Colposcopy and Treatment of Cervical Intraepithelial Neoplasia - RHO

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Avoiding errors in the colposcopic assessment of the cervix and colposcopic provisional diagnosis Table 10.2: A summary of colposcopic features guiding provisional diagnosis Diagnosis Colour tone Demarcation Margin Acetowhitening Surface Relation to TZ and SCJ Vascular Duration of features effect Normal - - - - - - Normal vascular pattern Normal, immature metaplasia Pinkish white, Nil or snow white, translucent, patchy acetowhite areas Indistinct, blends with the rest of the epithelium Smooth; crypt openings, islands of columnar epithelium seen Restricted to TZ; < 1 minute prominent near the SCJ Normal vascular pattern Normal, mature metaplasia Light pinkish Nil white hue. No confluent acetowhite area Blends with the rest of the epithelium Smooth, reveals crypt openings, nabothian follicles Restricted to TZ - Normal vascular pattern Inflammation Pale, patchy Nil areas, with intervening red areas and/or necrotic areas Indistinct, blends with the rest of the epithelium Irregular, variegated appearance Not restricted to < 2 minutes TZ, may be widely disseminated Diffusely distributed, fine red punctation involving cervix and vagina Low-grade CIN Moderately dense, shiny, opaque, thin lesions Well demarcated confluent lesions Irregular, feathery, jagged, digitating, angular or geographic Flat, smooth or microcondyloma -tous or micropapillary Mostly seen in the 1-2 minutes TZ, abuts the SCJ. Very early lesions may be outside TZ as satellite lesions Fine punctation and/or mosaic with in the AW lesion may be seen Iodine uptake Squamous epithelium black in colour; columnar epithelium, no change in colour No or partial uptake Takes up iodine, turns black or brown Partial iodine uptake No uptake Bleeding on touch Nil Nil Nil May be present Nil Ulceration Nil Nil Nil May be present Nil Discharge Clear secretion from the columnar epithelium Clear secretion from the columnar epithelium Clear secretion from the columnar epithelium Malodorous, profuse, mucopurulent or seropurulent or non-odorous thick, sticky, white discharge Nil 87
Chapter 10 Table 10.2 (cont.): A summary of colposcopic features guiding provisional diagnosis Diagnosis Colour tone Demarcation Margin Acetowhitening Surface Relation to TZ and SCJ Vascular Iodine uptake Duration of features effect High-grade CIN Dull, dense, greyish-white or oyster-white opaque lesion Well demarcated confluent lesions; internal demarcations and borders may be present Regular, smooth outlines; occasionally may be raised and rolled out Less smooth, more irregular and/or occasionally nodular surface Restricted to TZ, 2-4 minutes abutting the SCJ Coarse No iodine uptake punctation and/or coarse mosaic within the AW lesion may be seen; atypical vessels may be seen (+) Preclinical invasive cancer Chalky white, Well demarcated thick, dense, opaque lesions Raised and rolled out margins Irregular, nodular or mountains- andvalley pattern May involve the > 3 minutes entire cervix, large complex lesions obliterating the os Coarse raised No iodine uptake mosaics and/or breaking mosaics and/or, coarse punctations; atypical vessels always present (+++++) Overt invasive cancer Dense white areas, may be obliterated by profuse bleeding Entire cervix replaced by growth Entire cervix replaced by growth Ulceroproliferative growth Entire cervix replaced by growth extending to adjacent tissues Whiteness usually obliterated by bleeding Atypical vessels always present (++++++) No uptake, but bleeding obliterates iodine uptake patterns TZ: transformation zone ; SCJ: squamocolumnar junction; AW: Acetowhitening Bleeding on touch May be present in severe lesions Surface bleeding/- oozing common Profuse bleeding Ulceration Nil May be seen Always present Discharge Nil May be present due to secondary infection Malodorous, blood stained, purulent discharge due to secondary infection 88
