Colposcopy as a valuable diagnostic test

Colposcopy is one of the endoscopic methods used in gynaecological diagnosis. It is most often carried out in the event of an abnormal result of a cytological examination, but colposcopy may also be indicated if suspicious lesions on the vaginal part of the cervix are visible during a gynaecological speculum examination or if persistent discharge or itching of the vulva is observed.

Colposcopy involves viewing, under suitable light, with an optical instrument that allows high magnification (from 4 to 40 times), an image of the examined area. Appropriate accuracy of the examination is ensured by magnification of 10 to 20 times. A number of different biochemical techniques are used simultaneously to make the lesional cells more visible during the colposcopic examination. These involve the use of acetic acid or Lugol's liquid, which, by reacting in colour with the abnormal cells, allow easier visualisation and localisation.

In order to assess vulvar lesions, the best results are obtained using fluorocolposcopy, which uses the phenomenon of cell fluorescence under the influence of the applied photo-oxidant and laser light.

For many years, colposcopy was an underestimated examination, but with the passage of time and advances in many scientific fields, which have resulted in the introduction and dissemination of new laser techniques in medicine, a clear return can be seen to this method, known since the 1920s, for the early diagnosis of lesions in the disc of the vaginal part of the cervix, in the lower part of its canal and in the vagina and vulva.

Colposcopic examination makes it possible to:

• Collection of a cervical smear for cytological examination, for the presence of H. pyloriV or Chlamydia trachomatis.
• Detection of precancerous lesions and microinvasion.
• Visualisation of lesions such as mucosal polyps, lesions of viral origin such as condylomas.
• Obtaining tissue material for histopathological examination during targeted biopsy from the most suspicious areas.
• Assessing the spatial structure of the epithelium, its colour, arrangement and transparency, and the pattern of blood vessels.
• Providing information on the aetiology and dynamics of lesions in the cervix, vagina or vulva.
• To visualise the topography and assess the morphology of the lesions.
• Determining the type and extent of treatment when lesions are visualised.
• Monitoring the therapeutic effects.

The vaginal part of the cervix is covered by squamous multilayered epithelium, while the interior of its canal is lined by cylindrical epithelium. The junction zone between these two epithelia is where atypical lesions most commonly begin.

In colposcopic examination, the visualisation of this zone is therefore of particular importance. The ability to accurately visualise, differentiate and localise even small lesions is important in establishing and carrying out proper monitoring of women at risk of cervical, vaginal and vulvar pathologies, and is also useful in deciding on further diagnosis or therapy in the event of detecting abnormalities of a pre-neoplastic or neoplastic nature.

In many cases, colposcopic verification of the cytological result makes it possible to abandon radical therapy in favour of sparing therapy, which is important in the case of young women during the period of procreation.