Colposcopy Specialist in Kolkata, India

Colposcopy

Colposcopy is a diagnostic procedure to examine an illuminated, magnified view of the cervix and the tissues of the vagina. A colposcopic examination follows an abnormal cervical smear report. An abnormal smear report may be described as

• Mild changes in the cells (mild dyskaryosis)
• Moderate changes in the cells (moderate dyskaryosis)
• Severe changes in the cells (severe dyskaryosis)

An abnormal smear report indicates that there are precancerous changes in the cells covering the cervix, and requires further investigations using a colposcope. Many premalignant and malignant lesions on the cervix have detectable characteristics which can be identified through the colposcope, and biopsies taken for pathological examination.

Colposcopy is an outpatient procedure performed with the woman lying on her back, legs in stirrups, and buttocks at the lower edge of the table (a position known as the dorsal lithotomy position). A speculum is inserted to open the vagina so that the cervix at the top can be seen. The colposcope is a microscope that is placed outside the speculum (and outside the body) and the cervix visualised. Special dyes are used to paint the cervix to demonstrate any abnormal appearing areas. The dyes commonly used are acetic acid and iodine. It is very important to visualise an area on the cervix called the transformation zone where most of precancerous and cancerous lesions arise.

Areas of the cervix which turn white after the application of acetic acid or have an abnormal vascular pattern are abnormal, and application of iodine helps in highlighting these areas as they do not take the dark brown stain of the iodine. Colposcopic assessment classifies the lesion as low grade and high grade.

After a complete examination, the areas with the highest degree of visible abnormality are defined and biopsies obtained. Most doctors and patients consider anesthesia unnecessary, however, a local anaesthetic may be used to diminish patient discomfort, particularly if more than one biopsy samples are taken. The raw areas after biopsy are touched with silver nitrate sticks to control bleeding. Women can expect to have a thin grey discharge for up to several days after the procedure.

Pathology
Abnormalities on the biopsy samples are then described as:
• CIN 1 - one third of the thickness of the lining covering the cervix has abnormal cells
• CIN 2 - two thirds of the thickness of the lining covering the cervix has abnormal cells
• CIN 3 - the full thickness of the lining covering the cervix has abnormal cells

Treatment:
Without proper treatment, precancerous abnormalities may develop into cancerous lesions. Various treatments exist for significant lesions, most commonly loop excision of transformation zone (LLETZ), and knife cone excision. All treatment procedures aim to remove or destroy the abnormal cells.

LLETZ is the shortened name for the procedure Large Loop Excision of Transformation Zone. It is an outpatient procedure and the person undergoing the procedure can go home later. The procedure involves removing the transformation zone on the cervix bearing the abnormal cells by using a thin metal wire shaped like a loop through which an electric current is passed.- an electrosurgical technique. The procedure is done under local anaesthesia under colposcopic guidance. However for very anxious women or where the procedure is expected to be difficult, it may be appropriate to be done in operating theatres and under a general anaesthetic.

Follow up
Appropriate follow-up after treatment is very important. Follow-up is done by regular cervical smears starting at 6 months after treatment. For those who have had CIN 2 or worse should have annual smears for 10 years. Women treated for CIN1 can return to routine screening after 2 years of negative smears.