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COLPOSCOPY

COLPOSCOPY. Cervical Screening QARC Training School October 2012. Terminology. Dyskaryosis Cervical Intraepithelial Neoplasia (CIN). Disease progression. HPV infection; koilocytosis. CIN II. CIN III. Normal epithelium. CIN I. Invasive cervical cancer. Months. Years. Time.

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COLPOSCOPY

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  1. COLPOSCOPY Cervical Screening QARC Training School October 2012

  2. Terminology • Dyskaryosis • Cervical Intraepithelial Neoplasia (CIN)

  3. Disease progression HPV infection; koilocytosis CIN II CIN III Normal epithelium CIN I Invasive cervical cancer Months Years Time Borderline Mild Moderate Severe Dyskaryosis CIN I 57% CIN II 43% CIN III 32% Approx. likelihood of regression

  4. Indications for Colposcopy • ABNORMAL CYTOLOGY • Moderate or severely dyskaryotic result • Borderline/mild samples that are high risk (16 & 18) HPV positive • Abnormal glandular cells • FINDINGS OR SYMPTOMS • Suspicious appearance to cervix • Symptomatology – post coital bleeding

  5. Examination Cusco Speculum ??repeat LBC sample Acetic Acid +/- Lugols Iodine Colposcope Punch Biopsy Silver nitrate

  6. Treatment Excisional – LETZ, Knife Cone Destructive - Cold Coag, Laser Ablation Rarely - Hysterectomy

  7. Follow-Up prior to HPV testing After Treatment for high grade CIN (or worse) – Cervical sampling 6, 12 then annually for 10 years After Treatment for low grade CIN – 6, 12, 24 then normal recall After hysterectomy (if no Cervix) – no longer part of re-call! Gynaecologist sets intervals

  8. What is HPV test of cure? • Women who have a normal, borderline or mild cervical screening result six months after treatment for CIN and who also test negative for high-risk HPV have a very low risk of residual disease. • Samples taken six months post treatment that are cytology negative are HPV tested. • Women whose samples show no high-risk HPV will proceed to three year routine recall – avoiding the need for up to 10 years of annual cervical screening. • Women who have an abnormal cervical screening result or whose samples show high-risk HPV six months after treatment will be referred back to colposcopy.

  9. Question 1

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  17. Question 9

  18. Letz and pregnancy • Knife cone worse than Letz • Laser ablation carries no risk • Complications • Premature labour (<37/40) 1.7 RR • Premature rupture of membranes 2.7 RR • Low birthweight 1.8 RR • Cervical stenosis – emergency LSCS

  19. Colposcopy in Pregnancy • Aim is to exclude invasive disease • No evidence of more rapid progression in pregnancy • Avoid treatment but can biopsy • Warts more florid • Sampling and colposcopy are easily interpreted despite pregnancy changes • If has invasive disease when pregnant • Treat Ca cx if under 24/40 i.e. terminate pregnancy. After 24/40 deliver by LSCS as soon as baby is viable (32/40)

  20. Colposcopy after the menopause • Transformation zone is usually not visible • With low grade cytology try to repeat ‘sample’ after a course of topical oestrogen

  21. Cervical Dysplasia • Oncogenic virus is the cause of over 99% of cases • Co-factors • Smoking • Parity • Immunocompromise (Transplants & HIV)

  22. HPV triage as an adjunct to LBC & Colposcopy • LBC allows HPV testing • No value in the assessment of women with high grade dyskaryosis – assumption is that they are all HPV +ve • In women with borderline and mild dyskaryosis may allow decision about who needs colposcopy • Follow up after treatment for CIN

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