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Colposcopy

About Colposcopy in BC

Colposcopy services in BC were developed to act in a complementary manner to the Cervix Screening Program at BC Cancer. There are 27 hospital-based clinics throughout BC staffed by local gynecologists who have received standardized training through BC Cancer. All certified colposcopists use a uniform reporting system and standardized terminology and their results are incorporated into the Cervix Screening Program database. Certified colposcopists participate in quality assurance activities and continuing medical education which is offered to colposcopists in the form of the BC Cancer Annual Colposcopy Update. Find more information about this in the Resources tabs below. For Colposcopy clinic locations visit the Clinic Locator.

Referring
Refer if...

The Cervix Screening Program recommends a referral for colposcopy if the Pap test reports:

  • Atypical squamous cells of undetermined significance (ASCUS) persistent over 12 months
  • Low-grade squamous intraepithelial lesion (LSIL) persistent over 12 months
  • Atypical squamous cells cannot exclude HSIL (ASC-H)
  • High-grade squamous intraepithelial lesion (HSIL) – moderate or marked squamous dyskariosis
  • Atypical glandular cells not otherwise specified or favor neoplasia (AGC-NOS or AGC-FN)  
  • Adenocarcinoma in situ (AIS)
  • Squamous cell carcinoma, adenocarcinoma, or other malignancy

The Pap test is a screening test for an asymptomatic woman with a normal appearing cervix. The Pap test is NOT a diagnostic test.  If your patient has concerning symptoms (abnormal vaginal discharge and/or bleeding) or has an abnormal appearing cervix, refer her for a diagnostic colposcopy. If you are unsure about whether or not to refer, please contact a colposcopist to discuss your patient.

Patients with a history of intrauterine diethylstilbestrol (DES) exposure.


Frequently Asked Questions

Please refer your patient directly to a colposcopy clinic.

The colposcopy clinic list has contact information for each colposcopy clinic. Please contact clinics directly for clinic specific referral forms and information.
The Cervix Screening Program wait time standards are as follows:


From HSIL (marked), AGC-FN, AIS or carcinoma Pap test result to Colposcopy
 
4 weeks

From HSIL (moderate), ASC-H or AGC-NOS Pap test result to Colposcopy

8 weeks

From ASCUS or LSIL Pap test result (when ASCUS or LSIL has persisted for more than 12 months) to Colposcopy

12 weeks

Clinical referral for results not related to cytology

12 weeks*

*Specific referral information (e.g. your level of suspicion, exam findings) will ensure the colposcopy clinic can triage the patient appropriately.

We recognize that wait times may vary. Please contact us at screening@bccancer.bc.ca if you are having problems getting a timely colposcopy appointment for your patient.



Click here for a complete list of colposcopy program standards.







Results
Responsibilities 

The referring physician is responsible for referring patients who have been recommended for colposcopy to a colposcopy clinic for follow-up.

 

Once a patient has had a colposcopy, practices vary with respect to communicating colposcopy results and recommendations to the patient. The Colposcopy Short Stay Form (Diagnostic Report) will clearly state who is to communicate with the patient and who is to book follow-up appointments.

 

The Colposcopy Short Stay Form (Diagnostic Report) also provides information on diagnosis (colposcopic evaluation) and recommended management.


The colposcopist is responsible for assessing the patient referred to the clinic and providing a diagnosis and recommendation to the referring physician in a timely manner. 

 

The colposcopist is responsible for corresponding to the referring provider regarding who is to communicate results to patients and who is to arrange future follow-up (referring provider versus colposcopist). 


All patients will be informed by the Colposcopy Clinic who to contact for their test results. Patients are responsible for ensuring they receive their results from the provider indicated.

 

Medical Terms Used in the Colposcopic Reports

The following terms are commonly used in BC and are a part of the Colposcopy Short Stay Form.

Referral Cytology: The specific cytological abnormality that led to the colposcopic examination. This is usually the most recent Pap test prior to the actual colposcopic examination.

COLPOSCOPIC EXAMINATION

Colposcopic Impression: The colposcopist’s opinion as to the nature of any lesion seen, based on the classic colposcopic features of surface contour, color tone, borders, intercapillary distance, vascular patterns, etc. Colposcopic impression is the specific diagnosis that the colposcopist would expect to be returned on any accompanying biopsy material based on his or her visual interpretation.

Satisfactory Colposcopic Examination: The colposcopist was able to examine the cervix and visualize the entire squamocolumnar junction, and if a lesion is present, the entire lesion was also visualized.

Please note: If the colposcopist is unable to visualize the cervix (e.g. heavy bleeding or unable to locate cervix) the colposcopist is unable to evaluate the patient. No comment on whether the exam is satisfactory or not can be made.

Colposcopic Biopsy: The histopathological diagnosis of any directed biopsy that was obtained at the time of the colposcopic examination. If more than one biopsy is obtained the most advanced lesion is recorded.

Colposcopic Evaluation/Final Diagnosis: The clinical working diagnosis based on combining the information from both the colposcopic impression and the biopsy diagnosis. This diagnosis can never be less than the colposcopic biopsy, but may be greater than the colposcopic biopsy if the colposcopist believes the biopsy is not reflecting the most advanced pathology suspected based on their assessment. The management of the patient is based on this working diagnosis.


 

In BC, the Bethesda System is now used as the classification system for reporting Pap test results.

 
Cervical intraepithelial neoplasia (CIN) 1 / Low grade squamous intraepithelial lesion (LSIL) 
 
Cervical intraepithelial neoplasia (CIN) 2/3/ High grade squamous intraepithelial lesion (HSIL), Carcinoma in situ (CIS)
 
Squamous cell carcinoma (SCC)
 
Adenocarcinoma in situ (AIS)
 
Adenocarcinoma (AC)
 
Loop Electrical Excisional Procedure (LEEP) of the cervix:  This procedure uses a thin, low-voltage electrified wire loop to cut out abnormal cervical tissue.

Laser of the cervix or vagina: This procedure uses a CO2 laser to vaporize or cut out abnormal tissue.










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