What is the advanced cervical colposcopy

The presence of groups of patients with high risk of tumor formation cervical processes necessitates their constant supervision. Expose a woman many times is not necessary. Extended colposcopy - a safe way to cervical screening survey to determine the tumors in the early stages of development. The method allows using multiple increase and special tests to diagnose changes at the cellular level.

The structure of the cervix

The cervix is ​​the part of the uterus that connects the body cavity with the vagina. It has a conical or cylindrical shape, depending on the availability of labor. The cervix is ​​divided into vaginal and supravaginal part. The first half is available for visual inspection in the mirror. In the center of the neck is a hole - outer mouth extending into the cervical canal and ending internal throat.

From a functional and anatomical point of view it is accepted to allocate:

• ekzotserviks - vaginal mucous portion side body composed of stratified squamous epithelium;
• endocervical cervical canal or which is lined with high single-row cylindrical epithelium.

Located between two veils transition zone. That joint portion and endo ekzotserviksa be greatest attention as potentially dangerous in terms of tumor formation.

What is extended colposcopy

colposcopy method involves the study of the structure of the cervix, vaginal walls at multiple increase. Simple research limited to the study forms, the quantities of the cervical canal, color and relief portions mucosal transformation zone. If necessary, the gynecologist performs sampling of material for cytological study.

Extended colposcopy involves the use of special chemical environments that affect the body. With these drugs specific reaction occurs, which manifest differently on diseased or healthy tissue pathological process. Changes can accurately identify abnormal areas, trace vascular response. Similar plots additionally be targeted biopsy and subsequent cytology.

Extended procedure It helps clarify the diagnosis, which is not always possible to identify the eye without special tests. In this case, colposcopy is not considered invasive research method is absolutely safe way.

colposcope

It is an optical device with a light source and lenses for larger objects under study. Modern devices are equipped with eyepieces with variable zoom ratio and three-dimensional images. In addition, it is possible to individually adjust the colposcope for the doctor depending on the characteristics of view.

The tool allows you to reliably study the structure of cervical vaginal part under a microscope, to conduct special tests and biopsy. Under the control of a colposcope spend many surgical procedures on the cervix.

Indications for

Extended colposcopy - a modern non-invasive method for the diagnosis of cervical conditions. It is advisable to carry out a study in conjunction with the annual gynecological exam and a pelvic ultrasound. Regular monitoring of the main indicators of reproductive health can detect pathological conditions in the very early stages, which is especially important for precancerous diseases and cancer.

Colposcopy is a mandatory when:

• stock portions mucosal growths (polyps, warts);
• a distinct change epithelium areas (erosion, ectropion, leukoplakia, erythroplakia);
• cervical hyperplasia;
• Body planned study after treatment;
• receiving responses Pap smear with pathological changes;
• background or suspected cancerous cervical condition;
• preoperative preparation;
• prior to biopsy.

Preparatory stage

Colposcopy does not require special training. Many patients in the study is conducted under the conditions of outpatient clinics planned visit to a gynecologist. When detecting suspicious cervical specialist areas have been manipulated at once. In the presence of inflammation is desired to transfer procedure: increased amount of precipitates and lymphocytic infiltration of cells may influence the outcome of the study. A doctor holds a fence on cytology smears, appoints therapy. After completing the course of treatment is acceptable conduct extended colposcopy.

In the case of the planned manipulation you need 48 hours to refuse unprotected sex, douching, a topical treatment.

Selection of the optimal period

cervical colposcopy is not carried out directly during menstruation. Immaterial day cycle does not. However, the possibility of a study carried out in the first phase, or a few days before the bleeding. At this time, the allocation of a minimum of cervical mucus, rendering better.

Method of implementation

Simple colposcopy performed on the gynecological chair. The doctor inserts a mirror and displays the cervix, according to assistant tools for fixing. The device is installed at a distance of 20 cm. Specialist directs light rays onto the studied region, conducts increase setting up a clear image. With cervical sterile swab removed all selections to clear the area under investigation. At this stage, the study of the structure at different angles machine.

