Posted in Procedures

Colposcopy

Reference

Link: IARC Atlas of visual inspection of the cervix with acetic acid for screening, triage, and assessment for treatment.

Patient Information

Documentation

Colposcopy Biopsy Equipment List

  1. Colposcope (1)
  2. Colposcopy Biopsy Punch (3, preferably of different sizes)
  3. Kevorkian Endocervical Curette (1)
  4. Endocervical Speculum (1)
  5. Sponge Forceps (1)
  6. Labels with patient information (10)
  7. Nitrile Exam Gloves (2 pair each)
  8. Exam-room sheet (1 sheet)
  9. Chux Pads (4)
  10. Speculum (3 total: 1 white, 1 green, 1 blue)
  11. Lubricant Gel Packet (5)
  12. Pipelle (1)
  13. Formalin cups, in a row (4 cups)
  14. Foxtail Swabs (at least 15 or more)
  15. Sterile CTA (6 packages with 2 swabs each)
  16. Monsel’s solution (1 bottle)
  17. Acetic acid (1 bottle)
  18. Normal saline (1 bottle)
  19. Sterile urine cups (4 cups)
  20. Sanitary Pad (1)
  21. Iodine, either:
    • Lugol’s iodine (1 bottle), preferred Lugol’s is a solution of elemental iodine (5%) and potassium iodide (KI, 10%) together with distilled water.
    • Povidone iodine sticks (10) Povidone-iodine is a chemical complex of povidone, hydrogen iodide, and elemental iodine.

Procedure Note

COLPOSCOPY

Pre-procedure counseling and consent: Possible limitations and risks include pain, bleeding, infection, complications from anesthesia, partial success requiring repetition of procedure. Procedure-specific risks discussed. Peri-operative risks, benefits, and limitations discussed and understood – Patient wished to proceed. Patient was awake throughout the entire procedure. TIME OUT: performed, time is documented on consent form. Patient was identified using full name plus any suffix and DOB. Patient was evaluated and medical record reviewed to include medical history and laboratory findings, if ordered. Radiographs are not applicable to this procedure. Procedure and site/side matches the consent form. Patient/Legal Guardian awake throughout the procedure and was involved in the site/side marking. Final time out: Physician paused to verify that this is the correct patient, procedure and site/side when applicable. Physician verified the patient is positioned correctly for the procedure, and all necessary equipment is available.

External genitalia examined, Bartholin’s and Skene’s glands examined. Visual peri-rectal exam performed.

Bimanual exam performed, uterus palpated for position, size, and tenderness. Ovaries palpated for position, size, tenderness, symmetry.

Speculum inserted, vagina visually examined with attention for color, discharge, tone, and on vaginal mucosa for lesions, evidence of genital warts, or other abnormalities.

The cervix was identified. The entire transformation zone and squamocolumnar junction were visualized. Initial observation of the cervix was performed, with attention for abnormal vessels and annotation of visible lesions. Observation of cervix with acetic acid solution, with attention to visualization of entire squamocolumnar junction, and any visible lesions. Observation of cervix with Lugol’s iodine solution to clearly demarcate the squamocolumnar junction.

MODIFIED RCI: _
Color: _
Lesion margin and surface configuration: _
Vessels: _
Iodine staining: _

Pap smear _ performed.
Endocervical curettage was _ performed.
Endometrial biopsy was _ performed.

At conclusion of the procedure no further bleeding was noted. EBL _ mL. No complications.

Modified Reid Colposcopy Index (RCI)

Colour

0

  • Low-intensity acetowhitening (not completely opaque).
  • Indistinct acetowhitening.
  • Transparent or translucent acetowhitening.
  • Acetowhitening beyond the margin of the transformation zone
  • Pure snow-white color with intense surface shine.

1

  • Intermediate shade – grey/white color and shiny surface (most lesions should be scored in this category).

2

  • Dull, opaque, oyster white or grey.

Lesion margin and surface configuration

0

  • Microcondylomatous or micropapillary contour.
  • Flat lesions with indistinct margins.
  • Feathered or finely scalloped margins.
  • Angular, jagged lesions. Score zero even if part of the peripheral margin does have a straight course.
  • Satellite lesions beyond the margin of the transformation zone.

1

  • Regular-shaped, symmetrical lesions with smooth, straight outlines.

2

  • Rolled, peeling edges. Epithelial edges tend to detach from underlying stroma and curl back on themselves. Note: Prominent low-grade lesions often are over-interpreted, while subtle avascular patches of HSIL can easily be overlooked.
  • Internal demarcations between areas of differing colposcopic appearance. For instance a central area of high-grade change and peripheral area of low-grade change.

Vessels

0

  • Fine/uniform-calibre vessels closely and uniformly placed. At times, mosaic patterns containing central vessels are characteristic of low-grade histological abnormalities. These low-grade-lesion capillary patterns can be quite pronounced. Until the physician can differentiate fine vascular patterns from coarse, over-diagnosis is the rule.
  • Poorly formed patterns of fine punctation and/or mosaic.
  • Vessels beyond the margin of the transformation zone.
  • Fine vessels within microcondylomatous (tiny warts) or micropapillary lesions. Generally, the more microcondylomatous the lesion, the lower the score. However, cancer also can present as a condyloma, although this is a rare occurrence.

1

  • Absent vessels.

2

  • Well defined coarse punctation or mosaic, sharply demarcated and randomly and widely placed. Branching atypical vessels indicative of colposcopically overt cancer are not included in this scheme.

Iodine staining

0

  • Positive iodine uptake giving mahogany-brown color.
  • Negative uptake of insignificant lesion, i.e., yellow staining by a lesion scoring three points or less on the first three criteria.
  • Areas beyond the margin of the transformation zone, conspicuous on colposcopy, evident as iodine-negative areas (such areas are frequently due to parakeratosis – a superficial zone of cornified cells with retained nuclei.)

1

  • Partial iodine uptake – variegated, speckled appearance.

2

  • Negative iodine uptake of significant lesion, i.e., yellow staining by a lesion already scoring four points or more on the first three criteria.

Final Score: Colposcopic prediction of histologic diagnosis using the Reid Colposcopic Index (RCI)

0 – 2: Likely to be CIN 1

3 – 4: Overlapping lesion: likely to be CIN 1 or CIN 2

5 – 8: Likely to be CIN 2-3

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