An Introduction to Colposcopy Grothuesmann

Given the availability of a colposcope and a trained colposcopist this method is an essential tool for effective secondary prevention of female reproductive organ diseases. Colposcopic guided procedures enable a preceise diagnostic and consequent treatments with eventually organ preserving means. This power point presentation highlights the range of opportunities offered by Colposcopy.

1. An Introduction to Colposcopy Dr Dirk Grothuesmann http://dg-maternalhealth.de/

2. Secondary Cervix Cancer Prevention Secondary prevention means stop the progression of disease once it has already started (stop progression) Cytological screening Pap-Test Visual screening Colposcopy +/- HPV-Testing

3. Indication for Colposcopy Abnormal Pap smear Treatment and follow up of CIN Bleeding post-coital Postmenopausal Menorrhagia Persist vagina discharge Unhealthy cervix HPV pos / external vulva warts

4. Tools

5. Transformation Zone

6. Transformation Zone The Normal TZ is located between the old SCJ and the colposcopically -visible, new SCJ Dynamic Area Carcinogenic factors (HPV, carcinogenic Substances e.g. Smoking) are incorporated into vulnerable immature metaplastic Epithelia

7. Classification of Transformation Zone Bornstein J et al., 2011

8. Transformation Zone TZ I TZ II TZ III Sellors JW and Sankaranarayanan R, 2003

9. Steps in the C olposcopic Examination Obtain a relevant medical history Explain the procedure to the woman Obtain informed consent Speculum and obtain specimens for lab examination , HPV Test, PAP if necessary Apply normal saline solution Apply 5% acetic acid Apply Lugol’s iodine solution Perform cervical biopsies, if necessary Schneider A, 2013

10. 2011 IFCPC Nomenclature of Colposcopy Normal Findings

11. 2011 IFCPC Nomenclature of Colposcopy Abnormal Findings MINOR MAJOR Suspicious For CA

12. 2011 IFCPC Nomenclature of Colposcopy Normal Findings Squamous/Columnar Epithelium Gland Openings, TZ I Nabothian Cyst, Squamous Epithelium TZ II

13. 2011 IFCPC Nomenclature of Colposcopy Minor Abnormal Findings Acetowhite Epethilum 3 o’ clock, HPV + Punctuation Mosaic Acetowhite

14. Major abnormal Findings Inner Border sign Rag sign Major abnormal Findings CIN suspect

15. Major abnormal Findings Prominent gland opening Ridge sign Major abnormal Findings CIN suspect

16. Findings suspicious for Invasion Atypical vascular Patterns C A N C E R

17. 2011 IFCPC Nomenclature of Colposcopy Miscellaneous finding

18. Miscellaneous Findings Condylome Cervical condylomatous lesion

19. Miscellaneous Findings Polyp endocervical Inflammation Trichomoniasis Polyp, Inflammation IFCPC, IFCPC Nomenclature 2011

20. The modified Reid Colposcopic Index Colposcopic signs Color Lesion margin/surface configuration Vessels Iodine staining Zero point 0ne point Two point Reid and Scalzi , 1985

21. Line Diagrams of Cervix Hammond’s graph: (A) Cervical Canal, (B) Portio vaginalis of Cervix – Transformation Zone, (C) Portio vaginalis outside of Transformation Zone, (D) Vaginal Vault Odell’s diagram enables to mark individually d iagnosed Findings I II

22. Colposcopy - consequent Therap y = Teamwork

23. Literature Bornstein J et al., 2011 Colposcopic Terminology of the International Federation for Cervical Pathology and Colposcopy, American College of Obstetricians and Gynecologist, VOL. 120, (1), 166 – 172, from http://jgcs21.umin.jp/colposcopy_02.pdf IFCPC, IFCPC Nomenclature 2011, from http:// www.ifcpc.org/en/healthcare-professionals/resource-material/2011-ifcpc-nomenclature Massad L S et al., 2012 Updated Consensus Guidelines for the Management of Abnormal Cervical Cancer Screening Tests and Cancer Precursors, 2013, Journal of Lower Genital Tract Disease, 17 (5), S1 - S27 Reid R, Scalzi P. Genital warts and cancer. VIII. An improved colposcopic index for differentiating benign papillomaviral infection from high grade cervical intraepithelial neoplasia . Am J Obstet Gynecol. 1985; 153 , 611-618 Schneider A, 2013, Primary, secondary, and tertiary prevention of cervical cancer, Endo-Press: Tuttlingen , Germany, ISBN: 978-3-89756-448-0 Sellors JW and Sankaranarayanan R , 2003, Colposcopy and Treatment of Cervical Intraepithelial Neoplasia : A Beginners’ Manual , from http:// screening.iarc.fr/doc/Colposcopymanual.pdf Vercellino , G F, et al., Validity of the Colposcopic Criteria Inner Border Sign, Ridge Sign, and Rag Sign for Detection of High-Grade Cervical Intraepithelial Neoplasia , Obstetrics & Gynecology, 121 (3), 624 – 631 WHO, IARC Screening Group, An introduction to the anatomy of the uterine cervix (chapter one), from http://screening.iarc.fr/colpochap.php?chap=1 accessed 30 May, 2016

24. http://dg-maternalhealth.de/ Dr Dirk Grothuesmann Consultancy

25. Aim of my Project Dr . Dirk Grothuesmann Consultancy Improving Maternal Health and Gynecology Services by Training Health Care Providers: Relaying on standardized training modules I teach evidence-based obstetrical procedures, gynaecology surgery and related evaluation tools to local personnel in developed and developing countries. Completing the programs offered, skills gained enable to serve women in need in any requested setting. http://dg-maternalhealth.de/index2.html