understandingtestresutsbbhvvhhgddghvgAP.ppt

Understand results of colposcopy

1. Understanding Test Results

2. Cytology Codes
& management
Colposcopy-Management of cervical lesions

3. Cytology codes
0/G-?Glandular neoplasia (non cervical)
1-Inadequate Specimen
2/N-Negative
3/M-Low grade dyskaryosis (CIN 1)
4-High grade dyskaryosis (severe) (CIN 3)
5-High grade dyskaryosis ?invasive squamous carcinoma
6-?Glandular neoplasia of endocervical type
7-High grade dyskaryosis (moderate) (CIN 2)
8/B-Borderline change in squamous cells
9/E-Borderline change in endocervical cells
X-No Cytology test undertaken

4. Action Codes
A-To be used for all cases where the next test is to be
performed at the normal (routine) recall interval for the DHA
responsible for the women.
R-To be used for all cases in which a further smear is
recommended in an interval less than the routine recall interval
of the DHA.
S-To be used for all cases where referral to a gynaecologist is
recommended and for those smears from patients under the
care of a gynaecologist or other relevant specialist.
H-Record the result and do not change current recall details.

5. Cytology Infection Code Descriptions
0-Human Papilloma Virus (HPV) negative
1-Trichomonas
2-Candida
3-Wartvirus
4-Herpes
5-Actinomyces
6-Other (to be specified)
9-HPV positive
U-HPV unavailable
Q-No HPV test undertaken

6. Examples
N0A
1R3
4S

7. Guidelines for referral to the Colposcopy Clinic
Barts Health NHS Trust
Inadequate on 3 occasions
Borderline or mild dyskaryosis and high
risk HPV positive
Moderate or severe dyskaryosis
? Invasive or ? Glandular neoplasia
3 abnormal results over 10 years
Clinically suspicious cervix or symptoms

8. When referring women for colposcopy all women
should have explained to them:
The procedure of colposcopy
The possibility of a cervical biopsy

9. The Colposcope
This is a binocular
microscope that allows
magnification and
illumination of the
cervix.

10. The Colposcopy Examination
Acetic acid 5% is applied.
The abnormality is identified (aceto-white
change).
The colposcopic examination is considered
satisfactory when the entire transformation
zone has been identified, and a colposcopic
impression is made. A photograph may be
taken for accurate follow up.
One or more biopsies are then taken of the
abnormal areas.

11. How Acetic acid works
Acetic acid is applied to the surface of the cervix. The light from
the colposcope is reflected back from the enlarged nuclei of the
abnomal cells giving us the aceto-white change

12. Cervical punch biopsy forceps

13. Cervical Biopsies

14. Satisfactory Colposcopy

15. Unsatisfactory Colposcopy

16. Postmenopausal Cervix

17. Nabothian Cyst

18. Cervical Ectropion

19. Endocervical Polyp

20. HPV infection of the cervix
Colposcopic Features
Pale staining aceto-white lesion
Irregular, indistinct margins of lesion
Atypical vessels, fine mosaic pattern

21. HPV
Transmitted by intimate contact
An estimated 80% of sexually active
women will be exposed to the virus by
age 50
Most infections will regress
spontaneously after 6-12 months
Over time persistent infection can lead
to cancer and other HPV related
diseases

22. CIN1
Mild aceto-white
uptake
Irregular,
indistinct margins
of lesion
No obvious atypical
vessels/mosaic
pattern
In most women, will
revert back to
normal given time.
Approximately 5%
of all smears show
borderline or mild
dyskaryosis.

23. CIN2
Moderately
dense aceto-
white change
with atypical
vessels, mosaic
patterns
and punctation.
Approximately
1% of all smears
show moderate
dyskaryosis.

24. CIN3
Densely staining aceto-
white lesion
Straight margins
Atypical vessels, coarse
mosaicism, punctation
Large volume lesion
Poor iodine uptake
Approximately 0.5% of
all smears show severe
dyskaryosis.

25. Micro-invasive lesions of the cervix
Densely staining
acetowhite lesion
Atypical vessels,
suspicious of invasion
Often large volume
lesions
Poor iodine uptake
May bleed easily
Less than 0.1% of
smears suggest invasive
carcinoma.

26. Treatment –LLETZ (Large Loop Excision of
the Transformation Zone)
A diathermy pad is placed on the woman’s leg.
Local anaesthesia is injected into the four quadrants
of the cervix. An appropriately sized loop is chosen
and the abnormal area removed in one piece under
colposcopic guidance. Ball diathermy is used to
achieve haemostasis.
Facilities are available in the clinic in the event of an
emergency situation.
Follow up information is reinforced before the woman
leaves the clinic.

27. LLETZ

28. What are the complications?
Treatment for CIN is generally very safe. Very few complications
exist but some important problems can occur.
1.Bleeding.
2.Infection.
3.Cervical stenosis’ and ‘cervical incompetence’
4.Premature rupture of membranes during pregnancy leading to early
delivery
Women are advised not to insert ANYTHING into the vagina for at least 4
weeks.

29. What is the success rate?
Ninety five percent of women have a negative
smear 6 months following their first
treatment.

30. Follow-up
A follow-up check after treatment for
precancerous changes is absolutely essential.
We perform Liquid Based Cytology and HPV
testing six months after treatment.
If residual precancerous cells are left
behind, further Colposcopy and biopsy is
performed, and a repeat LLETZ procedure,
will be arranged if necessary.

31. Changes to practice
HPV testing
-TRIAGE
Given that cervical cancer will not develop without
HPV, women with borderline changes or mild
dyskaryosis who have a negative high risk HPV test
are not likely to need treatment and should be able to
safely return to routine screening.
-TEST OF CURE
It has now been clearly established that the
successful removal of abnormal cervical cells usually
also leads to the disappearance of the HPV within 12
months or so.

32. Further Information
www.bsccp.org.uk
www.jotrust.co.uk
www.patient.co.uk
www.cancerscreening.nhs.uk
www.londonqarc.nhs.uk