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Elisabeth Wegner, MD UVM Larner College of  Medicine  


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Clinical Update on Colposcopy
ASCCP Releases New Colposcopy Guidance 
The American Society for Colposocpy and Cervical Pathology (ASCCP), has released recommendations for Colposcopy, which were released in the October 2017 issue of the Journal of Lower Genital Tract Disorders. The recommendations cover: 

1. Standardized terminology for colposcopic practice
The new ASCCP colposcopy terminology is summarized here in Table 1. The 6 major areas include the following: (1) general assessment, (2) evaluation for presence of any acetowhite lesions, (3) description of normal colposcopic findings, (4) description of abnormal colposcopic findings, (5) description of other/miscellaneous findings, and (6) reporting of the colposcopic impression, defined as the highest-grade impression of any visible lesion on the cervix.
2. Reporting of comprehensive and minimal
colposcopy criteria
Recommendation: A comprehensive colposcopic examination should include description of the cervix visibility, squamocolumnar junction visibility, presence of acetowhitening, presence and visualization of a lesion, color/contours/borders/vascular changes of lesions, the location and size(s) of lesion(s), other features, and the colposcopic impression. A diagram or marked image annotating the findings should also be included. 

Risk-based Colposcopy
1. Adapting colposcopy practice to previous risk and colposcopy impression
Recommendation: Colposcopy practice may be modified based on the risk level (which can be viewed as the probability of finding precancer/cancer at the time of the procedure), based on reason for referral and colposcopy impression.  
2. Number and type of biopsies taken at colposcopy
Recommendation: Multiple biopsies targeting all areas with acetowhitening, metaplasia, or higher abnormalities are recommended. Usually, at least 2 and up to 4 targeted biopsies distinct acetowhite lesions should be taken.

3. Biopsy practice in women with low risk of pre-cancer
Nontargeted biopsies are not recommended for those with less than high-grade squamous intraepithelial lesion cytology, no evidence for HPV16/18, and a completely normal colposcopic impression (i.e. no acetowhitening, metaplasia, or other visable abnormality). 
4. Biopsy practice in women with very high risk
of precancer
Recommendation: In nonpregnant women 25 years and older with very high risk of precancer (at least 2 of the following: high-grade squamous intraepithelial lesion cytology, HPV16 and/or HPV 18 positive, high-grade colposcopy impression) either immediate excisional treatment without biopsy confirmation, or colposcopy with multiple targeted biopsies is acceptable. Endocervical sampling should be conducted according to the 2012 ASCCP Management Guidelines. If biopsies are
taken and do not show precancer, management according to the 2012 ASCCP Management Guidelines is recommended.

Colposcopy Procedures and Adjuncts
1. Colposcopy procedures for minimally acceptable and comprehensive practice 
Recommendation: Recommended minimally acceptable and comprehensive colposcopy procedures are summarized here in Table 2. Five major areas of colposcopy procedures were covered, including the following: (1) precolposcopy evaluation, (2) examination, (3) documentation, (4) biopsy sampling, and (5) postcolposcopy procedures.
2. Evaluation of colposcopy adjuncts 
Recommendation: Current evidence is insufficient to recommend for or against the use of any adjunct in colposcopic practice.