Colposcope

Colposcopy

colposcope — Mon, 28 May 2007 20:45:25 +0000

HISTORY

Colposcopy has only recently approached its proper place as an important ancillary aid in the practice of gynecology. Despite its late rebirth and popularization, colposcopy has been recognized as a valuable clinical tool abroad for nearly half a century, since shortly after it was first introduced by Hinselmann in 1925.

Colposcopy cannot be considered as a substitute for cytology. It neither competes with nor duplicates cytology but it can and does serve s most critical function in complementing the use of cytology, serving to help study those patients designated by the cytologic screening process as potential at risk, and focusing upon those specific sites warranting biopsy for histologic examination. Indeed, colposcopy stands between population screening and definitive tissue diagnosis.

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Equipment and Biopsy Technique using a Colposcope

colposcope — Mon, 28 May 2007 20:39:02 +0000

The colposcope, whether attached to the examining table or mounted on a free standing mobile base, is best placed to the left of the examiner in order to provide ample room for those procedures most often performed with the right hand. Accordingly, left handed physicians should locate their colposcopes on the right. In either case, the colposcope, positioned on a system of pivotal arms, can be expediently centered for the examination.

Some colposcopes are fastened to the top of a pole which is attached to a flat stand. Such stands are often somewhat unsteady, and the colposcopist frequently must place his feet on the base of the stand to ensure sturdiness. A self retaining bivalve speculum is needed for adequate visualization of the cervix and the vagina. A variety of sizes should be available. A speculum longer than 10 cm is seldom required, if use, it may be ejected from the vagina as a result of its unevenly distributed weight.

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Uses Of A Colposcope

colposcope — Mon, 28 May 2007 20:31:09 +0000

Colposcopy possibly has its greatest use in evaluating a patient with an abnormal papanicolaou test. Many patients with positive or doubtful papanicolaou smears exhibit no obvious target lesion on gross examination with the unaided eye. The challenge benefit of colposcopy is in its potential to help identify and localize with a high degree of accuracy lesions not visible by gross inspection. Directed biopsies of these targeted sites can then be taken.

Colposcopic examination ensures that biopsy specimens obtained in this way represent the most advanced histologic process present. Once one has located the areas of abnormality and identified the point of greatest cellular atypia by colposcopy, one can remove such loci in whole or in part under continued colposcopic guidance. This can be accomplished usually in an office setting and without anesthesia. The colposcopically directed biopsy has supplanted some less reliable techniques for localizing atypical lesions. The false negative rate of multiple blind biopsies from nonstaining areas approaches three to eight percent. Cytology, although a practical aid in mass screening for cancer, is obviously of little or no help in pinpointing or delimiting a lesion. The advent of colposcopy directed biopsies has obviated the need for at least eighty percent of diagnostic cervical conizations. Although cold knife conization is generally considered a minor surgical procedure, it is not innocuous. Serious complications may result, such as hemorrhage, infection, and infertility.

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Detecting Transformation Zones Using The Colposcope

colposcope — Mon, 28 May 2007 20:19:50 +0000

The squamous tissues of the vagina and cervix are designated colposcopically as the original or native squamous epithelium, the columnar is called the original or native columnar epithelium. Native squamous epithelium shows little variation from the subject to subject. Under the colposcope, it is uniformly pale pink and translucent and frequently exhibits a feathery vascular arrangement. Native columnar epithelium is unmistakable colposcopically. It is readily identified by its intense red hue and multiple grapes like projections or villi. Each villus possesses a single looped capillary which is sometimes seen colposcopically, especially with use of the green filter. Columnar epithelium, in contrast to squamous epithelium, usually fails to stain with iodine.

The colposcopic examination is directed primarily toward investigating the tissue in the area where original squamous and original columnar epithelia come together. At this squamous columnar interface, columnar epithelium is gradually transformed into squamous epithelium by a process of metaplasia. This dynamic area of change is known as the transformation zone. The transformation zone is the principal focus of colposcopic interest. A clear concept of the transformation zone is essential for understanding the origin and development of cervical neoplasia. It is within this location specifically that preclinical squamous cancer and epithelial dysplasias are believed to develop. The junction between original columnar and original squamous epithelium is transitory.

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Colposcopy

colposcope — Sat, 26 May 2007 05:51:02 +0000

A colposcopy seems much like a Pap smear, however, there a few important differences. You are positioned on the examination table as in a Pap smear; however acetic acid is placed on the cervix which causes the cervical cells to fill with water so light will not pass through them. The introduction allowed for the first time in vivo studies of the vessels in precancer and cancer of the uterine cervix in women. In 1932 Kreyberg introduced the adaptive vascular hypertrophy to designate the proliferation of the vascular supply, which he believed resulted from increased growth of the cancerous epithelium. A vast numbers of papers on the vascular patterns in preinvasive and invasive cancer of the cervix have appeared in the literature since 1940 and are mostly concerned with problems of diagnosis. Stereomicroscopic investigations of the capillary network of the normal cervix and cervical cancer were published by Kos et al. In 1960 and 1961.

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