Colposcopy is a gynecological procedure in which a colposcope is used to magnify and illuminate the vulva, vagina and cervix to examine them closely for signs of any abnormal tissue changes.
Colposcopy is a diagnostic procedure that is usually done after an abnormal Pap test with positive high risk HPV (human papilloma virus). It can also be done in an abnormal looking cervix even when Pap smear is negative or when there is an abnormal growth in cervix, vagina or vulva or if there is abnormal bleeding from the vagina after an intercourse. It is used to detect genital warts, cervical cancer, vaginal cancer and vulvar cancer.
Can a Colposcopy Detect Cancer?
Yes, a colposcopic biopsy can detect cervical, vulvar and vaginal cancer. Generally, colposcopy is performed in a doctor’s office. The procedure takes about 10 to 20 minutes. The patient is asked to lie on the exam table with foot support in the same manner as is done in pelvic exam or Pap smear. After that a speculum is inserted in the vagina for better visualization, as it opens up the vagina. A colposcope will be placed outside the vulva for better magnification and illumination of the vagina and the cervix. After examining, acetic acid solution is used to stain the abnormal cells white, also iodine solution can be used to stain the normal cells brown and the abnormal cells will be better highlighted in the acetowhitening zone of the abnormal cells. A biopsy may or may not be taken based upon the visualization of the abnormal cells. If a biopsy is done, then a small portion of the abnormal tissue is excised. The biopsied tissue will be sent to laboratory for further examination under a microscope. A biopsy procedure might cause mild discomfort, cramping pain and light staining later on.
What to Expect After Colposcopic Biopsy?
A colposcopic biopsy might be positive for dysplasia or might be negative. A colposcopic biopsy is usually a definite diagnosis, but one or more of the other diagnostic methods can also be used to examine the extent of the cancer. These include endocervical curettage (ECC), loop electrosurgical excision procedure (LEEP), conization, x-ray, CT scan, MRI, PET (positron emission tomography) scan, cystoscopy, proctoscopy (sigmoidoscopy), ultrasound and laparoscopy.
A colposcopic biopsy results may show:
Cervical Intraepithelial Neoplasia I (CIN I): This corresponds to mild dysplasia (abnormal cells) also known as low grade squamous intraepithelial lesion (LSIL).
Cervical Intraepithelial Neoplasia II (CIN II): This corresponds to moderate dysplasia and is also known as high grade squamous intraepithelial lesion (HSIL).
Cervical Intraepithelial Neoplasia III (CIN III): This corresponds to severe dysplasia, carcinoma in situ or adenocarcinoma in situ (AIS), also known as high grade squamous intraepithelial lesion (HSIL).
Colposcopic biopsy is pivotal in identifying and diagnosing cervical precancerous lesions as well as carcinoma in situ and plays a major role in cervical cancer prevention and screening. However, it requires other diagnostic testing to further evaluate the spread of cervical cancer and its metastasis.
Is Colposcopy Reliable?
Doctors have been relying on colposcopy for the diagnosis and prevention of cervical cancer, but the question is whether it alone is reliable and definitive or not. Many studies have questioned the inadequacy, non-standardization and subjectivity of traditional colposcopy in assessing and diagnosing the precancerous lesions of the cervix. Colposcopy largely depends on the acetowhitening zone. If during colposcopy acetowhitening zone is present then the area is biopsied and if the acetowhitening zone is not formed, the biopsy is not opted. There have been several reports, even in invasive cancer cases when the acetowhitening zone is not formed, and no biopsy has been taken. Hence, the detection of the cervical lesions is compromised, delaying the diagnosis and treatment and also increasing the mortality risk.
Thus, to improve the accuracy and sensitivity of conventional colposcopy Dynamic Spectral Imaging System (DYSIS) digital colposcope is trending to cope for the inaccuracy and subjectivity of its counterpart. The use of DYSIS has been shown to give more accurate information and has significantly increased the detection rate of cervical dysplasias and other lesions. Better patient care is being provided with more definitive diagnosis and early detection of cervical cancers.
- Saslow, D., Solomon, D., Lawson, H.W., Killackey, M., Kulasingam, S.L., Cain, J.M., Garcia, F.A., Moriarty, A.T., Waxman, A.G., Wilbur, D.C. and Wentzensen, N., 2012. American cancer society, American society for colposcopy and cervical pathology, and American society for clinical pathology screening guidelines for the prevention and early detection of cervical cancer. Journal of Lower Genital Tract Disease, 16(3), pp.175-204.
- Massad, L.S., Einstein, M.H., Huh, W.K., Katki, H.A., Kinney, W.K., Schiffman, M., Solomon, D., Wentzensen, N. and Lawson, H.W., 2013. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Obstetrics & Gynecology, 121(4), pp.829-846.
- Clarke, M.A., Long, B.J., Del Mar, R., Arbyn, M., Bakkum-Gamez, J.N., Wentzensen, N. and Schiffman, M., 2018. Association of high-grade cervical dysplasia with histopathologic evidence of cervical cancer at biopsy. JAMA oncology, 4(12), pp.1678-1682.
- Walker, P., Dexeus, S., De Palo, G., Barrasso, R., Campion, M., Girardi, F., Jakob, C., Roy, M., Dianzani, U. and Tatti, S., 2008. International terminology of colposcopy: an updated report from the International Federation for Cervical Pathology and Colposcopy. Obstetrical & gynecological survey, 63(9), pp.592-592.
- Dalla Palma, P., Giorgi Rossi, P., Collina, G., Buccoliero, A.M., Ghiringhello, B., Naldoni, C., Sani, C., Pellegrini, A., Carozzi, F. and the New Technologies for Cervical Cancer (NTCC) Working Group, 2011. The reproducibility of CIN diagnoses among different pathologists: data from histology reviews from a multicenter randomized study. American journal of clinical pathology, 135(6), pp.826-831.
- Massad, L.S., Einstein, M.H., Huh, W.K., Katki, H.A., Kinney, W.K., Schiffman, M., Solomon, D., Wentzensen, N. and Lawson, H.W., 2013. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Obstetrics & Gynecology, 121(4), pp.829-846.
- Wang, L., Wang, X., Jiang, X., Cai, M. and Wang, G., 2019. Application of DYSIS digital colposcope in screening for cervical cancer. Archives of Gynecology and Obstetrics, 299(4), pp.1151-1156.
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