This document provides an overview of colposcopy, including its history, principles, and procedures. It discusses the development of Pap smears and liquid-based cytology, as well as the history and use of the colposcope. The normal cervical anatomy is described, including the appearance of squamous and columnar epithelia and the squamo-columnar junction under colposcopy. Practical tips for colposcopic examination and the indications for colposcopy are also summarized.
Colposcopy training part 1 ,DR. SHARDA JAIN Dr. Jyoti Agarwal / Dr. Jyoti Bha...Lifecare Centre
Definition used in the consensus guidelines ASCCP +24 organizations 2013
Colposcopy
Colposcopy is the examination of the cervix , vagina and, in some instances the vulva, with the colposcope after the application of a 3--5% acetic solution coupled with obtaining colposcopically – directed biopsies of all lesions suspected of representing neoplasia
Colposcopy involves examining the cervix, vagina, and vulva with a binocular microscope. It allows detection of pre-cancerous and cancerous epithelial changes through identification of vascular patterns and epithelial abnormalities that appear after applying acetic acid or Lugol's iodine. The transformation zone, where squamous and columnar epithelia meet, is the main area of interest as most cervical cancers originate there. A colposcopy examination is considered satisfactory only if the entire transformation zone is visualized.
Laparoscopy is useful for diagnosing various gynecologic disorders that cause chronic pelvic pain, including endometriosis, adhesions, ovarian cysts, and pelvic inflammatory disease. It allows for direct visualization of the pelvic organs and structures. While laparoscopy may not find a cause in some cases, abnormalities are detected through laparoscopy in approximately 60% of patients who have undergone other diagnostic evaluations. Laparoscopy is also used therapeutically to treat conditions like ectopic pregnancies and tubo-ovarian abscesses.
The new pap guidelines recommend the following key changes:
1. The first pap smear should be at age 21 instead of younger teenagers, as pap smears before this age often led to unnecessary treatment.
2. For women in their 20s with normal immune systems and no previous abnormal pap results, pap smears can now be done every 2 years instead of annually.
3. For women in their 30s meeting the same criteria, pap smears can now be done every 3 years instead of annually.
The guidelines were updated based on new technologies for examining cervical cells and a better understanding of HPV and its latency period. The aim is to reduce overtreatment while still effectively screening for cervical cancer.
Manegement of adenexal masses in pregnancyWafaa Benjamin
Over the last 20 years, the use of ultrasound in pregnancy has dramatically increased the numbers of ovarian cysts diagnosed.
The majority of these ovarian cysts in pregnancy either resolve spontaneously or are due to benign conditions.
Ovarian cancer is extremely rare in women of childbearing age and thus most of these cysts can be managed conservatively.
In terms of malignancy potential, those that are malignant are likely to be borderline.
Unless there is a suspicion of malignancy or there is a significant cyst complication, such as torsion, surgery is not indicated.
MRI is a safe and useful tool to help evaluate cysts in more detail in situations where ultrasound provides an inconclusive answer.
If surgery is planned, this should take place during the second trimester to minimise the risk of miscarriage.
Whether surgery is done laparoscopically or using a traditional open approach, it is largely dependent on operator experience and patient preference.
Aspiration of ovarian cysts is only indicated where they appear simple on ultrasound and where they are causing pain or are thought to be obstructing the birth canal.
If surgery does not take place, then ultrasound follow-up during and after pregnancy may be advised accordingly.
Here are the key details from the case:
- 30-year-old patient presenting for first Pap smear in 3 years
- Asymptomatic
- Pap smear results show ASC-US
The appropriate next step given these details would be:
- Perform colposcopy to evaluate for any visible abnormalities since her Pap was ASC-US. ASC-US indicates some abnormal cells were seen but not enough for a definitive diagnosis of a precancerous lesion. Colposcopy allows for a closer visual examination of the cervix.
- If colposcopy is normal, repeat Pap smear in 6-12 months for follow up since she has not had regular screening.
- If colposcopy shows
The document discusses colposcopy, which uses a low-power microscope to examine the cervix. It describes cervical intraepithelial neoplasia (CIN) grades 1-3 and squamous intraepithelial lesions. The colposcope allows inspection of the cervix before and after acetic acid application using criteria like vascular patterns, whiteness, and iodine negativity to evaluate lesions. Colposcopy is used to screen for cervical cancer, evaluate abnormal pap smears, and follow up on CIN treatment. Steps involve inspection, biopsies if needed, and documentation. Advantages include aiding diagnosis and follow up while disadvantages include inadequacy for endocervical lesions.
This document provides information about hysteroscopies, including what they are, the equipment used, procedures, indications, and complications.
Hysteroscopies allow direct visual inspection of the cervical canal and uterine cavity and can be used for both diagnostic and therapeutic purposes. Equipment includes rigid or flexible hysteroscopes connected to a light source, camera, and monitor. Distension media like carbon dioxide, glycine, or saline is used to distend the uterine cavity during the procedure. Diagnostic hysteroscopies are used to evaluate conditions like abnormal uterine bleeding or infertility while operative hysteroscopies can be used to remove polyps, fibroids, or adhesions. Potential complications include issues from anesthesia, bleeding,
Colposcopy training part 1 ,DR. SHARDA JAIN Dr. Jyoti Agarwal / Dr. Jyoti Bha...Lifecare Centre
Definition used in the consensus guidelines ASCCP +24 organizations 2013
Colposcopy
Colposcopy is the examination of the cervix , vagina and, in some instances the vulva, with the colposcope after the application of a 3--5% acetic solution coupled with obtaining colposcopically – directed biopsies of all lesions suspected of representing neoplasia
Colposcopy involves examining the cervix, vagina, and vulva with a binocular microscope. It allows detection of pre-cancerous and cancerous epithelial changes through identification of vascular patterns and epithelial abnormalities that appear after applying acetic acid or Lugol's iodine. The transformation zone, where squamous and columnar epithelia meet, is the main area of interest as most cervical cancers originate there. A colposcopy examination is considered satisfactory only if the entire transformation zone is visualized.
Laparoscopy is useful for diagnosing various gynecologic disorders that cause chronic pelvic pain, including endometriosis, adhesions, ovarian cysts, and pelvic inflammatory disease. It allows for direct visualization of the pelvic organs and structures. While laparoscopy may not find a cause in some cases, abnormalities are detected through laparoscopy in approximately 60% of patients who have undergone other diagnostic evaluations. Laparoscopy is also used therapeutically to treat conditions like ectopic pregnancies and tubo-ovarian abscesses.
The new pap guidelines recommend the following key changes:
1. The first pap smear should be at age 21 instead of younger teenagers, as pap smears before this age often led to unnecessary treatment.
2. For women in their 20s with normal immune systems and no previous abnormal pap results, pap smears can now be done every 2 years instead of annually.
3. For women in their 30s meeting the same criteria, pap smears can now be done every 3 years instead of annually.
The guidelines were updated based on new technologies for examining cervical cells and a better understanding of HPV and its latency period. The aim is to reduce overtreatment while still effectively screening for cervical cancer.