Extended colposcopy comprises applying dyes. Most often used a weak solution of acetic acid and iodine. Acetic acid 3% leads to short vasoconstriction and mucosal edema cervix. Perhaps a slight tingling. Pathological lesions turn white, easily recognizable, atypical capillaries appear stronger, not shrinking.

A solution of Lugol's iodine causes the specific brown staining of the epithelium. This is called the sample Schiller. Normal cervical cells contain glycogen, which absorbs iodine and painted. Precancerous and cancerous cells do not accumulate glycogen remain pale.

Before extended colposcopy Gynecologist should clarify whether the patient has an allergy to the basic solutions needed for manipulation. If necessary, your doctor may change the colors, to conduct additional tests.

In identifying suspicious areas doctors "pinch off" small pieces of tissue for laboratory testing - biopsy. Manipulation on the cervix is ​​usually painless. Innervation of the vagina is stronger, so doctors use a local anesthetic, if necessary, removal of material.

after the procedure

Manipulation is absolutely not dangerous, it does not give the woman any sensations. Inspection takes place without contact by means of an optical system. The most "painful" for the patient can be extended colposcopy. In rare cases, when the sensitive mucous observed slight tingling sensation when applied to acetic acid. Recoating neck Lugol solution eliminates the discomfort.

Biopsy, removal of papillomas, warts of the cervix can be carried out under the supervision of a colposcope to enhance the accuracy. This independent minor surgery that does not require anesthesia or regional anesthesia limited.

After extended colposcopy patient may note the appearance:

• brownish precipitates and odor that are remnants of the dye in and out of the cavity;
• Spotting what is permissible after the removal of polyps or biopsies for 1-2 days;
• minor nagging pains in the lower abdomen after small surgical interventions under increasing control.

After the usual studies no restrictions are required. If the patient has invasive procedure performed when extended colposcopy, preferably several days to abstain from unprotected sex, administration tampons, suppositories into the vagina.

Possible consequences

Extended colposcopy is not carried out if:

• postpartum less than 2 months;
• abortion, curettage was performed 3-4 weeks ago;
• reconstructive manipulation of the neck over the last six months;
• the patient menstruation;
• are bleeding;
• pronounced inflammation.

Exception contraindications to manipulation reduces the likelihood of complications. Colposcopy - safe and informative way to learn neck. The only possible negative reaction to the extended method may be allergic to the solution components. In rare cases:

• temperature rise;
• uncharacteristic allocation;
• prolonged spotting;
• pain in the abdomen and lower back for more than 48 hours after the procedure.

The emergence of adverse signs of complications - a reason for a return visit to a specialist.

Conducting Pregnancy

Gestation is not a contraindication for colposcopy. In contrast, detection of suspicious lesions from potentially malignant necessary to ensure the health of the patient. Extended colposcopy during pregnancy is carried out less frequently, many experts fear of allergic reactions to drugs. However, this complication is rare. In pregnancy, the study assigned patients according to indications: a history of the background cervical pathologies, in the preparation of abnormalities in the smears.

Preferably perform extended colposcopy in the first trimester in the absence of contraindications, allergic reactions and threatened abortion.

The cervix during pregnancy greatly transformed. Hormonal changes cause epithelial edema, cyanosis mucosa. Vascular pattern changes, often resembles atypical structure. it is recommended to carry out research in the early stages to reduce the possibility of overdiagnosis.

Decoding results

Extended colposcopy is good because it does not need to wait for the results of the study. A doctor using equipment sees healthy cervix or there are pockets of unknown origin. Dyes help differentiate certain diseases, making it easier to diagnose. Confirms the diagnosis result of cytological or histological examination of body tissue site. The exact conclusion biopsy is usually done in 5-10 days.

Modern Colposcopes equipped with video equipment that can record real-time study. So disappears subjectivity manipulation. If necessary, the woman can show the results of the extended colposcopy another specialist.

