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Cervical cancer screening

Supplement. Colposcopy technologies and documentation

GUIDELINE UPDATES - This guideline was last updated 7/1/2022

Adjunctive technologies

A number of modern technologies based on spectroscopy and electrical impedance can be used in practice to increase the sensitivity, positive predictive value and specificity of colposcopy, including LuViva, DySIS and ZedScan.[1] Of these, only ZedScan is registered with the Therapeutic Goods Administration and is undergoing evaluation in Australia. These are not commonly used in Australia.

Modalities of treatment not commonly used in Australia

Cryotherapy

This is not recommended in resource-rich countries, where alternative treatment modalities exist, as the rate of clearance of HSIL (CIN3) is poor and the persistence or recurrence of HSIL (CIN2/3) is higher than with other techniques. When used for the treatment of a symptomatic inflamed ectropion or persistent low-grade disease, a double-freeze technique is preferred, and has lower rates of residual disease compared with a single-freeze technique.[2][3] It is rarely, if ever, used in Australia.

Thermal Coagulation (Semm or ‘Cold’ coagulation)

The thermal coagulator is a self-contained electrically powered device which works with a probe at 60–130 degrees Centigrade (it was known as ‘cold’ because it works at lower temperature than diathermy). The probe, which comes with half a dozen different profiles, goes through a self-sterilising cycle before being applied directly to cervix in 20-second applications that can be multiply repeated to cover the whole TZ. Studies have confirmed its efficacy in benign, low and high-grade abnormalities.[4][5] There is currently a resurgence of interest in using this modality in Europe, and in future it may be promoted in Australia.

Documentation

High-quality patient management requires meticulous documentation of the woman’s medical record. The results of consultations, examinations and treatments must be recorded, preferably electronically to facilitate submission of colposcopy data to the NCSR (see Colposcopy data required for the National Cancer Screening Register) and in providing written communication back to the primary care provider. Colposcopy data can be entered electronically into the National Cancer Screening Register using the Healthcare Provider Portal (this requires a Healthcare Provider Individual Identifier (HPI-I) and a Provider Digital Access (PRODA) account), or by HL7 direct links with specific clinical software systems

Description of abnormalities should be in line with the 2011 IFCPC terminology (see 2011 International Federation for Cervical Pathology and Colposcopy (IFCPC) nomenclature). The following information should be included:

  • the adequacy of the examination
  • the absence (or presence) of evidence of invasive disease
  • the presence of a squamous and/or glandular pre-cancerous abnormality
  • the extent of the TZ, ectocervically and endocervically and hence the TZ Type; 1, 2, or 3. This should also clearly mention extension of abnormalities onto the vaginal fornices, if present.
  • the number of cervical quadrants involved in any abnormality
  • the overall colposcopic impression.

Colposcopic findings at the time of treatment should be recorded especially if there has been a change in appearance of the cervix.

In addition the following should be included:

  • the mode and technique of treatment
  • the depth of tissue destruction achieved in all ablative treatments
  • the type of excision: Types 1, 2 or 3
  • the size of loop/fixed profile wire used in all LEEP/LLETZ and Fisher/Utah conisation procedures and the diathermy settings
  • the laser setting and length of time of application
  • any complication occurring during or immediately following the treatment.

Author(s):

References

  1. Tan JH, Wrede CD. New technologies and advances in colposcopic assessment. Best Pract Res Clin Obstet Gynaecol 2011 Oct;25(5):667-77 Available from: http://www.ncbi.nlm.nih.gov/pubmed/21664876.
  2. Mitchell MF, Tortolero-Luna G, Cook E, Whittaker L, Rhodes-Morris H, Silva E. A randomized clinical trial of cryotherapy, laser vaporization, and loop electrosurgical excision for treatment of squamous intraepithelial lesions of the cervix. Obstet Gynecol 1998 Nov;92(5):737-44 Available from: http://www.ncbi.nlm.nih.gov/pubmed/9794661.
  3. Chirenje ZM, Rusakaniko S, Akino V, Mlingo M. A randomised clinical trial of loop electrosurgical excision procedure (LEEP) versus cryotherapy in the treatment of cervical intraepithelial neoplasia. J Obstet Gynaecol 2001 Nov;21(6):617-21 Available from: http://www.ncbi.nlm.nih.gov/pubmed/12521783.
  4. Loobuyck HA, Duncan ID. Destruction of CIN 1 and 2 with the Semm cold coagulator: 13 years' experience with a see-and-treat policy. Br J Obstet Gynaecol 1993 May;100(5):465-8 Available from: http://www.ncbi.nlm.nih.gov/pubmed/8518248.
  5. Gordon HK, Duncan ID. Effective destruction of cervical intraepithelial neoplasia (CIN) 3 at 100 degrees C using the Semm cold coagulator: 14 years experience. Br J Obstet Gynaecol 1991 Jan;98(1):14-20 Available from: http://www.ncbi.nlm.nih.gov/pubmed/1998626.

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