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Colposcopy Colposcopy Colposcopy GFMER

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					Colposcopy


 Attila L Major, MD, PhD
Histology          Colposcopy



                                It has been estimated that annual
                                Pap smear testing reduces a
                                woman’s chance of dying of
            Cytology            cervical cancer from 4 in 1000 to
                                about 5 in 10,000 – a difference
                                of almost 90%
Nomenclature


   CIN I       CIN II               CIN III


Mild        Moderate    Severe          Carcinoma in
Dysplasia   Dysplasia   Dysplasia       situ
Hinselmann, 1925
Squamous Epithelium


                                   Columnar
                                   epithelium




                             SCJ
                                            squamous
                                            epithelium
    basal
    layer




            Stratification
Squamous Epithelium
                                     stratified, non-
                                     keratinizing
                                     epithelium




      original squamous epithelium
Cytological features

                               The standard
                               method for
                               staining
                               cytological
                               preparations is
                               that of
                               Papanicolaou




         squamous epithelium
Squamous Epithelium

    parabasal cells




                      superficial cells
Columnar Epithelium
Columnar Epithelium
   epithelium
   Columnar
             Normal columnar epithelium is easily recognised by




                                                                     Columnar Epithelium
                                                                     Columnar Epithelium
             its characteristic grape-like or villous appearance.
             Following application of acetic acid, the villi often
             appear white and are more easily recognizable.
Columnar
epithelium
Normal Cevix, Colposcopy


Columnar
epithelium
                           Columnar
                           epithelium

              SCJ



                    SCJ

 original                   original
 squamous                   squamous
 epithelium                 epithelium
Transformation Zone




                      Original
                      SCJ
Immature metaplasia
Immature metaplasia
Mature metaplasia

                                    The new epithelium results
                                    from transformation of
                                    columnar to squamous
                                    epithelium, through the
                                    process of squamous
                                    metaplasia




       Normal transformation zone
CIN 1 & CIN 2




          Histology
   CIN 3




In CIN 3 differentiation and stratification
may be completely absent


                                              In early stromal invasion a group of cells
                    12% ; 2-10 years          have breached the epithelial/stromal
                                              junction
Acetowhite change
Acetowhite change
Acetowhite change
Acetowhite change
Acetowhite change
Acetowhite change
  Vascular pattern
  Vascular pattern
Vas
Vas
cula
cula
r
r
patt
patt
ern
ern
Invasive
Vulval condylomata acuminata
Condyloma
#1
#2
#3
#4
#5
Nomenclature
The concept of cervical
intraepithelial
neoplasia proposes           CIN I      CIN II            CIN III
that all degrees of
abnormality should be
given the same name,      Mild        Moderate    Severe      Carcinoma
as part of a continuous   Dysplasia   Dysplasia   Dysplasia   in situ

spectrum of disease
     ASC-US
                          ASCUS




Repeat cytology
 at 12 months
                        at 6 months
                                                                  pos



                  neg

                          Repeat                                        Repeat cytology
                                           pos    Colposcopy      neg
                         Cytology                                       at 6 & 12 months




                                                      pos




                                                 management of
                                                   histological
                                                  abnormalities




                        Management Option 2.
       ASC-US
                        ASCUS




Repeat cytology
 at 12 months
                                                                 pos



                  neg

                                                                       Repeat cytology
                         HP V             pos    Colposcopy      neg
                                                                       at 6 & 12 months




                                                     pos




                                                management of
                                                  histological
                                                 abnormalities


                        Management Option 1.
                                               HSIL




HSIL
                                    Colposcopy (with ECC)




                                          Satisfactory
                                                                 yes
                                          colposcopy



                                    no



                         Lesion                                   No Lesion                             Biopsy-
                       identified                                 identified                         confirmed CIN




                 yes                      no

                                                                   Review                            management of
                                                                               change in diagnosis
                                                                   material                            histological
                                                                                                      abnormalities

management of                        Diagnostic excisional
                                                             no change
  histological                            procedure
 abnormalities

                                         Management HSIL
                                             AGC




   AGC
                                    Colposcopy (with ECC)
                                Endometrial sampling (> 35 years)




                                        Invasive disease              yes
                                                                                        Refer to specialist




                                no


                                                                                       Diagnostic excisional
                                                            AGC - favor neoplasia
                                           Initial Pap                                 procedure (cold-knife
                                                                   or AIS
                                                                                           conization)



                                          AGC - NOS
                                                                                                               HSIL or AGC


management of                                                                        Repeat Cytology
                          yes              CIN or AIS               no
  histological                                                                      every 6 months (4x)
 abnormalities



             Management AGC (Atypical Glandular Cells )
       ASC-H                                  ASC-H




management of      Biopsy-confirmed CIN
                                            Colposcopy       neg                        Review of the material
  histological          any grade
 abnormalities




                                                                                 no change         Change in diagnosis



                                                                                                                 management of
                                                              Repeat cytology                                      histological
                                                              at 6 & 12 months
                                                                                                                  abnormalities




          Management ASC-H (cannot exclude high-grade SIL)
                                                       LSIL




LSIL
                                               Colposcopy (with ECC)




                                                    Satisfactory
                                                                          yes
                                                    colposcopy
                                     no




                                    Lesion
                                  identified                  no
                                                                          No Lesion       Biopsy-
                    yes                                                   identified   confirmed CIN



  ASC or CIN


                                                                                       management of
               management of                                                             histological
                                                       Repeat cytology                  abnormalities
                 histological
                                                       at 6 & 12 months
                abnormalities




                          Management LSIL
  LSIL                                               LSIL
                                                 Adolescents;
                                                    option




                                               Repeat Cytology
            negative                                              ASC or CIN
                                               at 6 & 12 months




 Routine                                                                  Colposcopic
Screening                                                                   Triage




               Management LSIL; Option : Adolescents
Histology          Colposcopy



                                It has been estimated that annual
                                Pap smear testing reduces a
                                woman’s chance of dying of
            Cytology            cervical cancer from 4 in 1000 to
                                about 5 in 10,000 – a difference
                                of almost 90%
Microglandular endocervical hyperplasia




   polypoidal villi



           non-pathologic condition
Project summaries

     text
Screening

     It has been estimated that annual
     Pap smear testing reduces a
     woman’s chance of dying of
     cervical cancer from 4 in 1000 to
     about 5 in 10,000 – a difference
     of almost 90%
Microglandular endocervical
hyperplasia

				
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