all

1. IFCPC Symposium
IPV Meeting
Berlin
September 2011

2. The new IFCPC Nomenclature

3. Normal findings

4. General Assessment
• Adequate or not (inflammation, bleeding,
fibrosis etc
• Squamo-columnar junction visible fully,
partially or not
• Transformation zone Type is 1 or 2 or 3, as
before

5. Abnormal colposcopic findings
general principles
• Location of the lesion
– Inside or outside the TZ
– At which position (Clockface)
• Size of the lesion
– Percentage of the cervical surface
– Number of quadrants

6. Grade 1 or minor lesions
• Thin aceto-white epithelium
• Irregular geographical border
• Fine mosaic
• Fine punctation

7. Grade 2 or major lesions
• Dense aceto-white epitheilium
• Rapid aceto uptake
• Cuffed crypt openings
• Coarse mosaic or punctate vessels
• Sharp borders
• Inner border sign
• Ridge sign

8. Non specific
• Leukoplakia (keratosis, hyperkeratosis),
“erosion”
• Lugol’s iodine uptake or Schiller’s test
– Stained
– Unstained
– Partially stained

9. Suspicious for invasion
• Atypical vessels
• Fragile vessels, irregular surface, exophytic
lesion, necrosis, ulcertation (necrosis) tumour
or gross neoplasm

10. Miscellaneous findings
• The congenital transformation Zone
• Condyloma, polyp, endo or ecto cervical
• Inflammation
• Stenosis
• Congenital anomaly
• Post treatment consequences
• Endometriosis

11. The Transformation Zone
• Types 1,2 and 3 as before
• Now types 1,2 and 3 excision types
– So much confusion in terminology in the literature
– Dimensions in publications not standard
– Little evidence for effect of excision extent

12. Type I TZ Type II TZ Type III TZ
• completely
ectocervical
• fully visible
• can be small or
large
• has some
endocervical
component
• fully visible
• ectocervical
component may be
small or large
• has endocervical
component
• not fully visible
• ectocervical
component may be
small or large

13. Excision specimen dimensions

15. Thickness of specimen
Length of
specimen
Perimeter of
specimen
The dimensions of the Excised T Z specimen

16. Thickness = surface to stromal margin
Length = endo to ectocervical margin
Circumference = A to B of opened specimen
Endoce
mar
Ect
Surface
Margin
Stromal
margin
A

17. Proposal for excised TZ dimensions
nomenclature
• The distance from the surface to the stromal
margin is the thickness of the specimen
• The distance from the endocervical to
ectocervical margin is the length

18. Proposal to classify TZ excisional
treatment
• Type 1 Excision (large or small)
– Excision of an ectocervical TZ
• Type 2 Excision (large or small)
– Excision of a type 2 TZ
• Type 3 Excision (large or small)
– Excision of a type 3 TZ
– Excision of suspected CGIN or micro or for a previously
incomplete excision

19. Type 1 Excision
•Excision pathway
•Upper limit of visibility

20. •Path of excision
•Upper limit of visibility
Type 2 Excision

21. Type 3 Excision
•Upper limit visibility
•Excision path

22. Type 3 Excision
•Excision path
a
b
Volume and thickness of excised TZ
is predictive of premature labour

23. Conclusion
• Simple nomenclature system
• Will be adding
– Image correlation
– Vulvar and vaginal nomenclature
• Publication imminent