7. Colposcopy

Introduction

The aim of diagnostic colposcopy following an abnormal cervical screening test is to assess the nature, severity and extent of the abnormality. This requires the identification of the cervix and external os, the exclusion of invasive disease, the mapping and typing of the transformation zone (TZ), the identification of any visible abnormalities and the targeting of the most abnormal area(s) for biopsy. Systematic examination of the whole lower genital tract and accurate, concise recording of the findings are required to produce the highest sensitivity and best positive predictive value for diagnosing high-grade abnormalities, as well as determining if treatment is required and planning the most appropriate mode, timing and extent of therapy. 

In the renewed National Cervical Screening Program (NCSP) it is mandatory for colposcopists to report all diagnostic and therapeutic colposcopies to the National Cancer Screening Register (NCSR). 

Individual reports for colposcopies are not available at present, and the NCSR is working with the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and the Australian Society for Colposcopy and Cervical Pathology (ASCCP) to provide this in the future. This will enable colposcopists to review their own performance against defined benchmarks. Outcome measurement is a domain of the renewed CPD process as defined by the Medical Board, and these data will be evidence to support certification of ongoing participation in quality improvement in colposcopy.

To assist reporting, the process for mandatory reporting is available via some clinical software and through the Healthcare Provider Portal for NCSR, which is accessed via PRODA. Find out more at: www.ncsr.gov.au/RegisterAccess

In the meantime, queries about recertification and accreditation should be referred to RANZCOG and ASCCP. In the renewed program, the annual performance report prepared by the Australian Institute of Health and Welfare (AIHW) will include colposcopy data.

This chapter contains recommendations about the performance of colposcopy and related treatments. It is not intended to replace supervised training in accredited centres, nor attendance at colposcopy training and update courses, but offers guidance as to the minimum standards expected of a colposcopist providing services to the NCSP.

Author(s):

• Mr. C. David H. Wrede — Author
• A/Professor Alison Brand — Co-author
• Professor Ian Hammond — Co-author
• Cancer Council Australia Cervical Cancer Screening Guidelines Working Party — Co-author

See:

• Colposcopy terminology
• Principles of practice
• History, examination and investigation
• Treatment
• Colposcopy data for the National Cancer Screening Register
• Quality improvement in colposcopy
• Supplement. Colposcopy information for discussion with patient
• Supplement. Colposcopy technologies and documentation

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