2 prof walter culture
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allTRANSCRIPT
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IFCPC Symposium
IPV Meeting
Berlin
September 2011
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The new IFCPC Nomenclature
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Normal findings
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General Assessment
• Adequate or not (inflammation, bleeding, fibrosis etc
• Squamo-columnar junction visible fully, partially or not
• Transformation zone Type is 1 or 2 or 3, as before
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Abnormal colposcopic findingsgeneral principles
• Location of the lesion
– Inside or outside the TZ
– At which position (Clockface)
• Size of the lesion
– Percentage of the cervical surface
– Number of quadrants
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Grade 1 or minor lesions
• Thin aceto-white epithelium
• Irregular geographical border
• Fine mosaic
• Fine punctation
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Grade 2 or major lesions
• Dense aceto-white epitheilium
• Rapid aceto uptake
• Cuffed crypt openings
• Coarse mosaic or punctate vessels
• Sharp borders
• Inner border sign
• Ridge sign
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Non specific
• Leukoplakia (keratosis, hyperkeratosis), “erosion”
• Lugol’s iodine uptake or Schiller’s test
– Stained
– Unstained
– Partially stained
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Suspicious for invasion
• Atypical vessels
• Fragile vessels, irregular surface, exophyticlesion, necrosis, ulcertation (necrosis) tumouror gross neoplasm
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Miscellaneous findings
• The congenital transformation Zone
• Condyloma, polyp, endo or ecto cervical
• Inflammation
• Stenosis
• Congenital anomaly
• Post treatment consequences
• Endometriosis
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The Transformation Zone
• Types 1,2 and 3 as before
• Now types 1,2 and 3 excision types
– So much confusion in terminology in the literature
– Dimensions in publications not standard
– Little evidence for effect of excision extent
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Type I TZ Type II TZ Type III TZ
• completely ectocervical• fully visible• can be small or large
• has some endocervical component• fully visible• ectocervical component may be small or large
• has endocervical component• not fully visible• ectocervical component may be small or large
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Excision specimen dimensions
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Thickness of specimen
Length of specimen
Perimeter of specimen
The dimensions of the Excised T Z specimen
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Thickness = surface to stromal marginLength = endo to ectocervical marginCircumference = A to B of opened specimen
Endocervicalmargin
Ectocervical margin
SurfaceMargin
Stromalmargin
A
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Proposal for excised TZ dimensions nomenclature
• The distance from the surface to the stromal margin is the thickness of the specimen
• The distance from the endocervical to ectocervical margin is the length
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Proposal to classify TZ excisional treatment
• Type 1 Excision (large or small)
– Excision of an ectocervical TZ
• Type 2 Excision (large or small)
– Excision of a type 2 TZ
• Type 3 Excision (large or small)
– Excision of a type 3 TZ
– Excision of suspected CGIN or micro or for a previously incomplete excision
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Type 1 Excision
•Excision pathway
•Upper limit of visibility
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•Path of excision
•Upper limit of visibility
Type 2 Excision
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Type 3 Excision
•Upper limit visibility
•Excision path
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Type 3 Excision
•Excision path
a
b
Volume and thickness of excised TZ is predictive of premature labour
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Conclusion
• Simple nomenclature system
• Will be adding
– Image correlation
– Vulvar and vaginal nomenclature
• Publication imminent