Atsetobely epithelium

In certain cases, enhanced manipulation after acetic acid treatment revealed portions atsetobelogo epithelium. Symptom appears immediately after application of the chemical solution. Contours precise focus. Importantly, the faster the blanching of the area, the more pronounced structural changes observed in the epithelium and the worse the prognosis. Gentle foci atsetobelogo color observed in the presence of papillomavirus, the presence of chronic inflammation. Rough deep pockets, protruding above the surface of the cervical mucus favor the severe dysplasia.

In identifying areas atstobelogo epithelium must be further examination. The symptom is often a sign of serious conditions: dysplasia (viral infection of the neck).

leukoplakia

Extended colposcopy reveals foci of hyperkeratosis cover shell of the vaginal part of the cervix. Stratified epithelium and transformed in appearance resembles a whitish plaque. Similar changes are seen with the naked eye.
state of danger is asymptomatic and are at high risk of malignancy.
Leukoplakia can manifest pin spotting, minor belyami. However, such complaints are rare or accompany an advanced stage disease. Distinguish two forms.

• Simple - it refers to the background of cervical disease. In this case, the affected surface layers of surface epithelium.
• Proliferative forms. Transformation affects all levels and disrupts cell differentiation. Depending on the extent of damage is classified into three levels, as well as dysplasia - precancerous condition.

Extended colposcopy helps to establish the exact boundaries of the hearth. Schiller Conducting tests with Lugol solution exhibits a pathological condition in a yodnegativnyh portions. Leukoplakia almost keratinized cells do not contain and do not accumulate glycogen iodine.

Ectopia and cysts Nabothian

Ectopic the arrangement of columnar epithelial cervical vaginal canal at its portion that is not normally characteristic. However, ectopia is not considered pathological, requiring treatment. In a world of such an atypical location is considered passing specific feature that you want to monitor.

In the transition zone region located glandular structures or Nabothian gland. When inflammation, hormonal regulation violation occurs excessive accumulation of secretion in the gland cavity arises cyst.

transformation zone

The visible part of the cervix is ​​covered with a flat stratified epithelium. Cervical canal is lined with cylindrical cells. The connection between the different sheets is called the transformation zone. Search this site with an extended colposcopy is necessary. Such importance is the fact that the majority of malignant transformation begins with the transition zone.
Even with an increase in the transformation zone is hard to find, extended colposcopy with samples helps to reliably determine the location and type of the transition zone.

ectropion

It represents eversion portion cervical vaginal mucosa on the surface of the cervix. Distinguish congenital and acquired ectropion. Gaps in childbirth, abortion, plastic surgery on the neck often lead to such pathology. Extended colposcopy enables the nature of folding scar tissue to determine the cause of the disease. Uniform arrangement of the folds evidence in favor of innate forms and chaotic bumps talking about acquisitions.

Abnormally located mucosa exposed portion of the inflammatory response. The patient often complains of white discharge. Running process and the presence of HPV may lead to the emergence of dysplasias. Chronic inflammation, disruption of normal healing with a sharp cervical deformation causes transformation of individual cells.

atypical vessels

Malignant tumors lead to increased formation of blood vessels to supply the growing pathological nidus. Many experts consider the emergence of atypical capillaries first sign of the degeneration of the tissue.

Not considered normal corkscrew elements crimped shape randomly arranged permanently interconnected. With a strong plot transformation observed thickened, sometimes expands blood vessels, then abruptly cut off its course.

The main feature to accurately indicate the absence of atypia capillary constriction after applying the acetic acid solution with extensive research. Such elements are deprived of normal tunica muscularis, however not reduced in response to a stimulus.

vascular atypia may accompany certain inflammatory processes, conditions after radiotherapy. To determine the exact nature of the pathology which led to the emergence of abnormal capillaries requires a biopsy and cytology.

Mosaic

In the formation of deep lesions, abnormal vascular network of branches. Mosaic looks like islands surrounded by dense tissue altered capillary lines. After the treatment with acetic acid pathology becomes clearer: vascular red line frame segments of different sizes and shapes, wherein the abnormal cells are localized.