Manegement of adenexal masses in pregnancyWafaa Benjamin
Over the last 20 years, the use of ultrasound in pregnancy has dramatically increased the numbers of ovarian cysts diagnosed.
The majority of these ovarian cysts in pregnancy either resolve spontaneously or are due to benign conditions.
Ovarian cancer is extremely rare in women of childbearing age and thus most of these cysts can be managed conservatively.
In terms of malignancy potential, those that are malignant are likely to be borderline.
Unless there is a suspicion of malignancy or there is a significant cyst complication, such as torsion, surgery is not indicated.
MRI is a safe and useful tool to help evaluate cysts in more detail in situations where ultrasound provides an inconclusive answer.
If surgery is planned, this should take place during the second trimester to minimise the risk of miscarriage.
Whether surgery is done laparoscopically or using a traditional open approach, it is largely dependent on operator experience and patient preference.
Aspiration of ovarian cysts is only indicated where they appear simple on ultrasound and where they are causing pain or are thought to be obstructing the birth canal.
If surgery does not take place, then ultrasound follow-up during and after pregnancy may be advised accordingly.
Here are the key details from the case:
- 30-year-old patient presenting for first Pap smear in 3 years
- Asymptomatic
- Pap smear results show ASC-US
The appropriate next step given these details would be:
- Perform colposcopy to evaluate for any visible abnormalities since her Pap was ASC-US. ASC-US indicates some abnormal cells were seen but not enough for a definitive diagnosis of a precancerous lesion. Colposcopy allows for a closer visual examination of the cervix.
- If colposcopy is normal, repeat Pap smear in 6-12 months for follow up since she has not had regular screening.
- If colposcopy shows
The document discusses colposcopy, which uses a low-power microscope to examine the cervix. It describes cervical intraepithelial neoplasia (CIN) grades 1-3 and squamous intraepithelial lesions. The colposcope allows inspection of the cervix before and after acetic acid application using criteria like vascular patterns, whiteness, and iodine negativity to evaluate lesions. Colposcopy is used to screen for cervical cancer, evaluate abnormal pap smears, and follow up on CIN treatment. Steps involve inspection, biopsies if needed, and documentation. Advantages include aiding diagnosis and follow up while disadvantages include inadequacy for endocervical lesions.
This document provides information about hysteroscopies, including what they are, the equipment used, procedures, indications, and complications.
Hysteroscopies allow direct visual inspection of the cervical canal and uterine cavity and can be used for both diagnostic and therapeutic purposes. Equipment includes rigid or flexible hysteroscopes connected to a light source, camera, and monitor. Distension media like carbon dioxide, glycine, or saline is used to distend the uterine cavity during the procedure. Diagnostic hysteroscopies are used to evaluate conditions like abnormal uterine bleeding or infertility while operative hysteroscopies can be used to remove polyps, fibroids, or adhesions. Potential complications include issues from anesthesia, bleeding,
Imaging in obstetrics & gynaecology (part 1- Gynaecological scans in benign c...drmcbansal
Ultrasonography is a type of medical imaging that uses high-frequency sound waves to visualize structures within the body. It is a non-invasive technique that provides real-time images and does not use radiation. Common applications of ultrasound in gynecology include evaluating the uterus, ovaries, and fallopian tubes. A transvaginal probe is often used to obtain detailed images of the pelvic organs. Normal ultrasound appearances of the ovaries include scattered antral follicles that develop during the menstrual cycle. Ovulation is identified by a decrease in size of the dominant follicle. The corpus luteum that forms after ovulation can be seen as a cyst or echogenic area on ultrasound.
Role of hysteroscopy in Infertility, Dr Rajesh GajbhiyeRajesh Gajbhiye
Hysteroscopy plays an important role in the evaluation and treatment of intrauterine abnormalities found in infertile women. Diagnostic hysteroscopy is considered the gold standard for diagnosing conditions like submucous fibroids, uterine septum, intrauterine adhesions, and endometrial polyps that are common in infertile patients. Surgical treatment of these abnormalities by hysteroscopy has been shown to improve pregnancy rates compared to diagnostic hysteroscopy alone. Additionally, performing hysteroscopy before IVF treatment or endometrial scratching prior to a cycle has been associated with higher success rates, though more research is still needed to confirm these findings.
Recurrent implantation failure: British fertility society Guidelines2020Aboubakr Elnashar
This document discusses recurrent implantation failure (RIF) in IVF treatment. It covers investigations and causes of RIF including endometrial factors, gamete/embryo quality issues, and other potential causes. Treatment options are also reviewed addressing endometrial issues, improving gametes and embryos, lifestyle changes, and embryo transfer techniques. The document provides guidelines on RIF management based on levels of evidence.
1. Tubal anastomosis or IVF-ET must be considered based on factors like age, tubal damage extent, cost, and patient preference.
2. IVF-ET has a higher per-cycle success rate while tubal anastomosis has a higher cumulative success rate and may be more cost-effective.
3. Both have risks and neither is clearly superior, so options should be discussed individually to help couples feel they explored all options.
History of radical hysterectomy for cancer cervixSakshi Mundra
The document provides a history of radical hysterectomy for cervical cancer treatment over 2500 years. It discusses key pioneers and developments including Hippocrates attempting trachelectomy in 460-370 BC, Wilhelm Freund developing the first standardized radical hysterectomy technique in 1878, and Ernst Wertheim performing the first full radical abdominal hysterectomy in 1898. The modern radical hysterectomy was developed in the late 19th/early 20th century by surgeons including John Clark, Joseph Meigs, and Hidekazu Okabayashi. Classification systems for radical hysterectomy procedures including the Piver-Rutledge-Smith and Querleu and Morrow systems are also summarized.
Hysteroscopic procedures are getting refined and with the advent of miniature scopes , doing these procedures in he office is getting better and more comfortable.
The document discusses reasons for IVF failure and provides advice for doctors on supporting patients after a failed cycle. It recommends that doctors be empathetic, honest but compassionate with patients. It also suggests analyzing what went right/wrong with the cycle and considering changes to the protocol, lab techniques, embryo quality checks or referring patients to another clinic for the next attempt. The document emphasizes setting realistic expectations and preparing patients for potential failure to help both patients and doctors cope better.
Ovarian reserve tests provide an indirect measure of the cohort of recruitable antral follicles present in the FSH window at the beginning of each menstrual cycle..Functional Ovarian Reserve
Ultrasound plays a key role in evaluating infertility by assessing ovarian reserve, endometrial thickness and blood flow, detecting uterine anomalies, guiding oocyte retrieval and embryo transfer. New markers of endometrial receptivity and follicle development aim to improve success with single embryo transfer. Three-dimensional ultrasound enhances detection of uterine anomalies and may improve embryo visualization during transfer.
This document discusses the history and current state of colposcopy. It describes how colposcopy was developed in 1925 as a tool for examining cervical lesions. It has since spread worldwide and undergone many technological advances like digital imaging. Current uses of colposcopy include screening for cervical cancer, evaluating abnormal pap smears, and following up on conservative CIN treatments. The document outlines diagnostic criteria, management guidelines, and potential pitfalls of colposcopy. It envisions future advances through digital imaging and telecolposcopy to improve patient care.
