- Colleen M Feltmate, MD
Colleen M Feltmate, MD
- Assistant Professor
- Harvard Medical School
- Sarah Feldman, MD, MPH
Sarah Feldman, MD, MPH
- Associate Professor
- Harvard Medical School
Colposcopy is a diagnostic procedure in which a colposcope (a dissecting microscope with various magnification lenses) is used to provide an illuminated, magnified view of the cervix, vagina, and vulva (picture 1). Colposcopic evaluation of the cervix and vagina is based on the finding that malignant and premalignant epithelium have specific macroscopic characteristics relating to contour, color, and vascular pattern that are recognizable by colposcopy. The improved visualization of epithelial surfaces enhances the colposcopist's ability to distinguish normal from abnormal areas and to obtain directed biopsies from suspicious tissue. Colposcopy of the vulva, a keratinized epithelium, provides a magnified bright light examination. The primary goal of colposcopy is to identify precancerous and cancerous lesions so that they may be treated early.
In 2006, the American Society for Colposcopy and Cervical Pathology (ASCCP) convened a conference to create guidelines for management of women with abnormal cervical cancer screening tests and cervical intraepithelial neoplasia based on the best available evidence [1,2]. Multiple organizations committed to women's health and cancer care were represented at the conference. Colposcopy was recommended for the following general categories in adult women; (the recommendations were modified for adolescents):
- Specific cytological abnormalities:
- Persistent atypical cells of undetermined significance (ASC-US) or ASC-US with positive high-risk human papillomavirus (HPV) subtypes
- ASC suggestive of high-grade lesion (ASC-H)
- Atypical glandular cells (AGC)
- Low-grade squamous intraepithelial lesions (LSIL)
- High-grade squamous intraepithelial lesion (HSIL)
- Suspicious for invasive cancer
- Malignant cells present
These cytologic abnormalities and their management are described in detail separately. (See "Cervical and vaginal cytology: Interpretation of results (Pap test report)".) (See also individual topic reviews for each lesion).
- Massad LS, Einstein MH, Huh WK, et al. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Obstet Gynecol 2013; 121:829.
- www.ASCCP.org (Accessed on August 13, 2012).
- Chan YM, Lee PW, Ng TY, Ngan HY. Could precolposcopy information and counseling reduce women's anxiety and improve knowledge and compliance to follow-up? Gynecol Oncol 2004; 95:341.
- Takacs P, Chakhtoura N, De Santis T. Video colposcopy improves adherence to follow-up compared to regular colposcopy: a randomized trial. Arch Gynecol Obstet 2004; 270:182.
- Galaal K, Bryant A, Deane KH, et al. Interventions for reducing anxiety in women undergoing colposcopy. Cochrane Database Syst Rev 2011; :CD006013.
- MacLean AB. Acetowhite epithelium. Gynecol Oncol 2004; 95:691.
- Ferris DG, Litaker MS, ALTS Group. Prediction of cervical histologic results using an abbreviated Reid Colposcopic Index during ALTS. Am J Obstet Gynecol 2006; 194:704.
- http://screening.iarc.fr/viavilichap3.php?lang=1 (Accessed on August 13, 2012).
- Castle PE, Wentzensen N, Wheeler CM, et al. Effect of the number of biopsies on the subsequent acquisition of new human papillomavirus infections. Obstet Gynecol 2009; 114:1057.
- Schmid BC, Pils S, Heinze G, et al. Forced coughing versus local anesthesia and pain associated with cervical biopsy: a randomized trial. Am J Obstet Gynecol 2008; 199:641.e1.
- Church L, Oliver L, Dobie S, et al. Analgesia for colposcopy: double-masked, randomized comparison of ibuprofen and benzocaine gel. Obstet Gynecol 2001; 97:5.
- Pretorius RG, Zhang WH, Belinson JL, et al. Colposcopically directed biopsy, random cervical biopsy, and endocervical curettage in the diagnosis of cervical intraepithelial neoplasia II or worse. Am J Obstet Gynecol 2004; 191:430.
- Solomon D, Stoler M, Jeronimo J, et al. Diagnostic utility of endocervical curettage in women undergoing colposcopy for equivocal or low-grade cytologic abnormalities. Obstet Gynecol 2007; 110:288.
- Bornstein J, Sideri M, Tatti S, et al. 2011 terminology of the vulva of the International Federation for Cervical Pathology and Colposcopy. J Low Genit Tract Dis 2012; 16:290.
- American College of Obstetricians and Gynecologists. ACOG Practice Bulletin number 66, September 2005. Management of abnormal cervical cytology and histology. Obstet Gynecol 2005; 106:645.
- Cantor SB, Cárdenas-Turanzas M, Cox DD, et al. Accuracy of colposcopy in the diagnostic setting compared with the screening setting. Obstet Gynecol 2008; 111:7.
- Hopman EH, Voorhorst FJ, Kenemans P, et al. Observer agreement on interpreting colposcopic images of CIN. Gynecol Oncol 1995; 58:206.
- Ferris DG, Litaker M, ALTS Group. Interobserver agreement for colposcopy quality control using digitized colposcopic images during the ALTS trial. J Low Genit Tract Dis 2005; 9:29.
- Walker P, Dexeus S, De Palo G, et al. International terminology of colposcopy: an updated report from the International Federation for Cervical Pathology and Colposcopy. Obstet Gynecol 2003; 101:175.
- Underwood M, Arbyn M, Parry-Smith W, et al. Accuracy of colposcopy-directed punch biopsies: a systematic review and meta-analysis. BJOG 2012; 119:1293.
- Guido RS, Jeronimo J, Schiffman M, et al. The distribution of neoplasia arising on the cervix: results from the ALTS trial. Am J Obstet Gynecol 2005; 193:1331.
- Gage JC, Hanson VW, Abbey K, et al. Number of cervical biopsies and sensitivity of colposcopy. Obstet Gynecol 2006; 108:264.
- Jeronimo J, Schiffman M. Colposcopy at a crossroads. Am J Obstet Gynecol 2006; 195:349.
- Spitzer M, Apgar BS, Brotzman GL, Krumholz BA. Residency training in colposcopy: a survey of program directors in obstetrics and gynecology and family practice. Am J Obstet Gynecol 2001; 185:507.
- Wright TC Jr, Menton M, Myrtle JF, et al. Visualization techniques (colposcopy, direct visual inspection, and spectroscopic and other visual methods). Summary of task force 7. Acta Cytol 2002; 46:793.
- Alvarez RD, Wright TC Jr, Optical Detection Group. Increased detection of high-grade cervical intraepithelial neoplasia utilizing an optical detection system as an adjunct to colposcopy. Gynecol Oncol 2007; 106:23.
- Cardenas-Turanzas M, Freeberg JA, Benedet JL, et al. The clinical effectiveness of optical spectroscopy for the in vivo diagnosis of cervical intraepithelial neoplasia: where are we? Gynecol Oncol 2007; 107:S138.
- Balasubramani L, Brown BH, Healey J, Tidy JA. The detection of cervical intraepithelial neoplasia by electrical impedance spectroscopy: the effects of acetic acid and tissue homogeneity. Gynecol Oncol 2009; 115:267.
- - Repeat cervical cytology
- - Examination
- - Biopsies
- - Endocervical curettage
- VAGINAL COLPOSCOPY
- VULVAR COLPOSCOPY
- Visualization techniques
- Electronic screening techniques
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS