The task of expert colposcopy is to identify abnormal cellular changes in the cervix and in tandem with a targeted biopsy to determine the type and degree of change present in order to limit the extent of potential cervical pre-cancerous changes for the correct setting of treatment. The colposcope is a precision device (a high-resolution magnifying glass) that serves to examine the lining of the cervix and possible vascular changes to is, as well as changes in the lower genital tract (vagina), external genitalia (the vulva and the small and large labia) and the anogenital area. Expert colposcopy, with the help of an accurate visual assessment and the cytological result or the result of a targeted biopsy using a colposcope, evaluates the severity of possible pre-cancerous changes to the cervix and determines their final diagnosis with a final prognosis. There are no absolute contraindications to colposcopic examination. An examination with a biopsy is also safe for women undergoing anticoagulant treatment. The same is true of the colposcopic examination in pregnant women, with the exception of the diagnostic possibility of using endocervical curettage. No special preparation is needed, and the patient can eat and drink before the examination. The examination is scheduled during the time when the woman is not menstruating.
The most common reason to undergo colposcopy is an abnormal result from a cytological smear. This is indicated upon interpretation of ASC-US (atypical squamous cells of uncertain significance) cytology, especially in case of a repeated finding, or with its initial capture together with a positive DNA test for high-risk HPV viruses (HR-HPV), ASC-H (atypical squamous cells with a high-grade squamous-cell mucosal change), LSIL (low-grade squamous-cell intraepithelial lesion), HSIL (high-grade squamous-cell intraepithelial lesion), cervical cancer, and with suspected glandular abnormalities AGC (atypical glandular cells) and AIS (adenocarcinoma in situ).
Expert colposcopy is acceptable in combination with a cytological examination and an HPV test as a follow-up method after cervical conization for high-grade cellular pre-cancerous changes (CIN 2, 3). Among the other indications for colposcopic examination are any suspiciously palpable cervical or vaginal change, ulcer or growth eventually visible to the naked eye. Further, any unexplained bleeding in the lower genital tract and vulvar and vaginal HPV-associated changes, such as condylomas, i.e. so-called genital warts.
Like the taking of a cytological smear, your doctor will first insert a vaginal mirror into your vagina. Then, with the help of an expert colposcope (a device resembling a telescope on a handle), he or she will visually, painlessly and without contact examine your cervix. The doctor gradually applies special solutions (a diluted acetic acid solution, etc.) to the cervix so that he or she can examine in more detail areas demonstrating unusual features. Likewise, he or she can repeat a cytological swab from the cervix and take a culture swab to verify possible infection. If necessary, a tissue sample can be taken for histological examination from the affected area gently, and practically without trauma using a biopsy forceps, a so-called targeted punch biopsy. During a punch biopsy, some patients feel a small pinch, but only rarely; otherwise, it is effectively a painless sampling.
The whole examination will be projected onto a monitor and commentary provided. The doctor may show you the area with the suspected changes. The entire examination lasts about 10 – 20 minutes. For approximately 24 hours prior to the examination, you should avoid vaginal rinsing, using vaginal medication or sexual intercourse. Do not use tampons during menstrual bleeding before a scheduled colposcopy. The doctor will be able to tell you the result of the examination as soon as it is completed and will also suggest the types of possible treatment. If necessary, he or she will also schedule you another appointment to discuss the biopsy results and to provide any necessary treatment.
What is it for?
The aim of expert colposcopy is to evaluate the severity of abnormal cytological finding on the cervix, to determine the presence and extent of potential involvement of pre-cancerous changes, to specifically investigate the histological nature of such pre-cancerous changes, to determine a treatment plan and to indicate the need for conization.