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;Disclosures;Objectives;
; A short history on evolution of teaching where to biopsy; A short history on evolution of teaching where to biopsy; A short history on evolution of teaching where to biopsy; A short history on evolution of teaching where to biopsy; Biopsy the most abnormal appearing area.;;Colposcopic features of cervical lesions;Color – Normal or LSIL ;Color;Color;Color;Changes suggestive of HSIL (CIN 2 / CIN 3)
;Color;Color; J. Thomas Cox, MD;Changes suggestive of normal or LSIL (CIN 1)
Condylomatous or micropapillary contour ;Margins;Margins; Margins; Margins;Margins;Margins;;Changes suggestive of HSIL (CIN3); J. Thomas Cox, MD;Margins;A. Waxman, MD;Vessels;Changes suggestive of HSIL (CIN2 / CIN3);Vessels;Vessels
Changes suggestive of CIN 2,3
;We’ve shown you a system to “grade” the cervix, formulate your colposcopic impression, and select the “best” place to take a biopsy…;
So, how well does it work?;20 “expert” colposcopists examined ~900 digitized cervigrams from ALTS trial.
Each image reviewed by 2 experts
Each expert reviewed 112 images.
Asked to identify lesion, outline the lesion, and formulate a colposcopic impression.;Images from ALTS considered for ASCCP exams. Each evaluated by three “experts” blinded to diagnosis and HPV type.
To use the photo in an ASCCP test, we required agreement on a colposcopic impression from at least two of the experts that was consistent with Pap and biopsy diagnosis.;;Expert 1: LSIL;;Expert 1: Metaplasia;What’s your Colposcopic impression?;Expert 1: HSIL;If even experts can’t agree, how are we expected to make a colposcopic impression and choose the best place to take a biopsy? ;Number of biopsies that lead to ultimate diagnosis of CIN 3+ ;31 y.o. Pap: HSIL;Expert 1, Choice 1;…plus Expert 2, Choice 1;…plus Expert 3, Choice 1;…plus Expert 1, Choice 2;…plus Expert 2, Choice 2;…plus Expert 3, Choice 2;Biopsy results: CIN 1;Good News;What’s Old Is New Again;Colposcopy Dogma, 1975;Colposcopy Dogma, 2015 ;Biopsy,
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