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Colposcopy.Pdf CCololppooscoscoppyy ► Chris DeSimone, M.D. ► Gynecologic Oncology ► Images from Colposcopy Cervical Pathology, 3rd Ed., 1998 HistoHistorryy ► ColColpposcopyoscopy wwasas ppiioneeredoneered inin GGeermrmaanyny bbyy DrDr.. HinselmannHinselmann dduriurinngg tthhee 19201920’s’s ► HeHe sousougghtht ttoo prprooveve ththaatt micmicrroscopicoscopic eexaminxaminaationtion ofof thethe cervixcervix wouwoulldd detectdetect cervicalcervical ccancanceerr eeararlliierer tthhaann 44 ccmm ► HisHis workwork identidentiifiefiedd severalseveral atatyypicalpical appeappeararanancceses whwhicichh araree stistillll usedused ttooddaay:y: . Luekoplakia . Punctation . Felderung (mosaicism) Colposcopy Cervical Pathology 3rd Ed. 1998 HistoHistorryy ► ThrThrooughugh thethe 3030’s’s aanndd 4040’s’s brbreaeaktkthrhrouougghshs wwereere mamaddee regregaarrddinging whwhicichh aapppepeararancanceess wweerere moremore liklikelelyy toto prprogogressress toto invinvaasivesive ccaarcinomrcinomaa;; HHOOWEWEVVERER,, ► TheThessee ffiinndingsdings wweerere didifffficiculultt toto inteinterrpretpret sincesince theythey werweree notnot corcorrrelatedelated wwithith histologhistologyy ► OneOne resreseaearcrchherer wwouldould claclaiimm hhiiss ppatatientsients wwithith XX ffindindiingsngs nevernever hahadd ccaarcinomarcinoma whwhililee aannothotheerr emphemphaatiticcallyally belibelieevedved itit diddid ► WorldWorld wiwidede colposcopycolposcopy waswas uunnderderuutitillizizeedd asas aa diadiaggnosticnostic tooltool sseeconcondadaryry ttoo tthheseese discrepadiscrepannciescies HistoHistorryy ►►PapaniPapanicocolaoulaou aanndd TraTrauutt rrevevoolutionlutioniizezedd scrscreeeeninningg ofof cecerrvvicicaall cancecancerr wwitithh cytocytollogogyy ►►IItt wwaass easyeasy ttoo ccoolllelectct aanndd prprovideovidedd aa moremore obobjejecctitivvee findinfindingsgs tthahann cocollpoposscocoppyy ►►PapPap tetestingsting wwaass rarapidlpidlyy acceacceptpteded iinn NNororthth AAmmeriericcaa andand WWestesteernrn EEururoopepe asas tthhee scrscreeeeninningg tteestst ooff cchohoicicee ►►IItsts acaccceeptptanceance inin GermGermaannyy wawass ppoooror Papanicolaou, Traut: Diagnosis of uterine cancer by the vaginal smear, 1943 HistoHistorryy ► DuringDuring tthehe 6060’s’s ccolposcopyolposcopy mmaadede aa reressuurrgencegence ► NeNeww ststuudiesdies shshoowedwed tthhatat detectiondetection ofof ccaarcinomrcinomaa-- iinn--sisittuu (C(CIISS)) oorr ininvvasiasivvee cacarrcincinoomama werweree betbettterer detecteddetected byby combcombiiningning cytologycytology wwithith colcolpposcopicoscopic directeddirected biopsiesbiopsies . Total 838 cases . Colposcopy 663 (79%) . Cytology 729 (87%) . Combination 828 (99%) Navratil: Dysplasia, CIS and microinvasive carcinoma of the cervix uteri: Colposcopy, 1964. HistoHistorryy ►►TodTodayay ccoollpoposcoscoppyy hashas bebeeenn acceacceptpteded asas aa ddiaiagngnosostticic ttooooll inin eevavalluauatintingg ababnnormalormal ppapap teteststss ►►CCololpoposscocoppyy elelegaegantlntlyy iidentifidentifieses tthehe llocaocatitionon ofof aabbnnoormrmaall leslesiiononss allalloowwiningg ththee practpractitiitioonenerr ttoo obobtataiinn hhiiststololooggiicc