- 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, vulva, or anus (picture 1) . The primary goal of colposcopy is to identify precancerous and cancerous lesions so that they may be treated early.
Colposcopy is performed most commonly of the cervix, and is the main focus of this topic. It is used as further evaluation of abnormal cervical cancer screening tests (cytology and/or human papillomavirus testing).
Colposcopic evaluation is based on the finding that malignant and premalignant epithelium have specific visual characteristics in terms of contour, color, and vascular pattern that are recognizable using colposcopy. The improved visualization of epithelial surfaces with colposcopy compared with gross visual examination enhances the colposcopist's ability to distinguish normal from abnormal areas and to obtain directed biopsies.
The techniques for colposcopy of the female lower genital tract are reviewed here. Related topics are discussed in detail separately, including:
●Cervical cancer screening (see "Screening for cervical cancer")
- Pierce JG Jr, Bright S. Performance of a colposcopic examination, a loop electrosurgical procedure, and cryotherapy of the cervix. Obstet Gynecol Clin North Am 2013; 40:731.
- 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.
- 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).
- Herfs M, Yamamoto Y, Laury A, et al. A discrete population of squamocolumnar junction cells implicated in the pathogenesis of cervical cancer. Proc Natl Acad Sci U S A 2012; 109:10516.
- Schiffman M, Castle PE, Jeronimo J, et al. Human papillomavirus and cervical cancer. Lancet 2007; 370:890.
- 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.
- Carwile JL, Feldman S, Johnson NR. Use of a simple visual distraction to reduce pain and anxiety in patients undergoing colposcopy. J Low Genit Tract Dis 2014; 18:317.
- Gajjar K, Martin-Hirsch PP, Bryant A, Owens GL. Pain relief for women with cervical intraepithelial neoplasia undergoing colposcopy treatment. Cochrane Database Syst Rev 2016; 7:CD006120.
- MacLean AB. Acetowhite epithelium. Gynecol Oncol 2004; 95:691.
- Marina OC, Sanders CK, Mourant JR. Effects of acetic acid on light scattering from cells. J Biomed Opt 2012; 17:085002.
- http://screening.iarc.fr/viavilichap3.php?lang=1 (Accessed on August 13, 2012).
- Bornstein J, Bentley J, Bösze P, et al. 2011 colposcopic terminology of the International Federation for Cervical Pathology and Colposcopy. Obstet Gynecol 2012; 120:166.
- 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.
- 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.
- Wentzensen N, Walker JL, Gold MA, et al. Multiple biopsies and detection of cervical cancer precursors at colposcopy. J Clin Oncol 2015; 33:83.
- Huh WK, Sideri M, Stoler M, et al. Relevance of random biopsy at the transformation zone when colposcopy is negative. Obstet Gynecol 2014; 124:670.
- Gage JC, Hanson VW, Abbey K, et al. Number of cervical biopsies and sensitivity of colposcopy. Obstet Gynecol 2006; 108:264.
- 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.
- Diedrich JT, Felix JC, Lonky NM. Contribution of Exocervical Biopsy, Endocervical Curettage, and Colposcopic Grading in Diagnosing High-Grade Cervical Intraepithelial Neoplasia. J Low Genit Tract Dis 2016; 20:52.
- Gage JC, Duggan MA, Nation JG, et al. Detection of cervical cancer and its precursors by endocervical curettage in 13,115 colposcopically guided biopsy examinations. Am J Obstet Gynecol 2010; 203:481.e1.
- Buscema J, Woodruff JD. Significance of neoplastic atypicalities in endocervical epithelium. Gynecol Oncol 1984; 17:356.
- 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.
- 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.
- 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.
- Jeronimo J, Schiffman M. Colposcopy at a crossroads. Am J Obstet Gynecol 2006; 195:349.
- 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.
- 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.
- RELEVANT ANATOMY AND HISTOLOGY
- INSTRUMENTATION AND EQUIPMENT
- Other supplies and instruments
- PREPROCEDURE PREPARATION
- Review of history and records
- Informed consent and counseling
- - Procedural anxiety
- CERVICAL COLPOSCOPY
- - Repeat cytology and HPV testing
- - Gross visualization
- - Colposcopic examination
- - Approach to a difficult colposcopy
- - Biopsies
- - Endocervical curettage
- - Documentation
- - Follow-up
- VAGINAL COLPOSCOPY
- VULVAR COLPOSCOPY
- PREGNANT WOMEN
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS