Colposcope is a clinical diagnostic instrument used in gynecology, and is one of the gynecological endoscopes. It is suitable for diagnosing various cervical diseases and reproductive organ lesions, and is also an important method for the early diagnosis of male and female diseases. Invented by German scholar Hans Hinselman in 1925, the colposcope has been widely used for over half a century in diagnosing diseases of the lower reproductive system, especially for the early diagnosis of precancerous lesions, early cancers, and sexually transmitted diseases.
The colposcope can magnify the observed images by 10 to 60 times, allowing the detection of subtle lesions that are not visible to the naked eye. With this magnification effect, doctors can clearly see the extremely small details of lesions on the cervical and reproductive organ epithelium, which helps improve the accuracy of diagnosing cervical and reproductive organ lesions, providing a basis for early diagnosis of diseases, allowing patients to receive effective treatment earlier, and greatly increasing the cure rate of diseases.
During a colposcopy, the speculum is used to expose the vagina, cervix, and reproductive organs. The colposcope lens is positioned about 20 centimeters from the vaginal opening or reproductive organ, focusing on the epithelial tissue of the cervix or reproductive organ, adjusting the focus, and observing the magnified images of the cervix or reproductive organ epithelium through a computer screen. The computer can store and replay these images, facilitating follow-up observations of treatment effects. There is no pain for the patient during the examination. Therefore, the colposcope is widely used for examining vaginal, cervical diseases, and reproductive organ lesions, earning the reputation of being the doctor’s “fire eye”. It is highly favored by both patients and doctors and is widely used.
Classification
Function Classification
(1) Diagnostic Colposcope, also known as Standard Colposcope: This colposcope is only suitable for examinations and does not have special energy matching for surgical procedures.
(2) Diagnostic and Therapeutic Colposcope: This type of colposcope combines a standard colposcope with special energy, such as laser-assisted colposcopes, allowing for local laser surgery while conducting a colposcopy.
Imaging System Classification
(1) Optical Colposcope: Refers to a colposcope that images through an optical lens system.
(2) Electronic Colposcope: Refers to a colposcope that converts optical information into digital information for imaging using CCD.
Data Storage Methods
(1) Standard Colposcope: Refers to a colposcope that does not include a computer component, and examination data is still saved in the traditional handwritten manner. Image collection is primarily through photography and video recording.
(2) Computerized Colposcope: Refers to a colposcope that includes a computer information management system in its optical or electronic components, storing colposcopy data in standardized computerized language and real-time image collection.
Mechanical Classification
Colposcopes are divided into two major series: Electronic Colposcopes and Optical-Electronic Integrated Colposcopes. Electronic colposcopes are the first type used, utilizing digital electronic imaging technology through the colposcope imaging system to diagnose cervical diseases; the optical-electronic integrated colposcope is a new generation device designed for clinical diagnosis of cervical lesions by integrating the advantages of microscope optical systems and electronic colposcope imaging systems.
Colposcope Structure
1. Optical Colposcope: The optical colposcope mainly consists of the body, support, light source, and accessories.
(1) Body: Located at the top of the support, it has tilt adjustment and left-right adjustment handles, ensuring the body can rotate freely. It has two objective lenses at the front, a light source outlet, and a color filter. The rear end has binocular eyepieces, with inter-pupillary distance adjustment to match the examiner’s pupil distance, allowing the images from both eyepieces to overlap, forming an optimal three-dimensional image.
(2) Support: There are two types: land-based and suspended. The choice of support primarily depends on the conditions of the colposcopy room.
(3) Light Source: There are two types: internal light source and external cold light source.
(4) Accessories: Include photographic systems (standard photography, stereo photography, and one-time imaging systems), video recording systems, printing systems, and computer information management systems.
2. Electronic Colposcope: The electronic colposcope includes the imaging part, processor part, light source part, support part, and software part. The optical-electronic integrated colposcope includes the cold light source part, optical part, processor part, and software part.
3. Colposcope instruments and accessory instruments:Speculum, biopsy forceps, curette, gauze forceps, retractors, cotton balls, swabs etc.
Reagents: The essential reagents for colposcopy are: 3% acetic acid solution and 1% iodine solution.
Examination Diagnosis
1. Normal cervical vaginal squamous epithelium. The epithelium is smooth and pink. After applying 3% acetic acid, the epithelium does not change color. Iodine test positive.
2. Cervical vaginal columnar epithelium. The columnar epithelium in the cervical canal descends, replacing the squamous epithelium of the cervical vaginal part, clinically referred to as cervical erosion. The surface appears villous and red. After applying 3% acetic acid, it swells rapidly to form a grape-like appearance. Iodine test negative.
3. Transformation zone. This is the area where the squamous epithelium and columnar epithelium interlace, containing newly formed squamous epithelium and columnar epithelium that has not yet been replaced by squamous epithelium. Under the colposcope, branching capillaries can be seen; grape islands formed by metaplastic epithelium surrounding columnar epithelium; gland openings within metaplastic epithelium and retention cysts (cervical gland cysts) covered by metaplastic epithelium. After applying 3% acetic acid, there is a clear contrast between the metaplastic epithelium and the columnar epithelium within the ring. After applying iodine, the staining depth varies. Pathological examination shows squamous epithelial metaplasia.
4. Abnormal colposcopic images. The iodine test is negative, including:
(1) White epithelium: Turns white after applying acetic acid, with clear boundaries and no blood vessels. Pathological examination may indicate metaplastic epithelium or atypical hyperplasia.
(2) Leukoplakia: White patches, rough and elevated surface without blood vessels. Can be seen without applying 3% acetic acid. Pathological examination shows keratinization or incomplete keratinization, sometimes indicating HPV infection. Malignant lesions may be present in the deeper layers or surrounding areas, and biopsy should be routinely performed.
(3) Punctate structures: Previously known as leukoplakia base. Turns white after applying 3% acetic acid, with clear boundaries, smooth surface, and very fine red dots (punctate capillaries). Pathological examination may indicate atypical hyperplasia.
(4) Mosaic: Irregular blood vessels divide the white epithelium that proliferates after applying 3% acetic acid into clearly defined, irregularly shaped small patches, resembling a pattern inlaid with red threads. If the surface is irregularly protruding, pushing the blood vessels outward, it suggests rapid cell proliferation and should be monitored for potential cancer transformation. Pathological examination often shows atypical hyperplasia.
(5) Atypical blood vessels: Refers to blood vessels with extremely irregular diameter, size, shape, branching, orientation, and arrangement, such as spiral, dotted, hairpin, leaf-like, line-ball, or bayberry shapes. Pathological examination often shows varying degrees of cancerous changes.
5. Early cervical cancer. Under strong light, the surface structure is unclear, presenting a cloud-like, brain-like, or lard-like appearance, with a surface that is slightly raised or depressed. Local abnormal blood vessel proliferation, enlarged lumens, loss of normal branching, increased distance between vessels, and disordered orientation can show special morphological changes, resembling tadpole, stick, hairpin, spiral, or cotton ball shapes. After applying 3% acetic acid, the surface appears glassy and edematous or resembles cooked meat, often accompanied by atypical epithelium. Iodine test is negative or shows very light staining.
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