sasammplpleses ►►IItsts utilityutility asas aa scrscreeeeninningg tteestst iiss lilikkelelyy finfinishisheded iinn westewesternrniizedzed nanatitiononss OOvververvieieww ►►CyCyttologicologic indicatindicatiioonsns foforr colpcolpososcocoppyy ►►CyCyttoollogogicic correlacorrelatiotionn wwitithh hhiissttololooggyy ►►ToolTools,s, TTecechniquhniqueses aanndd stastaininss ooff cocollpoposscocoppyy ►►NoNorrmalmal cocolplposcooscoppiicc ananaattoommyy ►►AbnAbnormalormal ccoollpoposcoscoppicic ananaattoommyy ►►UUnunusuasuall cocollpoposscocopipicc anatanatomomyy ►►TrTreeatmeatmenntt ofof aabbnnoormrmaall hihistostollogogyy IInndidiccatioationnss fforor CCololppooscoscoppyy ►►AbnAbnormalormal ppapap ttestsests susugggegestivstivee ofof cceervirvicalcal ddyyspsplalassiaia ►►TyTyppeses aarere claclasssisiffiieded acacccorordindingg ttoo BBeeththesesddaa 22000011 nnomomeenncclalattururee ►►BeBestst toto ddelielineateneate whwhiichch pappap tteestssts correlcorrelatatee wwithith mimilldd ddyysplsplasiasiaa andand ththoseose wwhihichch areare moremore sesevvereree 20012001 BBethetheessddaa NNoomenmenclclaattureure ► MildMild dysdyspplasilasiaa ► SevereSevere ddysplasiysplasiaa . HPV effect (Human . ASC-H (Cannot rule Papilloma Virus) out HGSIL) . ASC-US (Atypical . HSIL (High Grade Squamous Cells of Squamous Unknown Significance) Intraepithelial Lesion) . LSIL (Low Grade . CIS (Squamous Squamous Carcinoma In-Situ) Intraepithelial Lesion) 20012001 BBethetheessddaa NNoomenmenclclaattureure ►►GlaGlandulndularar aabbnnoormrmaalitlitiieess ►►SShhoulouldd bebe hahandndlleded wwitithh ututmostmost cacautioutionn .. AGAGCC (Atypica(Atypicall GlandulGlandulaarr CCeelllsls ofof UUnknnknoownwn SigniSignifficance)icance) .. AAIISS (Adenoc(Adenocaarcinomarcinoma IInn--SiSittu)u) ►►BBiiopopsysy memeddialial ttoo tthehe ttranranssfoforrmatmatiionon zzononee FrFreeqquueennccyy ofof AbAbnnoorrmmaall PPaapp TTeeststss ► Estimated 50 million pap tests are performed each year ASCUS ► 5% are LGSIL abnormal HGSIL abnormal Cancer ► 2-3 Million ASCUS ► 1 Million LSIL ► 600,000 HSIL HistoHistollogicogic NNoomenmenclclaattureure ►►CCIINN (C(Ceerrvviiccalal InIntraetraepitpithhelielialal NeNeoploplasiasiaa)) .. CICINN 11 ccoorrreresspoponndsds ttoo mmiilldd dydyssplasiplasiaa .. CICINN 22 ccoorrreresspoponndsds ttoo modemoderaratete dysplasidysplasiaa .. CICINN 33 ccoorrreresspoponndsds ttoo severesevere dysdyspplasilasiaa .. CICISS aanndd CICINN 33 aarree thethe ssaameme entityentity HistHistopaopatholtholooggyy OOvververvieieww ►►CyCyttoollogogicic indindicaicationtionss ffoorr cocollpoposscocoppyy ►►CyCyttologicologic cocorrrelatrelatiionon withwith histologyhistology ►►ToolTools,s, TTecechniquhniqueses aanndd stastaininss ooff cocollpoposscocoppyy ►►NoNorrmalmal cocolplposcooscoppiicc ananaattoommyy ►►AbnAbnormalormal ccoollpoposcoscoppicic ananaattoommyy ►►UUnunusuasuall cocollpoposscocopipicc anatanatomomyy ►►TrTreeatmeatmenntt ofof aabbnnoormrmaall hihistostollogogyy HistoHistollogicogic ccororrreelatilatioonn ►►AsAs aa cocollpoposscocopipisstt,, hhiistostollogogyy isis moremore iimpmportortanantt tthahann ccytoytollogogyy ►►TheThe ccytoytollogogyy isis iimpmportortanantt fforor ttwowo reareassoonns:s: .. 