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Introduction
Cervical neoplasia represents an insidious
hazard to women of all ages. On a worldwide basis, cervical
cancer is the second most frequent malignancy in women. Adverse
effects of cervical cancer and its treatment may range from
infertility and sterility to untimely death. Cervical cancer
screening programs have decreased the incidence of cervical
cancer substantially by identifying women with premalignant
cervical disease while it is still amenable to conservative
management.
Colposcopy is the examination of the lower
genital tract in women by use of a low-power microscope. As
we know it today, the colposcope is a binocular or monocular
microscope on a stand that enables an examiner to visualize
the epithelium of the lower genital tract under magnification
and bright illumination. Although colposcopy was originally
described as a screening procedure, the introduction of cytologic
techniques by Papanicolaou in the 1940s led to its development
mainly as a secondary investigation to evaluate an abnormal
or unsatisfactory cervical smear. The modern colposcopic method
along with advances in cervical cytology has dramatically
improved the evaluation and treatment of lower genital tract
disease.
Colposcopy offers advantages over more
invasive diagnostic tests. Diagnoses can be made and patients
treated in an ambulatory setting without general anesthesia.
The minimally invasive nature of colposcopy preserves the
cervix for future childbirth. This is a particularly important
feature in light of the increasing prevalence of young women
with preinvasive forms of cervical disease.
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The purpose of colposcopy is to distinguish
among noninvasive, preinvasive, and invasive cervical neoplasia.
This approach requires an understanding of the appearances
of normal and abnormal lower genital tract epithelium and
the ability to differentiate reliably between the two. The
diagnosis is based on the evaluation of epithelial characteristics
of the cervix, as seen with the aid of the colposcope and
various applied staining solutions. A thorough knowledge of
the causative role of the human papilloma virus in cervical
disease is required. The effective management of these patients
relies on the clinician's ability to distinguish among invasive
cancer, its precursors, and other conditions. Skill and experience
are required for the performance of a complete and proper
examination. Once it has been carried out, therapy may be
individualized based on the nature, size, and distribution
of the patient's lesion (Ferris).
Historical overview
The history of colposcopy dates back to
1924, when Hinselmann, a German physician in Hamburg, was
asked to write the chapter 'Etiology, Symptoms and Diagnosis
of Uterine Cancer' in the third edition of the Handbook of
Gynecology (edited by Veit and Stoeckel). Hinselmann's response
to this challenge was truly remarkable! Confronted with the
limitations of palpation and naked-eye examination in the
early diagnosis of cervical cancer, he invented his own optical
aid: the colposcope. Click here for more information about
Hinselmann and his work.
In the United States, as early as 1929,
Levy described the need to study the genital tract with some
degree of magnification. In 1931 Emmert wrote an article introducing
the colposcope to North American physicians, and by 1932 the
colposcopic technique was beginning to be used in a few centers.
World War II created a 17-year hiatus in the development of
colposcopy in the United States because dialogue between German
and American colposcopists ceased.
The modern era of colposcopy began in 1953
when Bolten introduced modern colposcopy to the United States.
Initially it served as a tool to identify women with asymptomatic
early invasive disease. Subsequently, it has also helped physicians
identify preinvasive squamous neoplasia of the cervix. At
a meeting of the American College of Obstetricians and Gynecologists
in Miami in 1964, a group of enthusiastic colposcopists identified
the need for a colposcopy society. Thereafter, through the
dedicated efforts of many members of the society, various
colposcopy courses were initiated.
In the past 20 to 30 years colposcopy has
become the cornerstone of management in patients with abnormal
cervical or vaginal cytologic findings. By 1977 an estimated
3000 gynecologists had been trained in colposcopy, many of
whom were teaching in obstetrics and gynecology residency
training programs. The American Society of Colposcopy and
Cervical Pathology (the newer name of the original society)
charged its education committee with developing a core curriculum
for the teaching of colposcopy. Currently colposcopy is widely
practiced by a variety of physicians and is part of standard
training in many residency programs.
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