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Colposcopy and Treatment of Cervica
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INTERNATIONAL AGENCY FOR RESEARCH O
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Published by the International Agen
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Contents 11 Management that provide
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Acknowledgements The authors gratef
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Preface Health care providers have
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Chapter 1 An introduction to the an
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An introduction to the anatomy of t
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Chapter 2 An introduction to cervic
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An introduction to cervical intraep
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Chapter 3 An introduction to invasi
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An introduction to invasive cancer
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Chapter 4 Table 4.1: Indications fo
Page 43 and 44:
Chapter 4 FIGURE 4.2: Colposcope wi
Page 45 and 46: Chapter 4 FIGURE 4.6: Endocervical
Page 47 and 48: Chapter 4 Table 4.2: Preneoplastic
Page 49 and 50: Chapter 5 between the two ocular le
Page 51 and 52: Chapter 5 Obtain specimens for labo
Page 53 and 54: Chapter 5 FIGURE 5.2: Biopsy techni
Page 55 and 56: Chapter 5 tissue tends to mimic inv
Page 57 and 58: Chapter 6 invasive carcinoma. Even
Page 59 and 60: Chapter 6 ages (Figures 1.7d, 1.7e,
Page 61 and 62: Chapter 6 FIGURE 6.7: The colour ch
Page 63 and 64: Chapter 6 Crypt openings Immature s
Page 65 and 66: Chapter 6 a FIGURE 6.17: An area of
Page 67 and 68: Chapter 7 The colposcopic diagnosis
Page 69 and 70: Chapter 7 appears as individual sma
Page 71 and 72: Chapter 7 acid stain is correlated
Page 73 and 74: Chapter 7 FIGURE 7.15: Moderately d
Page 75 and 76: Chapter 7 FIGURE 7.23: A dense acet
Page 77 and 78: Chapter 7 FIGURE 7.30: Mustard yell
Page 79 and 80: Chapter 7 We recommend that the stu
Page 81 and 82: Chapter 8 highlights this responsib
Page 83 and 84: Chapter 8 Appearance before applica
Page 85 and 86: Chapter 8 diagnosis of AIS and aden
Page 87 and 88: Chapter 8 a ↑ FIGURE 8.10: Adenoc
Page 89 and 90: Chapter 9 Inflammatory lesions of t
Page 91 and 92: Inflammatory lesions of the uterine
Page 93 and 94: Inflammatory lesions of the uterine
Page 95: Chapter 10 Table 10.1: Common sourc
Page 99 and 100: Chapter 11 FIGURE 11.1: Flow chart
Page 101 and 102: Chapter 11 treatment policies for p
Page 103 and 104: Chapter 11 Vaginal delivery can be
Page 105 and 106: Chapter 12 involvement increases wi
Page 107 and 108: Chapter 12 Table 12.1: Eligibility
Page 109 and 110: Chapter 12 a b c d e f FIGURE 12.6:
Page 111 and 112: Chapter 12 during the follow-up in
Page 113 and 114: Chapter 13 (2) (1) FIGURE 13.2: Ele
Page 115 and 116: Chapter 13 (1) (2) (3) (4) (5) (8)
Page 117 and 118: Chapter 13 Once the specimen has be
Page 119 and 120: Chapter 13 in the endocervical cana
Page 121 and 122: Chapter 14 Decontamination, cleanin
Page 123 and 124: Decontamination, cleaning, high-lev
Page 125 and 126: References Herrero, R. (1997) Preva
Page 127 and 128: Further reading Suggestions on furt
Page 129 and 130: Appendix Leukoplakia Condylom
Page 131 and 132: Appendix regardless of your pregnan
Page 133 and 134: Appendix Monsel’s paste Ingredien
Page 135 and 136: Appendix 5 The modified Reid colpos
Page 137 and 138: Index Acetowhitening . . . . . . .
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Colposcopy and Treatment of Cervical Intraepithelial Neoplasia - RHO

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