INTRODUCTION

TO COLPOSCOPY

Prof. Dr. dr. H. Syahrul Rauf, Sp.OG (K)

INTRODUCTION
The colposcopic exam serves to
• Identify normal landmarks
• Identify abnormal areas in
relation to these landmarks
• Facilitate directed biopsy of
abnormal areas for histologic
diagnosis
• Rule out invasive cancer
Pre-malignant and malignant cervical conditions procedure
colposcopically identifiable epithelial changes
that generally occur within the
transformation zone
 SQUAMOUS
METAPLASIA
• Physiological replacement
of the columnar epithelium
with squamous epithelium
• The region where this
occurs in knowns as
TRANFORMATION ZONE
• IMPORTANT because
almost ALL cervical
cancer occur in this zone
NORMAL COLPOSCOPIC FINDINGS

The entire new squamocolumnar junction (SCJ) is visible. The transformation zone (TZ) if fully visualized.
The metaplastic squamous epithelium is pinkis-white compared to the pink original squamous epithelium
INSTRUMENTS
• Colposcope
• Vaginal specula in various sizes
• 3%-5% acetic acid
• Lugol’s iodine solution
• Cotton-tipped applicators and large cotton swabs and/or cotton balls
• Endocervical specula in various sizes
• Biopsy forceps such as Tischler, baby Tischler, or Kevorkian forceps
• Endocervical curette and/or endocervical brushes
• Ring forceps or tissue forceps
• Biopsy specimen container wit fixative and labels
• Hemostatic agent such as silver nitrate sticks or Monsel’s paste (ferric
subsulfate)
 Focal length 200-
Fiber optic cable to one or 350mm
two separate lamp

Arc lamp provide white illumination

Colposcope – Binocular or video, 300-mm focal length, variable magnification,

red-free (green or blue) filter
Green filter
Magnification
3.5x

7.5x

15x
The diopter scales on each eyepiece are set
to the 0 position when the dots on the
eyepieces and colposcope are aligned

Occula hoods. The right hood is extended to

help prevent obscuring ambient light
 Fine focusing is accomplished by turning
the fine focus handle

A mechanical or hydraulic patient examination table

with leg facilitates the colposcopy examination
Lateral vaginal retractor

A mini-Townsend cervical
biopsy forceps
Endocervical speculum

A narrow blade for a stenotic os

A wider blade for parous os

Tischle-Morgan biopsy forceps The Burke biopsy forceps

Tischle-Morgan bite

Kevorkian biopsy forceps Mini Townsend bite

 A thumb activated locking
mechanism on biopsy forceps

Keyes dermal biopsy punch to

sample vulvar lesion
Endocervical curette

London curette
 Silver nitrate sticks used
for hemostasis

Campion syringe to inject anesthetics

into cervix or proximal vagina

Normal saline, Monsel’s paste, Lugol’s iodine, 3%-5% acetic acid

(left to right)
The key ingredients of the exam are the
observation of the cervical epithelium
After application of normal saline
3-5 % of acetic acid
Lugol’s iodine solution in successive
steps
DOCUMENTATION
• Current computer-based systems are designed specifically to :
• Capture and store digitized colposcopic images
• Archive pertinent patient information
• Print visit information and color images for hard copy
documentation
• Provide patient tracking and recall services
• Procedure template or customized consultation letters
IMAGE RECORDING TECHNIQUES
Simple hand drawing
(most widely used but least accurate)

Colpophotography

Videocolposcopy
SIMPLE HAND WRITING
 COLPOPHOTOGRAPHY
• Cervical images as photographs or color
video
• Most colpophotography is now done with
a digital camera, as 35-mm film is more
costly and difficult to obatin

Camera are attached to the

colposcope’s beam splitter
 VIDEOCOLPOSCOPY
• Optical colposcopes that have a
beam splitter (image diverter)
and accessory portals permitting
the attachment of different types
of camera provide the best video
images and photographs

OPTICAL COLPOSCOPE WITH A BEAM

SPLITTER, ADAPTER AND CCD VIDEO
CAMERA
THANK YOU