This document discusses several complex cases involving intrauterine insemination (IUI). It describes patient histories, stimulation protocols, semen analysis results, and challenges that arose during IUI procedures. The panelists discuss options for each case, including risks of ovarian hyperstimulation, limitations of IUI for endometriosis patients, preventing premature ovulation, difficult insemination techniques, and using ultrasound guidance. The document provides guidance on managing risks and complications to optimize IUI success rates.
1) Hysteroscopy is a procedure that allows direct visualization of the uterine cavity and cervical canal using a thin telescope inserted through the vagina and cervix.
2) Key components of modern hysteroscopy include a telescope, light source, distention media (such as saline or CO2), and single- or multi-channel sheaths.
3) Hysteroscopy is used diagnostically to evaluate abnormal bleeding and infertility and operatively for procedures such as endometrial ablation, polyp removal, and septum division. Complications can include fluid overload, perforation, and infection.
The document discusses cervical histology and screening for cervical cancer. It describes the squamocolumnar junction (SCJ) and transformation zone of the cervix. The location of the SCJ changes with age due to regenerative changes. Screening guidelines from ACOG and WHO are provided regarding what ages to screen and what tests to use. Screening methods like Pap smear, HPV testing, visual inspection with acetic acid are outlined. Management of abnormal screening results including follow up testing and treatment options like cryotherapy, LEEP, and hysterectomy are summarized.
This document discusses endometrial ablation, which is a treatment for abnormal uterine bleeding where the endometrium is destroyed. It notes that endometrial ablation has advantages over hysterectomy as it is less invasive, allows the uterus to be preserved, and has a shorter recovery time. The document provides details on the various techniques for endometrial ablation and notes it is most effective when performed hysteroscopically to allow direct visualization. Preparation of the endometrium and cervix is recommended to improve outcomes.
This document summarizes information about uterine sarcomas, with a focus on leiomyosarcomas and endometrial stromal sarcomas. It discusses the clinical presentation, diagnostic challenges, classification, staging, prognostic factors, surgical management, and adjuvant therapies for these rare but aggressive uterine cancers. Key points include the difficulty of pre-operative diagnosis, the importance of surgical staging and cytoreduction, and the limited but emerging role of adjuvant therapies like radiation and chemotherapy.
Cytopathology is the study of exfoliated cells to detect normal and abnormal tissue morphology. Cells can be collected naturally or artificially from various body sites like skin, cervix, lungs, and lymph nodes. Cytopathology allows rapid, inexpensive diagnosis and monitoring of diseases without surgery. Pap smears screen for cervical cancer by examining cells from the cervix and vagina. Abnormal findings on Pap smears require follow up with colposcopy and possible biopsy. Screening reduces cervical cancer rates by facilitating early detection and treatment of precancerous lesions.
Cytopathology is the study of exfoliated cells to detect normal and abnormal cell morphology. Cells can be collected naturally or artificially from various tissues and fluids. Cytopathology allows rapid, inexpensive diagnosis and monitoring of diseases without surgical trauma through techniques like Pap smears. While useful for screening, cytopathology has limitations like relying on individual cell analysis and sometimes requiring confirmation by histopathology. Pap smears played a pivotal role in decreasing cervical cancer rates, though they have limitations in sensitivity and require adequate follow up. The transformation zone of the cervix, where abnormal cells often arise, can change throughout a woman's life.
Imaging in obstetrics & gynaecology (part 1- Gynaecological scans in benign c...drmcbansal
Ultrasonography is a type of medical imaging that uses high-frequency sound waves to visualize structures within the body. It is a non-invasive technique that provides real-time images and does not use radiation. Common applications of ultrasound in gynecology include evaluating the uterus, ovaries, and fallopian tubes. A transvaginal probe is often used to obtain detailed images of the pelvic organs. Normal ultrasound appearances of the ovaries include scattered antral follicles that develop during the menstrual cycle. Ovulation is identified by a decrease in size of the dominant follicle. The corpus luteum that forms after ovulation can be seen as a cyst or echogenic area on ultrasound.
Role of hysteroscopy in Infertility, Dr Rajesh GajbhiyeRajesh Gajbhiye
Hysteroscopy plays an important role in the evaluation and treatment of intrauterine abnormalities found in infertile women. Diagnostic hysteroscopy is considered the gold standard for diagnosing conditions like submucous fibroids, uterine septum, intrauterine adhesions, and endometrial polyps that are common in infertile patients. Surgical treatment of these abnormalities by hysteroscopy has been shown to improve pregnancy rates compared to diagnostic hysteroscopy alone. Additionally, performing hysteroscopy before IVF treatment or endometrial scratching prior to a cycle has been associated with higher success rates, though more research is still needed to confirm these findings.
Recurrent implantation failure: British fertility society Guidelines2020Aboubakr Elnashar
This document discusses recurrent implantation failure (RIF) in IVF treatment. It covers investigations and causes of RIF including endometrial factors, gamete/embryo quality issues, and other potential causes. Treatment options are also reviewed addressing endometrial issues, improving gametes and embryos, lifestyle changes, and embryo transfer techniques. The document provides guidelines on RIF management based on levels of evidence.
1. Tubal anastomosis or IVF-ET must be considered based on factors like age, tubal damage extent, cost, and patient preference.
2. IVF-ET has a higher per-cycle success rate while tubal anastomosis has a higher cumulative success rate and may be more cost-effective.
3. Both have risks and neither is clearly superior, so options should be discussed individually to help couples feel they explored all options.
History of radical hysterectomy for cancer cervixSakshi Mundra
The document provides a history of radical hysterectomy for cervical cancer treatment over 2500 years. It discusses key pioneers and developments including Hippocrates attempting trachelectomy in 460-370 BC, Wilhelm Freund developing the first standardized radical hysterectomy technique in 1878, and Ernst Wertheim performing the first full radical abdominal hysterectomy in 1898. The modern radical hysterectomy was developed in the late 19th/early 20th century by surgeons including John Clark, Joseph Meigs, and Hidekazu Okabayashi. Classification systems for radical hysterectomy procedures including the Piver-Rutledge-Smith and Querleu and Morrow systems are also summarized.
Hysteroscopic procedures are getting refined and with the advent of miniature scopes , doing these procedures in he office is getting better and more comfortable.
The document discusses reasons for IVF failure and provides advice for doctors on supporting patients after a failed cycle. It recommends that doctors be empathetic, honest but compassionate with patients. It also suggests analyzing what went right/wrong with the cycle and considering changes to the protocol, lab techniques, embryo quality checks or referring patients to another clinic for the next attempt. The document emphasizes setting realistic expectations and preparing patients for potential failure to help both patients and doctors cope better.
