What Does a Colposcopy Examine?
A colposcopy is a detailed examination of the cervix, vagina, and in some instances the vulva, using a colposcope (a magnifying instrument) after the application of 3-5% acetic acid solution, coupled with obtaining colposcopically directed biopsies of any lesions suspected of representing neoplasia. 1
Primary Areas Examined
- Cervix: The main focus of most colposcopic examinations, particularly evaluating the transformation zone and squamocolumnar junction for abnormalities 1
- Vagina: Examined as part of a comprehensive colposcopic assessment, especially important when HPV disease is suspected to be multifocal 2
- Vulva: May be included in the examination when indicated, particularly when HPV-related lesions are suspected or for unexplained symptoms 2, 3
Key Components of the Examination
- Magnification: The colposcope provides 10x-16x magnification to visualize subtle tissue changes not visible to the naked eye 1
- Acetic Acid Application: A 3-5% acetic acid solution is applied to the cervix before viewing, which helps highlight abnormal areas by causing them to appear white (acetowhite changes) 1, 4
- Blood Vessel Pattern Assessment: The colposcope allows for visualization of abnormal vascular patterns that may indicate precancerous or cancerous changes 1, 4
- Iodine Staining: Sometimes used to identify abnormal areas that fail to uptake the stain (Schiller's test) 4, 5
- Directed Biopsies: The colposcope guides the clinician to take biopsies from the most suspicious areas for histological evaluation 1, 4
What Makes a Satisfactory Colposcopy
- Complete Visualization: A satisfactory colposcopy requires that the entire squamocolumnar junction and the margin of any visible lesion can be visualized 1
- Transformation Zone Assessment: The complete transformation zone must be visible for the examination to be considered adequate 6
- Endocervical Assessment: When the squamocolumnar junction cannot be fully visualized, endocervical sampling may be necessary 1, 7
Clinical Indications for Colposcopy
- Abnormal Cervical Cytology: Primary indication for colposcopy, including ASC-US, LSIL, ASC-H, and HSIL results 1
- Positive HPV Testing: Particularly important for high-risk HPV types like HPV 16 and 18, even with normal cytology 7, 8
- Persistent HPV Infection: Colposcopy is recommended after repeat positive HPV testing at 12 months 8
- Suspicious Visual Findings: Abnormal appearance of the cervix during routine examination 4
Special Considerations
- Pregnant Women: Colposcopy can be performed during pregnancy but with modified protocols 4
- Postmenopausal Women: May require special techniques due to atrophic changes 4
- Adolescents: Special considerations apply to this population 4
- HPV 18 Positive Results: Due to the association with adenocarcinoma, endocervical sampling is often recommended during colposcopy 7
Common Pitfalls to Avoid
- Incomplete Examination: Failure to visualize the entire squamocolumnar junction may lead to missed lesions 1, 6
- Inadequate Biopsies: Not taking biopsies from all suspicious areas can result in underdiagnosis 1
- Overlooking Endocervical Canal: Particularly important when evaluating for adenocarcinoma or when HPV 18 is present 7
- Poor Colposcopic Technique: The reproducibility of colposcopy is limited and operator-dependent, requiring proper training and experience 1