婦女癌症 Women Cancer

21. 如何記錄陰道鏡檢查之所見

The purpose of a GYN colposcopic examination is to evaluate the condition of a patient who has cervical, vaginal, vulvar, urethral, or anal lesions be combined either those of whatever additional tests may be necessary to reach a complete diagnosis.

A large variety of abbreviations and nomenclatures have been used to report results. The recording media have included printed forms. Rubber stamps, serial colpo-drawings, and even graphic picture systems.

A uniform way of setting down all the normal and abnormal changes involving the surfaces of the genital area usually makes of easier and more efficient record keeping. Furthermore, this routine facilitates follow-up and improves communication with the referring physician we have devised such an approach, which we call a gynecoscopy record.

The examination of Colposcopy
1. The cervix is soaked with 3% acetic using packing forceps and saturated cotton balls， which are left in place for 60-90 seconds. A careful search is made of the vanginal' fornices' and parts of the transformation zone and cervix.
2. The cervix then is stained with quarter strength Lugol、s iodine and all areas inspected again. After the application areas are identified by their mustard yellow staining reaction.
3. If no source is found， an endocervical curettage (ECC) should always be performed to exclude an endocervical lesion.
4. The lower vaginal walls should be inspected carefully as the Speculum is withdrawn.
5. If an explanation for the abnormal smear is not yet apparent， the possibility of exfoliation from other sites must be considered， e.g. endometrial， ovarian， fallopian tube， or metastasis breast cancer. The possibility of cellular contamination form a urinary lesion should also be considered.

After making a colposcopic appraisal， it is important to Draw an accurate diagran of the findings to summarize the Appearance of the cervix just examined Biopsy sites should be recorded so that past or future Histology reports can be related to colposcopic diagram.
The radial position of the biopsy is recorded as 1 to 12 O、clock， according to a clock face. The cephalic-caudal
Position of the biopsy is recorded as A-E，where：
A. Denotes a biopsies proximal to the new SCJ.
B. Denotes a biopsies immediately peripheral to new SCJ.
C. Denotes a biopsies from a more distal portion of the transformation zone.
D. Denotes a biopsies from the cervical portion distal to the original SCJ.
E. Denotes a biopsies from the vaginal wall.
Diagnostic conization is mandatory for an unexplained cytologyc report predicting moderate dysplasia or worse in a woman with an unsatisfactory.
Colposcopic exam. However，when with faced with an unexplained suspicious smear in younger women and in patients in whom the transformation zone is fully visible， the decision for cone biopsy should be individualized. The most common explanation is a papillomavirus infection of the vagina，and such lesions must excluded first.
The overall predictive accuracy of the combined colposcopic index is higher than 95﹪.Furthermore，generating a colposcopic score is simple.A diagram that defines the colposcopic appearance is drawn，points are scored for each of the individual criteria， and then points are added to give the colposcopic index.

Warning Signs to Safeguard against Overlooking Invasive Cance:
01. Yellowish epithelium especially areas that bleed when touched..
02. Colposopically significant areas (index score >= 6 points) with an irregular surface.
03. Surface ulceration (particularly when bordered by acetowhite epithelium).
04. Atypical vessels (horizontal surface capillaries disptaying a "tadpole" or "comma"shape;
05. coarse subepithelial vessles showing an irregular caliber and a long， unbranched course).
06. extremely coarse mosaicism or punctation， especially if there are wide， irregular intercapillary distances.
07. Large complex lesions (dull， "oyster-white"epithelium occupying 3 or 4 cervical
08. Quadrants and showing a mixture of high-grade colposcopic patterns).
09. High-grade corposcopic lesions extending ＞5 mm into the cervical canal.
10. CIN 2 or 3 on a tangentially sectioned punch biopsy in which the bas3ment membrane Cannot be defined adequately.
11. Cytologic evidence of possible squamous carcinoma (CIS cells in large syncytial sheets，
12. prominent nucleoti, bizarre cells， or a "dirty background")
13. Cytologic evidence of adenocarcinoma in situ.
14. Recurrent abnormal cytology in a patient previously treated for CIN 3 (e.g. by cryosurgery， cone biopsy， or hysterectomy).
15. A Pap smear suggestive of CIN2 or higher in a postmenopausal woman.

Table : Scoring system for the Colposcopic Index