Ovarian reserve tests provide an indirect measure of the cohort of recruitable antral follicles present in the FSH window at the beginning of each menstrual cycle..Functional Ovarian Reserve
Ultrasound plays a key role in evaluating infertility by assessing ovarian reserve, endometrial thickness and blood flow, detecting uterine anomalies, guiding oocyte retrieval and embryo transfer. New markers of endometrial receptivity and follicle development aim to improve success with single embryo transfer. Three-dimensional ultrasound enhances detection of uterine anomalies and may improve embryo visualization during transfer.
This document discusses the history and current state of colposcopy. It describes how colposcopy was developed in 1925 as a tool for examining cervical lesions. It has since spread worldwide and undergone many technological advances like digital imaging. Current uses of colposcopy include screening for cervical cancer, evaluating abnormal pap smears, and following up on conservative CIN treatments. The document outlines diagnostic criteria, management guidelines, and potential pitfalls of colposcopy. It envisions future advances through digital imaging and telecolposcopy to improve patient care.
This document discusses several complex cases involving intrauterine insemination (IUI). It describes patient histories, stimulation protocols, semen analysis results, and challenges that arose during IUI procedures. The panelists discuss options for each case, including risks of ovarian hyperstimulation, limitations of IUI for endometriosis patients, preventing premature ovulation, difficult insemination techniques, and using ultrasound guidance. The document provides guidance on managing risks and complications to optimize IUI success rates.
1) Hysteroscopy is a procedure that allows direct visualization of the uterine cavity and cervical canal using a thin telescope inserted through the vagina and cervix.
2) Key components of modern hysteroscopy include a telescope, light source, distention media (such as saline or CO2), and single- or multi-channel sheaths.
3) Hysteroscopy is used diagnostically to evaluate abnormal bleeding and infertility and operatively for procedures such as endometrial ablation, polyp removal, and septum division. Complications can include fluid overload, perforation, and infection.
The document discusses cervical histology and screening for cervical cancer. It describes the squamocolumnar junction (SCJ) and transformation zone of the cervix. The location of the SCJ changes with age due to regenerative changes. Screening guidelines from ACOG and WHO are provided regarding what ages to screen and what tests to use. Screening methods like Pap smear, HPV testing, visual inspection with acetic acid are outlined. Management of abnormal screening results including follow up testing and treatment options like cryotherapy, LEEP, and hysterectomy are summarized.
This document discusses endometrial ablation, which is a treatment for abnormal uterine bleeding where the endometrium is destroyed. It notes that endometrial ablation has advantages over hysterectomy as it is less invasive, allows the uterus to be preserved, and has a shorter recovery time. The document provides details on the various techniques for endometrial ablation and notes it is most effective when performed hysteroscopically to allow direct visualization. Preparation of the endometrium and cervix is recommended to improve outcomes.
This document summarizes information about uterine sarcomas, with a focus on leiomyosarcomas and endometrial stromal sarcomas. It discusses the clinical presentation, diagnostic challenges, classification, staging, prognostic factors, surgical management, and adjuvant therapies for these rare but aggressive uterine cancers. Key points include the difficulty of pre-operative diagnosis, the importance of surgical staging and cytoreduction, and the limited but emerging role of adjuvant therapies like radiation and chemotherapy.
Cytopathology is the study of exfoliated cells to detect normal and abnormal tissue morphology. Cells can be collected naturally or artificially from various body sites like skin, cervix, lungs, and lymph nodes. Cytopathology allows rapid, inexpensive diagnosis and monitoring of diseases without surgery. Pap smears screen for cervical cancer by examining cells from the cervix and vagina. Abnormal findings on Pap smears require follow up with colposcopy and possible biopsy. Screening reduces cervical cancer rates by facilitating early detection and treatment of precancerous lesions.
Cytopathology is the study of exfoliated cells to detect normal and abnormal cell morphology. Cells can be collected naturally or artificially from various tissues and fluids. Cytopathology allows rapid, inexpensive diagnosis and monitoring of diseases without surgical trauma through techniques like Pap smears. While useful for screening, cytopathology has limitations like relying on individual cell analysis and sometimes requiring confirmation by histopathology. Pap smears played a pivotal role in decreasing cervical cancer rates, though they have limitations in sensitivity and require adequate follow up. The transformation zone of the cervix, where abnormal cells often arise, can change throughout a woman's life.
The document discusses cytology and exfoliative cytology. It describes how exfoliative cytology involves the microscopic study of cells that have desquamated from epithelial surfaces. Some applications of exfoliative cytology include detection of malignant cells, precancerous lesions, and infectious microorganisms. The document also outlines procedures for collecting and preparing different cytology specimens, such as body fluids, nipple discharge, bronchial brushings, sputum, gastric washings, and cervicovaginal smears. It provides details on fixation, staining techniques including Pap's stain, and morphological changes that indicate malignancy in cytology samples.
Colposcopy nstrumentation and principles on how to do 22Tariq Mohammed
This document discusses the principles and procedures of colposcopy examinations. It begins by defining a colposcope and its main uses. The most common reason for referral is abnormal cervical screening tests indicating possible precancerous lesions. During the exam, the cervix is examined under magnification with saline, acetic acid, and Lugol's iodine to identify any abnormal white lesions that could indicate precancer or cancer. The document outlines the proper colposcopy instrumentation, examination steps including the principles behind using acetic acid and Lugol's iodine, how to interpret the results, and the importance of thoroughly documenting findings.
Colposcopy is a procedure that magnifies and illuminates the cervix, vagina, and vulva to examine them for abnormalities. It is usually performed when a Pap smear is abnormal or the cervix looks abnormal. During colposcopy, acetic acid is applied to help identify abnormal areas, which appear white. Biopsies may be taken of abnormal areas for further examination. Interpretation involves examining features like acetowhitening, vascular patterns, and iodine uptake to assess the severity of cervical lesions and guide treatment. Colposcopy allows close examination of the cervix to diagnose conditions like cervical intraepithelial neoplasia or condyloma.
Colposcopy is a procedure that magnifies and illuminates the cervix, vagina, and vulva to examine them for abnormalities. It is usually performed when a Pap smear is abnormal or the cervix looks abnormal. During colposcopy, acetic acid is applied to help identify abnormal areas, which appear white. Biopsies may be taken of abnormal areas for further examination. Interpretation involves examining features like acetowhitening, vascular patterns, and iodine uptake to assess the severity of cervical lesions and guide treatment. Colposcopy allows close examination of the cervix to diagnose conditions like cervical intraepithelial neoplasia or condyloma.
Cervical intraepithelial neoplasia (CIN) refers to pre-cancerous changes that occur in the cells of the cervix. CIN is classified into three grades (CIN 1-3) based on how deep the abnormal cells are in the cervix. Human papillomavirus infection is the main cause of CIN. Screening through Pap tests and HPV testing can detect CIN early. Diagnosis involves colposcopy and biopsy of abnormal areas. Treatment options depend on the grade of CIN and include cryotherapy, loop electrosurgical excision, and conization. Leaving low-grade CIN untreated may allow spontaneous regression.
