7. Colposcopy

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Introduction

The aim of diagnostic colposcopy following an abnormal cervical screening test is to assess the nature, severity and extent of the abnormality. This requires the identification of the cervix and external os, the exclusion of invasive disease, the mapping and typing of the transformation zone (TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone.), the identification of any visible abnormalities and the targeting of the most abnormal area(s) for biopsy. Systematic examination of the whole lower genital tract and accurate, concise recording of the findings are required to produce the highest sensitivity and best positive predictive value for diagnosing high-grade abnormalities, as well as determining if treatment is required and planning the most appropriate mode, timing and extent of therapy.

In the renewed National Cervical Screening Program (NCSPNational Cervical Screening ProgramA joint program of the Australian, state and territory governments. It aims to reduce morbidity and mortality from cervical cancer, in a cost-effective manner through an organised approach to cervical screening. The program encourages women in the target population to have regular Pap smears.) colposcopists are required to submit data from diagnostic and therapeutic colposcopy to the National Cancer Screening RegisterA database of identifiable persons containing defined demographic and health information, established for a specific purpose. In the case of cervical screening or other cancer screening registers, the purpose includes inviting eligible persons for screening, sending reminders when they are overdue for screening, follow up of abnormalities, statistical reporting and research. (NCSRNational Cancer Screening Register). In return, they will receive data directly from the NCSRNational Cancer Screening Register to enable them to review their own performance against defined benchmarks. These data can then be submitted to fulfil requirements for recertification in colposcopy. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOGThe Royal Australian and New Zealand College of Obstetricians and Gynaecologists) will manage the certification and recertification processes for colposcopists. In the renewed program, the annual performance report prepared by the Australian Institute of Health and Welfare (AIHWAustralian Institute of Health and Welfare) will include colposcopy data.

This chapter contains recommendations about the performance of colposcopy and related treatments. It is not intended to replace supervised training in accredited centres, nor attendance at colposcopy training and update courses, but offers guidance as to the minimum standards expected of a colposcopist providing services to the NCSPNational Cervical Screening ProgramA joint program of the Australian, state and territory governments. It aims to reduce morbidity and mortality from cervical cancer, in a cost-effective manner through an organised approach to cervical screening. The program encourages women in the target population to have regular Pap smears..

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