DOC-20250822-WA0hdhxksjdgjsiksjdj000..pptx

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1. Visual inspection with acetic acid (VIA):

2. Visual inspection with acetic acid (VIA): naked eye examination of cervix – 5% acetic acid Primary screening test for SEE & TREAT Approach It is a Screening tool Done in females of Age b/w 30-65 yrs In limited resource setting – at least 2 – 3 times in lifetime Used for Detection of precancerous and early invasive cancer

3. Understanding anatomy and physiology Cervix – Divided in to 2 parts Ectocervix – pink in colour & Smooth Non keratinised Stratified squamous epithelium , Lies within the vagina Endocervix – reddish & velvety in colour Lined by Single layer of c olumnar cells Lies close to the Uterus External OS : Cervix opens in to the vagina

4. Difference between normal & Dysplatic epithelum Normal epithelium – Unstained by 3-5% Acetic Acid & Appears Pink Normal Nucleo cytoplasmic ratio. Dysplastic epithelium - Has dysplastic cells , Increased Nucleocytoplasmic Ratio , Nuclear proteins Will coagulate & appears white ( Aceto -White) areas .

5. Visual Inspection with Lugols iodine

6. VILI Out dated Test , not done now a days . Not Recommended by WHO It is not a primary screening Test LugoJ's iodine It consists of 10% potassium iodide with 5% iodine . Normal Cervical Epithelium – Has sufficient glycogen Stores Dysplastic Epithelium – Glycogen is used up , Lack of Glycogen stores.

7. Normal Epithelium On Application of Lugols Iodine Iodine is glycophilic Stained as Mahogany brown colour . On Application of Lugols Iodine No glycogen Stores Does not stain and Appears as yellow in colour . Dysplastic Epithelium Principle (Schillers test).

8. COLPOSCOPY

9. Colposcopy Colposcopy is in-situ examination of the cervix with a low magnification (6–16 times) microscope . It is complementary and not a substitute for cytology. Done by Colposcope , The instrument was devised by Hinselmann in 1925. Colposcope and colpomicroscope are the low-power binocular microscope, mounted on a stand. It is designed to magnify the surface epithelium of the vaginal part of the cervix including entire transformation zone. The magnification is to the extent of 15–40 times in colposcopy and about 100–300 times in colpomicroscopy

10. COLPOSCOPY IS a OPD PROCEDURE . Can visualise Exocervix Cannot visualise Endocervix , so to rule out lesion in Endocervix , ENDOMETRIAL CURETTAGE done .

11. PROCEDURE The patient is placed in lithotomy position. The cervix is visualized using a Cusco’s speculum . Colposcopic examination of the cervix and vagina is done using low power magnification (6-16 fold). Cervix is then cleared of any mucus discharge using a swab soaked with normal saline. Green filter and high magnification can be used now. Next, the cervix is wiped gently with 3 percent acetic acid and examination repeated. Acetic acid causes coagulation of nuclear protein which is high in CIN. This prevents transmission of light through the epithelium, which is visible as white ( acetowhite ) areas

12. Colposcopic indices Reid's colposcopic index (RCI) lt is a systematic, objective method of colposcopically grading the severity of premalignant cervical lesions. Maximum score is 8. The index consists of four colposcop ic variables each with scores (0- 2): • lesion margin •Colour of acetowhitening • blood vessels. and • iodine staining.

13. Swede's colposcopic index (SCI): This includes lesion size as a variable to be scored i n addition to the 4 variables found in the Reid colposcop ic index, along with few modifications to Definitions of the scores for the other variables. Maximum score is 10.

14. CERVICOGRAPHY After application of 5% Acetic acid ↓ Photograph of entire external os is taken with 35mm camera ↓ Sent to colposcopist , for selecting the areas for biopsy This technique is done when colposcopist is not available at the spot 50% sensitivity and 50% specificity Not cost effective .