PAP SMEAR PATHOLOGY Various slide ABOUTE many candition can see in popanicula smear test short disscution about epidemiology and screening hpv bethesda reporting and how to pop smearing when to pop smear and organism metaplasia and other condition lsil hsil cin1 cin2 cin3 ascus asch
This document discusses liquid based cytology (LBC) and compares it to conventional pap smears. It provides a history of LBC dating back to 1970 and describes two main LBC systems - ThinPrep and SurePath. With ThinPrep, cells are collected in a preservative fluid and then filtered and transferred to a slide. With SurePath, cells are collected in a preservative fluid and separated via density gradient centrifugation before being placed on a slide. Studies have shown LBC reduces inadequate samples and increases specificity compared to conventional pap smears. LBC also better preserves cell morphology. The document focuses on how LBC has advantages over conventional pap smears for detecting cervical intraepithelial neoplasia lesions.
This document outlines the procedure and findings of Pap smear screening and management of abnormal results. A Pap smear involves collecting cervical cells to screen for precancerous lesions. Findings are reported using the Bethesda system and include categories like normal, atypical squamous cells, low-grade lesions, and high-grade lesions. Abnormal results require follow up like colposcopy, treatment of precancerous lesions, or hysterectomy for more severe cases. Regular Pap smear screening can effectively reduce cervical cancer incidence and mortality.
This document discusses various causes and investigations for infertility. The major causes include ovarian, tubal, uterine, cervical and peritoneal factors. Ovarian factors account for 30-40% of cases and include anovulation, luteal phase defects, and follicular issues. Tubal factors cause 25-35% of infertility through infections, adhesions or blockages. Investigations to diagnose ovulation include basal body temperature, cervical mucus analysis, hormone levels, ultrasound and laparoscopy. Tubal patency is assessed using hysterosalpingography, laparoscopy and dye tests. Uterine abnormalities are investigated with ultrasound and hysteroscopy. Cervical factors are analyzed with post-co
Oral exfoliative cytology is a technique that examines cells collected from the oral mucosa. It can help detect undiagnosed diseases through a simple procedure and confirm suspected diseases without trauma. The document discusses the definition, role, indications, advantages and preparation methods of oral cytology. It describes how to make smears and various staining and fixation techniques used. Cytological classification systems and what normal and abnormal oral cells look like are presented. The uses of oral cytology in detecting oral cancer and newer diagnostic methods like cytomorphometry are also summarized.
Manual vacuum aspiration is a procedure used for early pregnancy termination. It involves preparing the manual vacuum aspirator by assembling its parts and creating a vacuum. The procedure also includes preparing the patient, performing a pelvic exam, inserting the cannula into the uterus and using suction to remove uterine contents. Complications include infection, incomplete abortion and uterine perforation.
The document provides detailed steps and requirements for performing manual vacuum aspiration as well as other gynecology procedures like Pap smear collection, visual inspection with acetic acid and Lugol's iodine, counseling for abnormal cervical screening results, implant insertion and removal, and IUCD insertion. The skills stations cover important techniques and considerations for basic obstet
Cervical cancer arises from the transformation of cervical cells through dysplasia, metaplasia, and neoplasia. The majority are squamous cell carcinomas and adenocarcinomas. Cervical intraepithelial neoplasia (CIN) describes abnormal cervical cells on a scale of CIN I to CIN III based on severity. Colposcopy allows physicians to examine the cervix with magnification after acetic acid application to detect abnormalities. Cervical cancer screening through Pap smears aims to detect precancerous lesions early through cell sampling and analysis. Risk factors include early sexual activity, multiple partners, HPV infection, and smoking.
Medical investigations in gynecological patientsMuni Venkatesh
This document outlines methods for investigating and examining gynecological patients. It discusses obtaining a thorough patient history, performing a physical exam including pelvic and breast exams, conducting diagnostic tests and procedures in the office like STI testing and Pap smears, and ordering diagnostic lab tests. The goal is to properly evaluate, diagnose, and treat women's health issues.
The document discusses Pap smear testing for cervical cancer screening. It provides details on:
1) The history and effectiveness of Pap smears in detecting precancerous lesions and cervical cancer early. Regular Pap smear screening can prevent up to 70% of cervical cancers.
2) Guidelines for Pap smear screening including initial screening at age 21 or within 3 years of becoming sexually active, screening intervals of every 3 years for ages 30-70, and ending screening at age 70.
3) Limitations of conventional Pap smears including low sensitivity and false negatives, and how liquid-based cytology techniques can improve results.
Cervical carcinoma is a common cancer in women aged 35-45 years in developing countries. Nearly all forms are squamous cell carcinoma arising from infection with human papillomavirus. Risk factors include early age of first intercourse, multiple sex partners, smoking, and immunosuppression. Precancerous lesions are classified as CIN I-III based on severity of dysplasia. Early stage IA cancer is treated with local excision while stage IB-IIA receives radical hysterectomy with or without radiation. Locally advanced stage IIB-IVB is typically treated with concurrent chemoradiation. Five-year survival decreases with more advanced stage from 87-90% for IB-IIA to 14% for stage IV
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This document summarizes a study that aimed to quantify the prevalence of hyperplasia and cancer in endometrial polyps among women with postmenopausal bleeding (PMB). The study conducted a systematic review and meta-analysis of 10 studies and found an overall prevalence of hyperplasia and cancer of 8.9%. However, there remains uncertainty around the exact prevalence due to heterogeneity in prior studies. There is also no consensus on whether polyps should be routinely removed or if expectant management could be adopted in some cases. Future research with large prospective studies is needed to help guide clinical practice.
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This document discusses submucous fibroids (SMF) and their treatment. It provides background on the prevalence of SMF and their effects on infertility and recurrent pregnancy loss. It describes the classification of SMF and techniques for hysteroscopic myomectomy including using bipolar versus monopolar energy. Key steps in the procedure include differentiating type 1 and 2 fibroids, extracting tissue chips, and ensuring hemostasis. Long-term outcomes of hysteroscopic resection are generally good with high satisfaction rates. The document also briefly discusses techniques for endometrial ablation and hysteroscopic septum resection.
Dr Ayman Ewies - Mirena: why 50% of women dislike it?AymanEwies
1) The study found a high discontinuation rate of Mirena, with 50% of women stopping use before the recommended 5 years due to adverse effects like bleeding and pain.
2) Many women reported progestogenic side effects such as headaches, weight gain and depression, which led to early removal for 44% of participants.
3) Satisfaction with Mirena was low, with only 50% of women reporting being satisfied with the device.
Dr Mona Elshafie and Dr Ayman Ewies - The Effect Of Leptin On Maturation Of T...AymanEwies
1) Leptin administration to immature rats accelerated ovarian maturation, as seen in ultrastructural changes including enhanced folliculogenesis and development of corpora lutea.
2) It led to initiation of steroidogenesis in granulosa, theca and stroma cells, and premature ovulation between 26-30 days.
3) Histological analysis found increased numbers of growing and antral follicles and decreased primordial and atretic follicles in leptin-treated ovaries.