In practice, the distinction is made between soft and rough mosaic. In identifying portion on the periphery of the transformation zone, not projecting above the surface of the surrounding tissue pathology refers to a mild form. Extended colposcopy with samples strengthens border, when applied to the fabric color of iodine does not usually change. If the field is not too bright, approximately the same size, over the hearth is observed.

Rough mosaic has broken form. Notes atsetobelaya reaction, vascular furrows bright and juicy. In identifying the "blistering", towering above the surface subject to the mandatory histological examination. Cervical like state especially potentially dangerous.

Punktatsiya and vascular anomaly

Punktatsiya epithelial extended colposcopy procedure assumes the appearance of red marking points on the exposed area. Capillaries form a portion of the loop positioned vertically. Distinguish between gentle and rough punktatsiyu.

1. "Delicate" form occurs at mild lesions. Visible apt evenly spaced points.
2. "Rude" type is more unfavorable. Punktatsii large, irregularly thickened. After coating with acetic acid clearly show through, indicating the benefit of abnormal vascular structure.

Extended colposcopy with samples allows us to trace the space in between the elements. Regular intervals characteristic of uniform punktatsii. Unevenly increases the distance a bad prognostic sign.

Iodine negative zone

Extended colposcopy involves performing Schiller test. Normally, the test is positive. Application of Lugol's solution to the mucous neck resulting in uniform coloring of notches in a dark brown color. Due to the content of glycogen in clumps multilayered epithelium of the accumulation of iodine and the corresponding change in color. a cylindrical cover portions endocervical iodo absorb considerably less. Due to this feature, gynecologists are able to accurately identify the location of the transformation zone.

The appearance of white or iodine negative areas constitutes a violation of metabolic processes of cells. Vozmodno there is a tumor or precancerous transformation. To establish the nature of the pathology biopsy performed sighting several places yodnegativnoy zone.

Form protocol and deadlines

There are different classifications for the interpretation of the results of the extended colposcopy. The simplest seen divides into three categories:

1. minor changes, signs of persistent papillomavirus, dysplasia 1 degree;
2. are suspicious areas, there is the appearance of atypical vascular reactions;
3. potentially malignant lesions. Clearly observed abnormal capillaries, uneven surface of the cervix, dysplastic metamorphosis severe.

Regardless of the system chosen gynecologist explains patsientkesut existing problems, appoint additional investigation and treatment.

extended colposcopy protocol results include:

• the number, nature of the discharge;
• Description external os;
• type, location of the transition zone;
• vascular pattern;
• color, type of epithelium;
• Description pathological entities: polyps, kondillomy;
• period and the course of reactions during the processing of acetic acid;
• shades, changing the epithelial sample Schiller;
• reaction capillaries on chemicals;
• indication of the number and localization of tissue taken for biopsy.

Extended manipulation takes 15-30 minutes. Results of further strokes on the neck are usually obtained after 5-7 days.

Good and bad results of the study

An experienced doctor with a high degree of probability will report on existing pathology. However, to establish an accurate diagnosis experts biopsy followed by histology, cytology smears. After researching the cellular structure of the tissue taken from suspicious areas established cause of the occurrence of certain colposcopic picture.

Extended colposcopy using samples allows more accurate differential diagnosis.

Normally Colposcopic picture mucous neck has the following description:

• body surface is distinct, uniformly pink in color;
• endocervical represented cylindrical and flat layered ekzotserviks cells;
• a transition zone located within the age indicators allowed metaplasicheskie elements;
• acetic positive sample reaction and Schiller.

Occurrence yodnegativnyh, atsetobelyh foci outgrowths mucosal vascular structure changes indicative of a pathological process.

reliability

colposcopy method is highly informative. It suggests a reproductive health of internal genital organs on the basis of the visible parameters. The study reveals asymptomatic forms of tumors in the earliest stages. Additional tests with the extended procedure specify the clinical picture. If necessary the target biopsy, which greatly increases the accuracy of the results.