Condyloma, ectopy and papilloma are of importance
• Colposcopy findings
Normal colposcopic columnar epithelium- red grape like
structures with furrows
Squamous epithelium- homogenous grey
• Abnormal findings-
• White epithelium- leukoplakia
Leucoplakia must be looked for before applying acetic acid
It is a white area of thickened epithelium seen on the portio by
the naked eye or by means of a colposcope
Caused by a layer of keratin on the surface of the epithelium
Immature squamous epithelial cells develops into keratin
producing cells or glycogen producing cells
Keratin production is abnormal in cervicovaginal mucosa
• Caused by HPV; keratinizing CIN; keratinizing carcinoma; chronic trauma from diaphragm, pessary or tampon and radiotherapy
• Condylomatous reactions caused by HPV may appear frond-like
or can lead to leucoplakia
• Biopsies should be taken especially when they arise from the
transformation zone. • Frank invasive carcinoma can be identified before the application of acetic acid by the presence of the following:
microexophytic epithelium—the surface is irregular, raised or
ulcerated; atypical corkscrew or comma-shaped vessels of irregular calibre and branching pattern are seen
Viewing the lesion through a green filter allows clearer
demonstration of the vasculature. • Acetowhite epithelium-
• Epithelium that turns white after application of acetic acid
(3%-5%) is called acetowhite epithelium
• The application of acetic acid coagulates the proteins of
nucleus and cytoplasm and makes the protein opaque and white
• The acetic acid does not affect mature, glycogen producing
epithelium
• These areas appear pink during colposcopy
• Dysplastic cells are most affected- contains large nuclei with abnormally large amounts of chromatin
• The columnar villi – Less dark red and the pale
acetowhitening of the villi may resemble a grape-like appearance
• Metaplastic epithelium- grey and filmy
• Punctation
• Dilated capillaries terminating on the surface appear from the
ends as collection of dots
• Occurs in a well demarcated area of acetowhite epithelium-
abnormal epithelium- CIN
• The punctate vessels are formed as the metaplastic epithelium
migrates over the columnar villi
• CIN- capillary persists and appears more prominent
• Mosaics
• Terminal capillaries surrounding roughly circular or polygonal
shaped blocks of acetowhite epithelium crowded together
• Arise from coalescence of many puntate vessels or from the
vessels that surround the cervical gland openings
• Higher grade lesions, CIN-2 and CIN-3
• Atypical blood vessels with irregular diameter and
branching- invasive carcinoma
• Irregular surface contour with ulceration and friability
• Biopsies may be taken from suspicious areas under colposcopic guidance
• Bleeding can be controlled with the application of Monsel’s or
silver nitrate solution or by a pack
• The application of Lugol’s iodine used to be done routinely in
the past—abnormal epithelium did not take up the stain as the dysfunctional dysplastic cells were devoid of glycogen
• However, this is not mandatory if a thorough colposcopic
examination has been done. • Colposcopy can
Avoid unnecessary biopsy if the findings are normal
Select the appropriate site of biopsy
Reduce the size of biopsy and conization
• Colposcopy-restricted to first trimester pregnancy- causes
bleeding besides causing discomfort once fetal head enters the pelvis • Reid colposcopic index Colposcopic Zero point One point Two points signs Colour of Low-intensity Grey-white AW Dull, oyster-white; acetowhite acetowhitening; with shiny Grey (AW) area snow-white, shiny surface AW; indistinct AW; transparent AW; AW beyond the transformation zone AW lesion Feathered margins; Regular lesions Rolled, peeling margin and angular, jagged with smooth, edges; internal surface lesions; flat lesions straight demarcations (a configuration with indistinct outlines central area of margins; highgrade change microcondylomatous and peripheral or micropapillary area of lowgrade surface change) Vessels Fine/uniform vessels; Absent vessels Well defined coarse poorly formed patterns punctation or of fine punctuations coarse mosaic and/or fine mosaic; vessels beyond the margin of transformation zone; fine vessels within microcondylomatous or micropapillary lesions Iodine staining Positive iodine uptake Partial iodine Negative iodine giving mahogany up-take by a uptake by a lesion brown colour; negative lesion scoring 4 scoring 4 or more uptake of lesions or more points points on the above scoring 3 points or less on above three three criteria on above three categories – categories variegated, speckled appearance Colposcopic prediction of histologic diagnosis using the reid colposcopic index
RCI Overall score Histology
0-2 Likely to be CIN-1 3-4 Overlapping lesion 5-8 Likely to be CIN 2-3