Dr Ayman Ewies - Endometrial Polyps in Postmenopausal WomenAymanEwies
1. The study examined endometrial polyps in 2625 postmenopausal women referred to a PMB clinic over 5 years.
2. It found that 17% of women had endometrial polyps, and of these polyps, 7.8% showed hyperplasia or cancer.
3. Higher BMI and thicker endometrium were independent predictors of hyperplasia and cancer in polyps. Women with both a BMI over 32.5 and endometrial thickness over 10.8mm had the highest risk.
Dr Ayman Ewies - What makes an effective e-tutorial?AymanEwies
This document discusses what makes an effective e-tutorial. It notes that e-learning is great because it is comprehensive, accessible, responsive, up-to-date, and greener than traditional learning. Effective e-tutorials should be engaging and interesting through the use of case studies, interactive tasks, assessment questions, videos, animations and graphics. They should also be comprehensive, highlight advanced content, include key points and user feedback. Support is provided to authors through guidelines, templates and incentives. Challenges include ensuring quality through updating, copyright issues, and plagiarism.
Dr Ayman Ewies and Dr Seu Gunasekera Best Oral PresentationAymanEwies
The document announces the 27th annual congress of the European Society of Gynaecological Endoscopy (ESGE) to be held from October 7-10, 2018 in Vienna, Austria. The congress will take a holistic approach to women's health, focusing on quality assurance and innovation. Seuvandhi Gunasekera of the United Kingdom, along with co-authors Ahmed Ghoubara and Ayman Ewies, will receive an award for their scientific work titled "Rate of hysterectomy following 419 Novasure procedures - real-life experience of a teaching hospital in the UK", which was selected for an oral presentation during the plenary sessions of the congress.
The Sandwell and West Birmingham Hospitals NHS Trust provides healthcare services to over 300,000 people living in the Sandwell and West Birmingham areas. It operates two main hospital sites, Sandwell General Hospital in West Bromwich and City Hospital in Birmingham. The Trust employs over 5,000 staff and provides a wide range of acute medical and surgical services including A&E, maternity, outpatients, and diagnostic imaging.
Dr Ayman Ewies - Doctors versus nurses in managing women with PMBAymanEwies
The Sandwell and West Birmingham Hospitals NHS Trust provides healthcare services to over 300,000 people living in the Sandwell and West Birmingham areas. It operates two main hospital sites, Sandwell General Hospital in West Bromwich and City Hospital in Birmingham. The Trust employs over 5,000 staff and provides a wide range of acute medical and surgical services including A&E, maternity, outpatients, and diagnostic and therapy services.
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The Sandwell and West Birmingham Hospitals NHS Trust operates two main hospitals in the West Midlands region of England - Sandwell General Hospital in West Bromwich and City Hospital in Birmingham. The trust provides a range of acute hospital services including accident and emergency, medicine, surgery, maternity, and outpatient care to over 350,000 people living in Sandwell and parts of western Birmingham.
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The Sandwell and West Birmingham Hospitals NHS Trust operates two hospitals in the West Midlands region of England - Sandwell General Hospital in West Bromwich and City Hospital in Birmingham. The trust provides a range of acute hospital services including accident and emergency, medicine, surgery, maternity, and outpatient care to over 350,000 people living in Sandwell and parts of western Birmingham.
Dr Ayman Ewies - Are animal laboratory models superior to virtual reality sim...AymanEwies
The document discusses different models for training in advanced hysteroscopic surgery procedures, which have a slow learning curve. It evaluates animal models using cattle uteruses versus virtual reality simulation. Trainees provided feedback over two years of training courses. The cattle uterus model scored the highest with a 94.65% overall score, replicating tissue properties better than virtual simulators which averaged 83.88%. While virtual simulators have limitations like cost and lack of realism, animal models provide a realistic environment for developing skills before clinical training. The cattle uterus is concluded to be a superior model for its similarity to the human uterus and ability to practice resection techniques.
This study evaluated an office hysteroscopy service with 700 annual cases. A retrospective review of 141 women undergoing NovaSure endometrial ablation from 2011-2015 found 79% did not require further treatment, while 21% received additional care including 10% who had a hysterectomy. A survey of 100 women in the office hysteroscopy service from 2015-2016 found high satisfaction, with 93 women scoring overall acceptability ≥8 and stating they would repeat the procedure. While 17 women reported severe pain during treatment, staff were found to be supportive and privacy was maintained.
Dr Ayman Ewies - Abnormal Uterine Bleeding in Pre-menopausal Women: When Shou...AymanEwies
This document summarizes a study on abnormal uterine bleeding in pre-menopausal women. The study examined 3006 endometrial samples from women aged 30 to 50 who presented with abnormal uterine bleeding. It found that the rate of atypical hyperplasia and carcinoma increased with each successive 5-year age group, with the highest rates occurring in women aged 45-50. Specifically, atypical hyperplasia was 3.85 times more likely and carcinoma was 4.03 times more likely in women aged 45-50 compared to those under 40. While abnormal growths can occur under age 40, the study supports guidelines recommending endometrial sampling for women over 45 presenting with abnormal uterine bleeding.
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This document discusses a cross-sectional survey that was conducted to determine the prevalence of sexually transmitted infections (STIs) among women attending colposcopy clinics in order to inform screening policies. The survey found that the women attending colposcopy were not at higher risk of STIs than the general population. Current NHS guidelines state that asymptomatic patients do not need routine STI screening during colposcopy visits. The survey results support these guidelines and suggest that universal STI screening is not required for colposcopy patients.
Dr Ayman Ewies - Postcoital Bleeding National SurveyAymanEwies
This document discusses the inconsistent management of postcoital bleeding (PCB) by UK doctors and the need for evidence-based guidelines. A survey of UK gynecologists found wide variations in how they manage and investigate PCB. Despite links between PCB and cervical pathology, less than half repeat smear tests for women with a negative history and only 15% refer women directly to colposcopy clinics. The lack of consensus and guidelines on PCB management makes it important to standardize care based on the best evidence.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
4. 4
History of Pap Smears
In 1923, Dr. George Papanicolaou
studied vaginal fluid in women to
observe cellular changes during
the menstrual cycle.
Accidentally, he observed cells
from a woman who had cervical
cancer.
In 1943, he and Herbert Traut
published the new technique.
In the late 1950ies, Pap smear
screening started!
5. 5
History of Colposcope
1925 Hinselman invented the Colposcope.
1929 Levy increased magnification.
1931 Emmerit introduced it to The USA.
1954 Bolten set up 1st Colposcopic clinic in
The USA.
7. 7
Limitations of Traditional PAP Smear
1. Unsatisfactory smears (blood,
mucous, etc.).
2. False positive rate: 2-5%.
3. False negative rate: 15-30%.
Number of cells looked at is only
0.1 - 1% of the original sample.
8. 8
Liquid-Based Cytology (LBC)
Cells collected in an alcohol-based solution.
Cells separated from blood and mucus by centrifugation.
Cells dispersed and transferred to a slide - single layer
cytology.
↓ Unsatisfactory smears by 78%.
↑ Detection of high grade CIN by 17-24%.
↑ sensitivity from 68 to 76%.
