensus Guidelines for the Management of Abnormal Cervical Cancer Screening Tests and Cancer Precursors, 2013, Journal of Lower Genital Tract Disease, 17 (5), S1 - S27 Reid R, Scalzi P. Genital warts and cancer. VIII. An improved colposcopic index for differentiating benign papillomaviral infection from high grade cervical intraepithelial neoplasia. Am J Obstet Gynecol. 1985; 153, 611-618 Schneider A, 2013, Primary, secondary, and tertiary prevention of cervical cancer, Endo-Press: Tuttlingen, Germany, ISBN: 978-3-89756-448-0 Sellors JW and Sankaranarayanan R, 2003, Colposcopy and Treatment of Cervical Intraepithelial Neoplasia: A Beginners’ Manual, from http://screening.iarc.fr/doc/Colposcopymanual.pdf Vercellino, G F, et al., Validity of the Colposcopic Criteria Inner Border Sign, Ridge Sign, and Rag Sign for Detection of High-Grade Cervical Intraepithelial Neoplasia, Obstetrics & Gynecology, 121 (3), 624 – 631 WHO, IARC Screening Group, An introduction to the anatomy of the uterine cervix (chapter one), from http://screening.iarc.fr/colpochap.php?chap=1 accessed 30 May, 2016
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- 28. Aim of myProject Dr. Dirk Grothuesmann Consultancy Improving Maternal Health and Gynecology Services by Training Health Care Providers: Relaying on standardized training modules I teach evidence-based obstetrical procedures, gynaecology surgery and related evaluation tools to local personnel in developed and developing countries. Completing the programs offered, skills gained enable to serve women in need in any requested setting. http://dg-maternalhealth.de/index2.html