This document discusses updates to colposcopy techniques for examining genital HPV infections. It describes the colposcopic features of different HPV-related lesions in the vagina and vulva. It also outlines pitfalls that can occur in colposcopy practice and the need for proper training. The future of colposcopy is discussed, with predictions that technological advances will revolutionize the field through digital imaging and telemedicine.

1. Prof. Aboubakr Elnashar
Benha University Hospital. EGYPTABOUBAKR ELNASHAR

2. Update of colposcopy of genital HPV
Meisels et al (1982):
Florid,
spiked,
flat,
condylomatous vaginitis.
Flat condyloma & mild dysplasia represent the
same biologic phenomenon, namely, productive
HPV infection
(Reid,1993).
ABOUBAKR ELNASHAR

3. The expression of viral activity may be clinical or
subclinical when it is recognizable only on
colposcopy.
Exophytic & flat condylomata are not homologous
diseases.
Exophytic is usually caused by cutaneotropic viruses
(6,11).
Flat are more likely to contain medium(31,33) or
high risk(16,18) HPV types.
ABOUBAKR ELNASHAR

4. Micropapillary condyloma should not be confused
with micropapillomatous labialis.
ABOUBAKR ELNASHAR

5. Colposcopy of the vulva
*Steps:
1.Examination after smearing with a water soluble
lubricant.
2.Prolonged acetic acid test
3.Toludine blue test: little clinical value.
ABOUBAKR ELNASHAR

6. * The junction between the glycogen bearing
vaginal epithelium & keratin producing vulval
epithelium: high risk for intraepithelial neoplasia.
*Abnormalities:
diffuse acetowhite,
localized acetowhite,
leukoplakia,
micropapillae,
papules.
ABOUBAKR ELNASHAR

7. Colposcopy of the vagina
Colposcopy of the vagina is complicated by four
problems:
preinvasive disease of the vagina is often multifocal;
the area to be examined is large &
most of it is difficult to view at right angles;
many of these patients have already had a
hysterectomy so not all of the area involved may be
visible.
ABOUBAKR ELNASHAR

8. Because the treatment of vaginal intraepithelial
neoplasia (VAIN) is so difficult, it is more important
to differentiate viral disease from premalignant
lesions.
ABOUBAKR ELNASHAR

9. In general:
1.The colposcopic features of VAIN are similar to
those seen in CIN.
2.The colposcope must be moved from side to side
to examine the opposite wall, & it sometimes helps
to withdraw & rotate the speculum slightly while
looking through the blades from the side.
ABOUBAKR ELNASHAR

10. 3.The anterior & posterior walls of the lower half of
the vagina can be inspected while slowly
withdrawing the speculum.
4.Application of lugol’s iodine is essential after
inspection with acetic acid to reduce the risk of
overlooking an area of abnormality.12-14
ABOUBAKR ELNASHAR

11. Update on colposcopy in pregnancy
Difficult. & reserved for the most experienced
colposcopist.
Reassurance of the patient.
ECC is contrindicated & one directed biopsy.
Large speculum is usually needed
Sponge forceps to remove the mucous & acetic acid
as a mucolytic
ABOUBAKR ELNASHAR

12. Unsatisfactory colposcopy: repeat after 8 w
The aim is to exclude cancer
CIN: follow up &
definitive treatment 1-2 mo postpartum.
ABOUBAKR ELNASHAR

13. Pitfalls in practice of colposcopy
A. In the technique
1. Failure to use a diagnostic protocol
2. Deviation from a diagnostic protocol.
3. Failure to visualize TZ.
ABOUBAKR ELNASHAR

14. B. In diagnosis
1. Misinterpretation of exaggerated patterns of
pregnancy, previously treated cervix, cervical
cancer.
2. Failure to select appropriate biopsy sites,
enough biopsies, sufficient volume of tissue.
3. Failure to accurately record colposcopic findings
ABOUBAKR ELNASHAR

15. C. In management
1. Miscommunication with the pathologist.
2. Failure to correlate cytology, colposcopy &
histopathology.
3.Destructive therapy without biopsy, for invasive or
glandular lesions.
ABOUBAKR ELNASHAR

16. D. In the colposcopist
1. Inadequate training.
2. Inadequate experience.
3. Inadequate understanding of the disease.
4. Failure to keep up with scientific developments
5. Failure to maintain skills.
6. Failure to seek consultation.
ABOUBAKR ELNASHAR

17. Diploma of colposcopy
•No one should be allowed to practice colposcopy
without having proper training or without a diploma
in colposcopy
(Jordan,1995).
•It would be a legal document that would safeguard
the public & raise the status of the colposcopist.
ABOUBAKR ELNASHAR

18. Future research in colposcopy
(Hilgarth,1998)
1. Computerized colposcopic documentation &
consecutive analysis of colposcopic findings.
2. Clinical significance & biologic behavior of minor
lesions visible with colposcopy in the presence of
different HPV types.
3. Clinical significance & relation to HPV infection of
minor lesions beyond the TZ.
4. Vulvar lesions in vulvodynia related to HPV
infection.
ABOUBAKR ELNASHAR

19. Future of colposcopy
(Niekerk,1998)
1. There are going increasing costs of medical care
& the demand for better quality control will
intensify.
2. Technical advances will revolutionize this area &
digital imaging, the storage of up to 4.500 images
on an optical disk & rapid teletransmission of
images will become practical..
The use of these new technologies for better &
more cost effective patient care is the challenge we
will have to meet in the 21st century.
ABOUBAKR ELNASHAR

20. ABOUBAKR ELNASHAR