↑ specificity from 79 to 86%.
Cost effective.
10. 10
Liquid-Based Cytology (LBC)
However, a recent randomized study (Sykes, 2008)
found that the sensitivity for both LBC and
conventional smears:
– 81% for any epithelial abnormality.
– 92% for high grade lesions.
LBC was significantly less likely to be reported as
unsatisfactory (2.7% v 9.1%).
14. 14
What is it all about?
Naked-eye visualization will only detect invasive disease
but cannot differentiate pre-cancerous disease from the
normal cervix.
Cervical cytology may indicate the presence of
precancerous cells.
Colposcopy fills the gap between naked eye and cyto-
pathology.
CYTOLOGY DISCOVERS THE CRIME
COLPOSCOPY LOCATES THE CULPRIT!
15. 15
Colposcope
It is a binocular microscope that allows magnification (6-
40 fold) and illumination of the cervix.
By applying various stains to the cervix, abnormalities can
be identified:
– Benign
– Precancerous
– Malignant changes
Its primary use is to evaluate the cervix in case of abnormal
cervical smear as an aid to diagnosis, rather than as a
diagnostic tool itself.
17. Video Clip 1 - 1:34 min
The Colposcope
..VideosClip 1 - The
Colposcope - 1.34 min.flv
18. 18
Indications
1. 3 consecutive unsatisfactory smears:
o Invasive cancers may be associated with inflammatory processes and bleed on
contact; therefore, women with persistent inadequate cytology should undergo
colposcopy.
2. 3 consecutive borderline nuclear (BN) abnormalities:
o The incidence of high grade CIN after single sample reporting BN change is
only 11%.
3. 1 BN change in endocervical cells:
o The incidence of cervical cancer and pre-invasive disease is 4-16% and 17-
40%, respectively.
4. 2 consecutive mild dyskariosis – ideally after 1:
o The incidence of high grade CIN after one mild dyskariotic smear is 40-53%.
5. 1 Moderate or severe dyskariosis.
o The incidence of high grade CIN after one moderate dyskariotic smear is 74-
77%.
o The incidence of high grade CIN after one severe dyskariotic smear is 80-90%.
19. 19
Indications
6. Smear suggestive of malignancy.
7. Glandular abnormalities.
o The incidence of cervical cancer and pre-invasive disease in these women is 40 – 43% and
20 – 28%, respectively.
8. Any degree of dyskariosis in those who underwent treatment for CIN and did
not return to routine recall.
9. PCB or IMB after age of 40 if cancer is suspected.
10. Suspicious cervix regardless of the smear report.
11. Repeated inflammatory cytology.
12. Cervical lesions e.g. condyloma acuminata which may have associated pre-
invasive or invasive disease.
20. 20
At least 90% of women with 3 BN or 2 mild dyskariotic smears should
be seen in colposcopy clinic within 8 weeks of referral.
At least 90% of women with moderate or severe dyskaryosis should be
seen in colposcopy clinic within 4 weeks of referral.
At least 90% of women with glandular neoplasia and possible invasion
should be seen colposcopy clinic within 2 weeks of referral.
At least 90% of women with BN change in endocervical cells should be
seen in colposcopy clinic within 8 weeks of referral.
At least 90% of women with Borderline ?high grade should be seen in
colposcopy clinic within 8 weeks of referral.
Waiting Times
22. 22
Instruments Required
8. Kogan’s endocervical canal speculum.
9. Punch biopsy forceps.
10. Pots with formalin for specimens.
11. Haemostatic substance e.g. Monsel’s solution (ferrous subsulphate)
dried to a thick paste and silver nitrate sticks.
12. Fine needle (27 gauze size), dental syringe & cartridge of local
anesthetic with vasoconstrictor (e.g. citanest containing prilocaine
hydrochloride 3% with octapressin).
13. Selection of loops and diathermy balls (3-5 mm diameter).
30. 30
Practical Tips
Women are examined in the lithotomy position.
Colposcopy is best carried out on days 10-14 of the cycle
when the cervical mucous is clear and not tenacious.
Colposcopic assessment is difficult when there is
significant vaginal bleeding.
Low and medium magnification is used for initial
assessment, while high magnification (20-fold+) is used to
detect the finer details of vascular patterns.
A green filter highlights blood vessel patterns.
31. 31
Practical Tips
If a smear is required , this should be taken before the application of
acetic acid.
The acetic acid is left in contact with the cervix for 10 seconds.
Lugol’s iodine may be used to delineate atypical epithelium (Schiller’s
test):
– Normal squamous epithelium contains glycogen Mahogany brown (-ve
Schiller’s test).
– Columnar epithelium contains little or no glycogen fails to take up the
iodine stain (+ve Schiller’s test).
– Atypical squamous epithelium contains little or no glycogen fails to
take up the iodine stain (+ve Schiller’s test).
32. 32
Practical Tips
Colposcopy is a subjective tool recognizing different
patterns and their corresponding histological abnormalities is
dependent upon the experience.
Draw a picture of findings.
33. Video Clip 3 - 6:18 min
The Colposcopic Procedure
..VideosClip 3 - Colposcopic
Procedure - 6.18.flv
35. 35
Colposcopic Assessment
Assessment of women presenting with abnormal cervical
cytology relies on colposcopic assessment of the TZ.
The 2 sites of possible colposcopic abnormality reside
within the epithelia and the vasculature of the cervix.
The knowledge of the appearance of the 3 types of normal
epithelia and their relationship is of considerable importance.
Recognizing what is normal is an essential prerequisite
before being able recognize abnormalities
36. 36
The Normal Cervix
The cervix is dynamic, undergoing changes from
fetus until old age.
The size and shape of the cervix vary amongst
individual and at different stage of an individual’s
life e.g.
– Pregnancy large, soft & ↑ vascularity.
– Menopause atrophic changes.
– Nulliparous circular external os.
– Multiparous slit-like transverse external os.
38. 38
The Normal Cervix
The cervix contains 2 types of epithelia:
1. Stratified squamous lines the ectocervix.
2. Simple columnar lines the endocervix.
39. 39
The Normal Cervix
Squamous Epithelium
There are 2 types:
1. Original:
Multi-layered, Smooth & pink.
Does not stain white with acetic acid.
Stains brown with Lugol’s iodine.
2. Transformed (metaplastic):
Gland openings may be visualized on
colposcopic assessment.
If these openings get blocked
Nabothian follicles.
40. 40
The Normal Cervix
Columnar Epithelium
It appears red* and velvety.
At colposcopy, it has a typical grape-like structure.
It turns to white with 3-5% acetic acid application.
It stains yellow with Lugol’s iodine.
It may present on ectocervix: “ectopy or ectropion”.
*Single layered allows visualization of vasculature beneath the epithelium.
42. The Normal Cervix
Squamo-columnar junction (SCJ)
Puberty & PregnancyAdolescence Adult
TZ
Menopause
TZ
-Pre-pubertal SCJ is inside the external os.
-After the menarche ectropion “eversion of columnar epithelium into the vagina”.