1)1) indicationindication toto perfoperforrmm ccoolposcopylposcopy .. 2)2) ggiivesves tthehe colposcopistcolposcopist aa “hin“hintt”” ofof thethe histologyhistology ►►HiHistostollogogyy isis iimpmportortanantt fforor ddeettermerminininingg papatitieenntt treatmtreatmenentt ►►CyCyttoollogogyy dodoeses nnoott eqequauall hhisistotollogogyy HistoHistollogicogic ccororrreelatilatioonn ►►ASCASC--UUSS .. MosMostt cocommmonmon tytyppee ofof aabbnnoormarmall papapp .. IsIs itit aa prpremalignemalignaantnt chchanange?ge? .. No!No! RoughlyRoughly 770%0% ofof AASSCC--USUS ppaapsps aarere rreelatelatedd toto vvaaginitis,ginitis, aattrroophphy,y, ggraranulnulaationtion tisstissuue,e, chronicchronic cervicicervicittis,is, etcetc .. OnlOnlyy 3030%% araree dyspldysplaasticstic iinn nanaturturee ► 90% are CIN 1 ►5-10% are CIN 2-3 Morin et al. J Reprod Med, 2001 HistoHistollogicogic ccororrreelatilatioonn ►►LLSISILL .. CoCommmon,mon, 11 mmilillliionon ppaappss diadiaggnosnoseedd eeaachch yeayearr .. MosMostt errerrooneoneouuslysly mamannageagedd papapp testestt.. WWhhy?y? ►Pap repeated frequently ►HPV testing .. 330%0% ofof LLSILSIL ppaappss hhararborbor CICINN 22 andand CICINN 33 onon colcolpposcopicoscopic ddirectedirected biopsiesbiopsies .. ColColpposcopyoscopy nneedseeds toto bebe donedone fifirstrst aandnd forforeemostmost toto aasscertaincertain hhistoistollogicogic diadiaggnosisnosis HistoHistollogicogic ccororrreelatilatioonn ►►ASCASC--HH .. 2828--440%0% ofof thesethese ppaapp testtestss areare CICINN 22--33 onon histologihistologicc biopsbiopsyy .. AAcccordicordinngly,gly, HPVHPV testingtesting isis positivepositive 7070--886%6% .. ColColpposcopicoscopic eexaminxaminaationtion wwiillll revealreveal aa wwiiddee rrananggee ofof ffindindiingngss ►►HHSISILL && CICISS .. ExpExpeectct wwoorrrisomerisome colcolpposcopicoscopic abnabnorormalimalittiesies wwithith thethessee pShperaamappn. Am tete J Clissn tsPathtsol 2001 CCololppooscopicscopic CCororrreelatilatioonn ► MildMild dysdyspplasilasiaa ► SevereSevere ddysplasiysplasiaa . Acetowhite changes . Dull, pearly grey . Bright white epithelium . Clear demarcation . Faint to difficult to between normal and interpret demarcation abnormal epithelium between abnormal and normal epithelium . Fine punctations normal epithelium . Coarse punctations . Mosaicism . Abnormal vessels OOvververvieieww ►►CyCyttoollogogicic indindicaicationtionss ffoorr cocollpoposscocoppyy ►►CyCyttoollogogicic correlacorrelatiotionn wwitithh hhiissttololooggyy ►►ToToools,ls, TTeecchnhniiqqueuess aandnd staistainnss ofof colpcolpososcocoppyy ►►NoNorrmalmal cocolplposcooscoppiicc ananaattoommyy ►►AbnAbnormalormal ccoollpoposcoscoppicic ananaattoommyy ►►UUnunusuasuall cocollpoposscocopipicc anatanatomomyy ►►TrTreeatmeatmenntt ofof aabbnnoormrmaall hihistostollogogyy TTooololss,, TTeecchhnniiqquueses && SSttaaininss ►►CCololpoposscocoppee .. SteSterreoscopiceoscopic binoculabinocularr mmicicrosrosccopeope .. MMagagninificficatioationn fromfrom 88×× toto 4400×× .. GeGennerallyerally ppaanonoraramimicc viviewew atat 1010×× mostmost useuseffulul .. AA greengreen fifilterlter ►Used to highlight vascular patterns ►Demarcate color differences
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