Colposcopy

In this test, the cervix and vagina are visually examined by an instrument containing a magnifying lens and a light (colposcope). Colposcopy is primarily used to evaluate abnormal cytology or grossly suspicious lesions and to examine the cervix and vagina after a positive Papanicolaou (Pap) test.

During the examination, a biopsy may be performed and photographs taken of suspicious lesions with the colposcope and its attachments. Risks of biopsy include bleeding (especially during pregnancy) and infection.

Purpose

• To help confirm cervical intraepithelial neoplasia (CIN) or invasive carcinoma after a positive Pap test
• To evaluate vaginal or cervical lesions
• To monitor conservatively treated CIN
• To monitor patients whose mothers received diethylstilbestrol during pregnancy

Patient preparation

• Explain to the patient that this test magnifies the image of the vagina and cervix, providing more information than a routine vaginal examination.
• Inform the patient that she needn't restrict food or fluids.
• Tell her who will perform the examination and where, that it's safe and painless, and that it takes 10 to 15 minutes.
• Tell the patient that a biopsy may be performed during colposcopy and that this may cause minimal but easily controlled bleeding. If a biopsy is performed, tell the patient to expect cramping comparable to menstrual cramps.
• Make sure the patient or a responsible family member has signed an informed consent form.

Equipment

Colposcopy: gloves, colposcope, vaginal speculum, 3% to 5% acetic acid solution, swabs

Biopsy: gloves, biopsy forceps, endocervical curette, forceps for uterine dressing, tenaculum, ring forceps, Monsel's (ferric subsulfate) solution, biopsy bottle and preservative, sterile cotton balls, Pap test equipment (glass slide, wooden spatula, swabs, and fixative)

Procedure and posttest care

• The examiner puts on gloves. With the patient in the lithotomy position, the examiner inserts the speculum and, if indicated, performs a Pap test. Help the patient relax during insertion by telling her to breathe through her mouth and concentrate on relaxing her abdominal muscles.
• The cervix is gently swabbed with a dry or saline-soaked swab and then with acetic acid solution to remove mucus.
• After the cervix and vagina are examined, biopsy is performed on areas that appear abnormal.
• Bleeding is stopped by applying pressure or hemostatic solutions.
• After a biopsy, instruct the patient to abstain from intercourse and to avoid inserting anything in her vagina (except a tampon) until healing of the biopsy site is confirmed.

Normal findings

Normally, cervical vessels show a network and hairpin capillary pattern, with about 100 microns between them. Squamous epithelium is smooth and pink; columnar epithelium appears grape like. Different tissue types are sharply demarcated. The transformation zone, the area between the squamous and columnar epithelium, should be visualized.

Abnormal findings

Abnormal colposcopy findings include white epithelium (leukoplakia) or punctate and mosaic patterns, which may indicate underlying CIN; keratinization in the transformation zone, which may indicate CIN or invasive carcinoma; and atypical vessels, which may indicate invasive carcinoma.

Other abnormalities visible on colposcopic examination include inflammatory changes (usually from infection), atrophic changes (usually from aging or, less often, the use of oral contraceptives), erosion (probably from increased pathogenicity of vaginal flora due to changes in vaginal pH), and papilloma and condyloma (possibly from viruses).

Histologic study of the biopsy specimen confirms colposcopic findings If the results of the examination and biopsy are inconsistent with the results of the Pap test and biopsy of the squamocolumnar junction, conization of the cervix for biopsy may be indicated.

Interfering factors

• Failure to clean the cervix of menstrual blood or foreign materials, such as creams and medications (possible obstruction to visualization)
• Patient's inability to lie in the lithotomy position