Introduced by Dr. Hans Hinselmann between 1922 and 1925, colposcopy is a means of investigation for the diagnosis of benign and malignant cervicovaginal pathologies. It allows us to recognize, delimit and diagnose the different normal and abnormal aspects of the exocervix and vagina. The investigation is divided into two types: The colposcopic diagnosis is a “predictive” diagnosis; the main purpose is to identify a lesion, to perform a targeted biopsy; it is a diagnostic imaging test whose “gold standard is histology.” As a second-level test in screening programs, the indications for colposcopy are represented by abnormal PAP tests and/or HPV tests, follow-up of CIN in pregnancy, guidance on the diagnostic-therapeutic approach of CIN and follow-up after conservative therapy; the test is also carried out in the diagnosis of HPV infections, benign cervicovaginal pathologies and in the evaluation of lesions from sexual abuse. The colposcopic investigation takes into consideration some fundamental parameters: CSJ; transformation zone diagnosis (T1–T2–T3); diagnosis of the topography and extent of the lesion; grading diagnosis of the lesion; colposcopically guided biopsy; diagnosis of atypical vessels. The Transformation Zone is classified according to what is reported by the “International Federation for Cervical Pathology and Colposcopy” (2011 Rio de Janeiro I.F.C.P.C.). The Normal and Abnormal Transformation Zone have two different paths: the Normal Transformation Zone originates from the Uro-Genital Sinus with centripetal movement of the original native epithelium (Mayer’s Theory) while the Abnormal Transformation Zone originates from a process of subsequently confluent parcellate metaplasia originating from sub-cylindrical reserve cells (Fluhmann theory). Abnormal colposcopic findings (ANTZ) are divided into “Grade 1 (Minor) Lesions” and “Grade 2 (Major) Lesions” and “non-specific” colposcopic images. “Suspicion of cervical invasion” is represented by “atypical vessels.” The second level in the screening process with abnormal PAP test and/or positive HPV test must be carried out only by gynecologists with adequate training and experience in reference centers with high caseloads. Training models have been foreseen by the E.F.C. with a theoretical phase (basic courses and advanced courses) and a training phase at selected accredited centers that carry out screening activities. The quality of a colposcopist’s activity must be compared to “standard indicators.” The EFC recognized 6 indicators: diagnosis of CSJ and ZT, treatments performed only after colposcopy, treatment reserved only in cases of CIN 2+, minimum number of annual colposcopies for each individual operator in PAP tests positive for LSIL and HSIL.La colposcopia; therefore, in screening programs in cases of abnormal PAP Tests and/or positive HPV Tests, it can be defined as the only second-level method in the diagnosis relating to cervical cancer screening.

Colposcopy

章节
发表日期：

2026年

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Angelo Baldoni,
Matteo Terrinoni

摘要

Introduced by Dr. Hans Hinselmann between 1922 and 1925, colposcopy is a means of investigation for the diagnosis of benign and malignant cervicovaginal pathologies. It allows us to recognize, delimit and diagnose the different normal and abnormal aspects of the exocervix and vagina. The investigation is divided into two types: The colposcopic diagnosis is a “predictive” diagnosis; the main purpose is to identify a lesion, to perform a targeted biopsy; it is a diagnostic imaging test whose “gold standard is histology.” As a second-level test in screening programs, the indications for colposcopy are represented by abnormal PAP tests and/or HPV tests, follow-up of CIN in pregnancy, guidance on the diagnostic-therapeutic approach of CIN and follow-up after conservative therapy; the test is also carried out in the diagnosis of HPV infections, benign cervicovaginal pathologies and in the evaluation of lesions from sexual abuse. The colposcopic investigation takes into consideration some fundamental parameters: CSJ; transformation zone diagnosis (T1–T2–T3); diagnosis of the topography and extent of the lesion; grading diagnosis of the lesion; colposcopically guided biopsy; diagnosis of atypical vessels. The Transformation Zone is classified according to what is reported by the “International Federation for Cervical Pathology and Colposcopy” (2011 Rio de Janeiro I.F.C.P.C.). The Normal and Abnormal Transformation Zone have two different paths: the Normal Transformation Zone originates from the Uro-Genital Sinus with centripetal movement of the original native epithelium (Mayer’s Theory) while the Abnormal Transformation Zone originates from a process of subsequently confluent parcellate metaplasia originating from sub-cylindrical reserve cells (Fluhmann theory). Abnormal colposcopic findings (ANTZ) are divided into “Grade 1 (Minor) Lesions” and “Grade 2 (Major) Lesions” and “non-specific” colposcopic images. “Suspicion of cervical invasion” is represented by “atypical vessels.” The second level in the screening process with abnormal PAP test and/or positive HPV test must be carried out only by gynecologists with adequate training and experience in reference centers with high caseloads. Training models have been foreseen by the E.F.C. with a theoretical phase (basic courses and advanced courses) and a training phase at selected accredited centers that carry out screening activities. The quality of a colposcopist’s activity must be compared to “standard indicators.” The EFC recognized 6 indicators: diagnosis of CSJ and ZT, treatments performed only after colposcopy, treatment reserved only in cases of CIN 2+, minimum number of annual colposcopies for each individual operator in PAP tests positive for LSIL and HSIL.La colposcopia; therefore, in screening programs in cases of abnormal PAP Tests and/or positive HPV Tests, it can be defined as the only second-level method in the diagnosis relating to cervical cancer screening.