colposcopy 101 - MD Anderson Cancer Center

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colposcopy 101 - MD Anderson Cancer Center
COLPOSCOPY 101
Cervical Cancer Prevention ECHO
2015
Overview of Colposcopy
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Background
Purpose of Colposcopy
Colposcopic findings
Case studies
Background and History
• Colposcopy has been with us since about the 1930’s
• Pap smear was only implemented in the 1950’s
Purpose of Colposcopy
• DETECT Cervical Cancer
• Evaluate the abnormal Pap smear
• Detect and treat cervical dysplasia
How to
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Need Colposcope
5% acetic acid
Biospy forceps
Kevorkian curet
EXPERIENCE !!!
Colposcope
Instruments
When to
• LGSIL, HGSIL, AGC and ASC‐H Pap smears all need colposcopy
• ASC with high risk HPV needs colposcopy
• 2 consecutive ASC Pap smears need colposcopy
• Even pregnant patients with abnormal Pap smears can have colposcopy
How to Communicate the Findings
Colposcopy – satisfactory or unsatisfactory
• Sometimes called adequate
Description of appearance of lesion:
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Acetowhite
Mosaicism
Punctation
Abnormal vessels
Satisfactory vs. Unsatisfactory
• The entire transformation zone can be visualized
• The entire lesion can be visualized
Acetic Acid
• Acetic acid “stains” metaplastic and dysplastic epithelium
• The higher nuclear content of these epithelia blocks the transmission of light to the underlying stroma
Use of the Greenfilter
• The greenfilter assists in delineating abnormal vasculature
• “brings out” the abnormal vessels
• Works via selective absorption/reflection of light waves
Acetowhite Epithelium
• Cervical epithelium appears white with acetic acid
• Usually means HPV infection
Condyloma
• Acetowhite epithelium
• Raised, hyperkeratotic area
Mosaicism
• Tile‐like pattern in a background of acetowhite epithelium
• Usually a hallmark of CIN II
Punctation
• Hairpin capillaries seen on end in a background of acetowhite epithelium
• May be coarse or fine
• Usually indicative of a high grade lesion
Abnormal Vessels
• Irregular, non‐branching blood vessels
• Abrupt changes in direction
• Usually indicative of at least a high grade lesion vs. early cancer
How to Put it All Together
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Abnormal Papsmear
Colposcopy
Recognize the patterns
Take biopsies and do ECC if necessary
Treat appropriately

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