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What is a Colposcope?
Colposcope
Stereoscopic, Binocular Microscope with 3 specifications: low magnification (10 40) * Focal length (20 25 CM) Width of visual field > 25 MM. - NB: Colpomicroscope (150 200)
Value of Colposcopy
1. Fill the gap bet. N/E & Cytopathology. 2. Early detection for precancerous lesions of lower genital tract (CIN, VAIN, VIN). 3. Decrease diagnostic conization and hysterectomy. 4. Complementary for cytology or VIA (Each one cover the disadvantages of the other).
Instrument
1.Colposcope:
Optical system ( 7.5 40 ). Illumination system ( Dim or Bright ). Stand (Easy movement). Accessories ( Gray filter Camera +Electronic flash ).
Instrument cont
2.Auxillary:
Set for cytology. Set for Biopsy. Speculae ( non polished or plastic ) & Kogans. Chemicals( Lugols Iodine - Acetic acid 3% - Monsols sol .saline) Cotton Buds-singleys forceps iris hook
Instrument cont..
III-extra auxillary:
Eye piece. Video printer. Computer graphic.
TERMINOLOGY
Anatomical Terminology
1. Ectocervix (= vaginal surface of CX.). 2. Endocervix (= cervical canal). 3. Eversion (Dynamic process) may be true (erosion) or false (ectropion).
TERMINOLOGY cont..
Pathological terminology
Metalplasia. Dysplasia (BET SQU. Epith & CIS.) (Dediff. + disarrangement). CIN (I, II, III). Micro invasive (< 5mm + no vascualr and lymphatic extension). Invasive carcinoma: Hyper keratoses : (= leukoplakia) Parakeratosis.
HISTOLOGICAL TERMINOLOGY
Epith.
Covering:
. Squamous. . Columnar
Original epithelia
Underlying
Stroma.
Cytological Terminology
Smear comment
*positive smear. *negative smear. *doubtful Smear.
Dyskaryotic cell
( N/C Anisocytosis HyperchromsiaClumping).
Colposcopic Terminology
Many classifications
Graz 1975
I) Normal colposcopic findings I) Normal
Rome 1990
II) Abnormal colposcopic finding: a) Atypical T.Z.: b) Suspect Frank invasive carcinoma.
III) Unsatisfactory (indecisive) Colposcopic findings. IV) Miscellaneous colposcopic findings
II) Abnormal colposcopic findings: A) Within the transformation zone. B) Outside the transformation zone e.g. ectocervix, vagina.
III) Colposcopically suspect invasive cancer. IV) Unsatisfactory colposcopy
Transformation zone TZ
Definition:
The area between the original squamocolumnar junction caudally (which is now squamo _Metaplastic junction) to the current (secondary) squamo Metaplastic columnar junction cranially (where islands of physiological Metaplastic Epithelium is identified)
Indications
I) Diagnostic:
Abnormal pap, smear.VIAM Any suspicious lesion (CX Vagina vulva). In utero exposure to diethyl stilbestrol (or) related drugs. Infertility (?) [cervical factor]. Sexual assault victims.
II) Therapeutic:
Role of Colposcope
1. During Diagnosis:
Localization of TZ
Prove (or) disprove invasive cancer. Localization of the most ABN. Site for biopsy. Evaluation of extent (need for Conization).
Suitability of the lesion for local destruction. Indications for conization: No Colposcopic lesions (+ve pap. Smear). Too extensive lesion. ECC Atypia. Micro invasion by Colposcopy + Biopsy. Extensive CIN III but fertility is needed.
Counseling:
Exam.
Inspection. Bimanual exam, (?!). Insertion of speculum (precautions).
B) Amplified:
Acetic
Acid 3% (3 4 min).
Intercapillary distance.
Contour (surface pattern).
Keratosis.
Aceto
Iodine
uptake.
gland openings.
Cervical
Interpretation
Colposcopic Benign Aspect Pre & Maling. Criteria aspect 1. Vascular pattern Fine Regular Coarse & ABN. 2. Intercap. Distance Within N. range Large than N. 3. Contour Smooth Irregular elevations and valleys.
4. colour tone
Reddish Grey Yellow reddish yellow whitish grey & Fatty glazy
Interpretation
Colposcopic Criteria Benign Aspect
cont
Pre & Maling. aspect
Diffuse
- Localized - peripheral + I2 positive strip intervening Fine
Sharp
- Widely spread. - Within C. canal or directed towards it. Coarse & crusty
7. Keratosis
8. Acetowhite Area
9. Iodine uptake 10. Cervical gland openings
Slight to moderate
Well delineated sharp
Intense
Weak or serrated
Pitfalls of Colposcopy
1. False squamo- columnar j.(finger speculum smear ). 2. High squamo columnar J. in canal (> 5mm up). 3. Previously treated cervix by cryo, or laser. 4. Adenocarcinoma in situ (difficult) - hysterocolpomicroscope. 5. Subjective method (cervicography & digital color imaging Colposcopy (DCIC) are objective methods.
Lines of Treatment
1. No treatment. 2. Follow up. 3. Local destructive therapy (Electro coagulation diathermy cryocautery cold coagulation laser , photodynamic). 4. Cone biopsy. 5. Hysterectomy.
Recommendations
Colposcopy is not a difficult procedure, but without good training, maximum benefits are not realized and serious mistakes can be made. In modern practice, Colposcopy has become an integral part of the gynecologic examination.
Recommendations
cont
vacuum, rather it must be performed in combination with cytology ,VIA and tissue sampling. Cervicography , digital colour imaging Colposcopy (DCIC) & computer aided colposcopy are objective rather than subjective methods.