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".) (See also individual topic reviews for each lesion).