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Recognizing different cervical conditions
Accurate colposcopic diagnosis of distinct grades of CIN is challenging. Differentiating CIN2 from small area of CIN3 by colposcopy may be nearly impossible. Detecting small area of high-grade lesion within the larger CIN1 summons considerable colposcopic expertise as well. It is more difficult to distinguish between CIN1 and immature metaplasia.
The use of scoring systems may improve the quality of colposcopy, but in daily practice, there is a need for practical selection criteria, which allow to find the most severe area for colposcopy-directed biopsy.
Colposcopic features suggestive of metaplasia:
• A smooth surface with fine, uniform-caliber vessels
• Mild acetowhite change
• Negative or partial positivity with Lugol's iodine
Colposcopic features suggestive of low grade disease
(minor changes):
• Smooth surface with an irregular outer border
• Slight acetowhite change
slow to appear and
quick to dissapear
• Mild, often speckled iodine partial posivitity
• Fine punctation and fine regular mosaic
Colposcopic features suggestive of high-grade disease
(major changes)
• Generally smooth surface with sharp outer border
• Dense acetowhite change, may be oyster white
appears early
slow to resolve
• Iodine negativity
• Coarse punctation and wide irregular mosaic of different size
Signs of microinvasion
• Yellow discoloration
• Ulceration
• Thickened areas
• Nodularity
• Abnormal vascularity
• Rapid increase in size
Colposcopic features suggestive of invasive cancer:
• Irregular surface, erosion or ulceration
• Dense acetowhite change
• Wide irregular punctation and mosaic
• Atypical vessels
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