-Adulthood SCJ at the external os due to physiological metaplasia.
-Postmenopausal inversion of the cervix.
43. 43
The Normal Cervix
Squamo-columnar junction (SCJ)
2 types are described:
1. The original (native) SCJ:
This is present from birth.
The exact location of the SCJ varies between individuals and at
various stages in an individual’s life.
2. The acquired (new) SCJ:
At the time of puberty cervix and uterus enlarge cervical
eversion more of the columnar epithelium is exposed to the
high vaginal acidity metaplasia new SCJ at the junction
of the metaplastic area and columnar epithelium.
45. 45
The Normal Cervix
Squamo-columnar junction (SCJ)
TZ = the area between new and original SCJ
External os
New SCJ
Metaplasia
Original SJC
mature
immature
46. 46
The Normal Cervix
Squamous Metaplasia
It is the replacement of columnar epithelium by stratified squamous
epithelium.
Various stages from immature to mature may be recognized on
colposcopic examination inexperienced colposcopist may confuse
immature metaplasia with abnormality.
It is a normal, irreversible, physiological process.
Its maximum occurrence is during times of high oestrogenic
stimulation e.g. adolescence, while taking COC, and during the 1st
pregnancy.
47. 47
The Normal Cervix
Squamous Metaplasia
Colposcopic features suggestive of metaplastic change:
1. Smooth surface with fine, uniform-calibre vessels.
2. Slight aceto-white change with application of acetic
acid.
3. No or partial brown staining with application of
Lugol’s iodine.
50. 50
The Normal Cervix
Transformation Zone (TZ)
It is the area between the original and new SCJ.
It contains columnar and squamous metaplastic epithelium
of varying maturity.
It is of variable shape and width.
Recognition of the TZ and its varying stages of metaplasia
is mandatory for colposcopic practice.
TZ is a dynamic region of the epithelium and deviation to
abnormality occurs within the unstable metaplastic
epithelium.
51. 51
The Normal Cervix
Transformation Zone (TZ)
Components of a normal TZ may be:
– Islands of columnar epithelium surrounded by metaplastic
squamous epithelium, gland openings and Nabothian cysts.
52. 52
The Normal Cervix
Transformation Zone (TZ)
Components of a normal TZ may be:
– Islands of columnar epithelium surrounded by metaplastic
squamous epithelium, gland openings and Nabothian cysts.
TZ at periphery & a patch on the anterior lip
gland openings
53. The Normal Cervix
Transformation Zone (TZ)
Active TZ at periphery & a separate
area on the anterior lip
8 month later, TZ is progressing
55. The Normal Cervix
Transformation Zone (TZ)
When TZ is advanced, various shades of
brown may appear according to the
maturity of metaplastic epithelium
This TZ has a stippled appearance
with iodine due to the various stages
of maturity of metaplastic epithelium
64. 64
The Normal Cervix
Ectropion
It relates to the eversion of the columnar epithelium so that it is visible
in the vaginal portion of the cervix.
Although a physiological phenomenon, it can cause confusion in
colposcopic assessment, especially if large and fragile.
67. 67
The Normal Cervix
Normal Menopause
Oestrogen deficiency produces significant changes to
cervix:
1. ↓ vasculature and interstitial fluid.
2. Flattening of the endocervical epithelium.
3. TZ recedes within cervical canal ↑ rate of inadequate smears.
4. Thinning of the squamous epithelium ↑ susceptibility to minor trauma
subepithelial petechiae.
5. Poorly glycogenated epithelium.
6. ↓ mucous production.
68. 68
The Normal Cervix
Colposcopic appearance of menopausal cervix
1. Colposcopy is difficult because of:
1. Atrophic changes
2. Discomfort
2. Examination is more likely to be unsatisfactory as the SCJ
recedes and the TZ may not be visualized in its entirety.
3. The use of Kogan’s endocervical speculum may help
visualizing the lower 1 cm of the cervical canal; however,
this may be difficult if the os is stenosed.
69. 69
The Normal Cervix
Colposcopic appearance of menopausal cervix
4. Acetic acid may not give significant effect because of lack
of vasculature and thinning of the epithelium.
5. Lugol’s iodine can give patchy yellow appearance because
of lack of glycogen (in older women, it may be uniformly
yellow because of complete absence of gylcogen).
70. The Normal Cervix
Normal Menopause
-The menopausal cervix stains light brown to yellow with iodine
-The dark spots are due to subepithelial haemorrhages (petechiae)
71. 71
The Normal Cervix
Normal Menopause
The use of local vaginal oestrogen for 2-4 weeks may
reverse some of the atrophic changes improve
appearance of TZ
1. ↓ rate of unsatisfactory colposcopy.
2. May reverse borderline cytological abnormalities.
72. 72
The Normal Cervix
Pregnancy and Puerperium
Colposcopy is difficult as pregnancy advances (no much
changes in the 1st trimester) because of:
1. Cervix gets enlarged and softer.
2. Eversion of the endocervical canal due to increased vascularity
and interstitial oedema.
3. Polypoid appearance of the columnar epithelium due to the
hypertrophy of the villi and the decidual changes.
4. TZ is enlarged with marked active metaplasia.
5. Thick tenacious mucous production.
6. ↑ Vascularity acetowhite reactions of CIN (density, mosaicism
and punctation) are more pronounced overdiagnosis.
73. 73
The Normal Cervix
Pregnancy and Puerperium
Smears taken during pregnancy and early puerperium
(within 6 weeks) are usually of suboptimal quality because
of:
1. Epithelial changes and enlarged TZ.
2. Progestogenic effect clumping of the cells
difficult analysis on a conventional smear.
3. Decidual changes large cells may be confused
with dyskariosis or glandular abnormality.
74. 74
The Normal Cervix
Pregnancy and Puerperium
The main aim of colposcopy is to rule out invasive disease
and help pursue conservative management until after
delivery.
If there is no suspicion of invasive disease conservative
management with cytology and colposcopy each trimester
re-evaluation 8-12 week postpartum.
75. 75
The Normal Cervix
Pregnancy and Puerperium
Treatment of CIN is almost never indicated during
pregnancy.
Biopsies should only be undertaken if there is suspicion
of invasive disease.
Punch biopsies are not recommended since they are
usually insufficient to rule out invasive process.
The biopsy should be a cone performed in theatre (risk of
significant haemorrhage, infection, preterm labour and/or
miscarriage).
76. 76
The Normal Cervix
Nabothian Cysts
They occur when cervical gland openings get covered mucous
collection within.
Biopsy is not justified.
They do not require any treatment.
78. Colposcopy Flow Chart
See & Treat
Cervical biopsy
Apply acetic acid 3-5% Suspicious cervix manage accordingly
Identify SCJ
SCJ seen SCJ not seen
No lesion visualizedLesion visualized
Assess site, size & degree
± Schiller’s test
Colposcopy deemed satisfactory Colposcopy deemed unsatisfactory
Gross inspection of cervix to its entirety
Look for leukoplakia or abnormal vessels
Use green filter
79. To be a good colposcopist you have to persevere!