COLPOSCOPY AND CERVICAL BIOPSY
All suspicious Pap smears should be evaluated by colposcopy. The colposcope is a portable microscope (magnification from 10× to 25×) that allows the examiner to visualize the cervix and obtain a sample of abnormal tissue for analysis. Nurse practitioners and gynecologists require special training in this diagnostic technique.
After inserting a speculum and visualizing the cervix and vagi-nal walls, the examiner applies acetic acid to the cervix. Subsequent abnormal findings that indicate the need for biopsy include leuko-plakia (white plaque visible before applying acetic acid), acetowhite tissue (white epithelium after applying acetic acid), punctation (dilated capillaries occurring in a dotted or stippled pattern), mosaicism (a tile-like pattern), and atypical vascular patterns.
An endocervical curettage may be performed during colpos-copy if a problem is suspected based on Pap smear findings. This analysis of tissue from the cervical canal is used to determine whether abnormal changes have occurred in the cervical canal. If these biopsy specimens show premalignant cells or CIN, the patient usually needs cryotherapy, laser therapy, or a cone biopsy (excision of an inverted tissue cone from the cervix) (ACOG Committee Opinion #195, 1998).
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