Colposcopy. Attila L Major, MD, PhD

Transcription

1 Colposcopy Attila L Major, MD, PhD

2 Histology Colposcopy Cytology It has been estimated that annual Pap smear testing reduces a woman s chance of dying of cervical cancer from 4 in 1000 to about 5 in 10,000 a difference of almost 90%

3 Nomenclature CIN I CIN II CIN III Mild Dysplasia Moderate Dysplasia Severe Dysplasia Carcinoma in situ

4 Hinselmann,, 1925

5 Squamous Epithelium Columnar epithelium basal layer SCJ squamous epithelium Stratification

6 Squamous Epithelium stratified, nonkeratinizing epithelium original squamous epithelium

7 Cytological features The standard method for staining cytological preparations is that of Papanicolaou squamous epithelium

8 Squamous Epithelium parabasal cells superficial cells

9 Columnar Epithelium Columnar Epithelium Columnar epithelium

10 Columnar epithelium Normal columnar epithelium is easily recognised by its characteristic grape-like or villous appearance. Following application of acetic acid, the villi often appear white and are more easily recognizable. Columnar Epithelium

11 Normal Cevix, Colposcopy Columnar epithelium Columnar epithelium SCJ SCJ original squamous epithelium original squamous epithelium

12 Transformation Zone Original SCJ

13 Immature metaplasia

14 Mature metaplasia The new epithelium results from transformation of columnar to squamous epithelium, through the process of squamous metaplasia Normal transformation zone

15 CIN 1 & CIN 2 Histology

16 CIN 3 In CIN 3 differentiation and stratification may be completely absent 12% ; 2-10 years In early stromal invasion a group of cells have breached the epithelial/stromal junction

17 Acetowhite change

18 Acetowhite change

19 Acetowhite change

20 Vascular pattern Vas cula r patt ern

21 Invasive

22 Vulval condylomata acuminata

23 Condyloma

24 #1

25 #2

26 #3

27 #4

28 #5

29 Nomenclature The concept of cervical intraepithelial neoplasia proposes that all degrees of abnormality should be given the same name, as part of a continuous spectrum of disease CIN I CIN II CIN III Mild Dysplasia Moderate Dysplasia Severe Dysplasia Carcinoma in situ

30 ASC-US ASCUS Repeat cytology at 12 months at 6 months pos neg Repeat Cytology pos Colposcopy neg Repeat cytology at 6 & 12 months pos management of histological abnormalities Management Option 2.

31 ASC-US ASCUS Repeat cytology at 12 months pos neg HPV pos Colposcopy neg Repeat cytology at 6 & 12 months pos management of histological abnormalities Management Option 1.

32 HSIL HSIL Colposcopy (with ECC) Satisfactory colposcopy yes no Lesion identified No Lesion identified Biopsyconfirmed CIN yes no Review material change in diagnosis management of histological abnormalities management of histological abnormalities Diagnostic excisional procedure Management HSIL no change

33 AGC AGC Colposcopy (with ECC) Endometrial sampling (> 35 years) Invasive disease yes Refer to specialist no Initial Pap AGC - favor neoplasia or AIS Diagnostic excisional procedure (cold-knife conization) AGC - NOS HSIL or AGC management of histological abnormalities yes CIN or AIS no Repeat Cytology every 6 months (4x) Management AGC (Atypical Glandular Cells )

34 ASC-H ASC-H management of histological abnormalities Biopsy-confirmed CIN any grade Colposcopy neg Review of the material no change Change in diagnosis Repeat cytology at 6 & 12 months management of histological abnormalities Management ASC-H (cannot exclude high-grade SIL)

35 LSIL LSIL Colposcopy (with ECC) no Satisfactory colposcopy yes yes Lesion identified no No Lesion identified Biopsyconfirmed CIN ASC or CIN management of histological abnormalities Repeat cytology at 6 & 12 months management of histological abnormalities Management LSIL

36 LSIL LSIL Adolescents; option negative Repeat Cytology at 6 & 12 months ASC or CIN Routine Screening Colposcopic Triage Management LSIL; Option : Adolescents

37 Histology Colposcopy Cytology It has been estimated that annual Pap smear testing reduces a woman s chance of dying of cervical cancer from 4 in 1000 to about 5 in 10,000 a difference of almost 90%

38 non-pathologic condition Microglandular endocervical hyperplasia polypoidal villi

39 Project summaries text

40 Screening It has been estimated that annual Pap smear testing reduces a woman s chance of dying of cervical cancer from 4 in 1000 to about 5 in 10,000 a difference of almost 90%

41 Microglandular endocervical hyperplasia