Colposcopy: IFCPC terminology in the report, from the transformation zone to major findings

Colposcopy is a descriptive exam. The decision to biopsy, follow or treat depends on the report stating, in the same words the gynecologist uses, whether the exam was adequate, where the squamocolumnar junction is and which findings were seen. The terminology of the International Federation for Cervical Pathology and Colposcopy (IFCPC) exists for this: to standardize the vocabulary and allow the report to be compared from one exam to the next.

This article follows the order of the IFCPC terminology for the cervix.

General assessment

Before any finding, the report answers three questions:

• Was the colposcopy adequate? If not, why: bleeding, inflammation, scarring, cervix not visible.
• Was the squamocolumnar junction (SCJ) seen? Completely visible, partially visible or not visible.
• What is the type of transformation zone?

The three types of transformation zone

• Type 1: completely ectocervical and fully visible.
• Type 2: with an endocervical component, but fully visible.
• Type 3: with an endocervical component that is not fully visible.

The transformation zone type guides the type of excision when one is indicated, and a type 3 zone means part of the at-risk area was not examined. For this reason it should never be missing.

Normal findings

Original squamous epithelium (mature or atrophic), columnar epithelium (including ectopy), metaplastic squamous epithelium, Nabothian cysts, gland openings and deciduosis in pregnancy.

Abnormal findings: grade 1 and grade 2

Abnormal findings are described with their location (inside or outside the transformation zone, by clock-face position) and size (number of quadrants involved or percentage of the cervix).

• Grade 1 (minor): thin acetowhite epithelium with an irregular or geographic border; fine mosaic; fine punctation.
• Grade 2 (major): dense acetowhite epithelium with rapid appearance; thickened (cuffed) gland openings; coarse mosaic; coarse punctation; sharp border; inner border sign; ridge sign.
• Nonspecific: leukoplakia (keratosis, hyperkeratosis), erosion, Lugol staining or non-staining.

Suspicion of invasion

Atypical vessels and additional signs, such as fragile vessels, irregular surface, exophytic lesion, necrosis, ulceration and tumor, should be described separately, because they change the urgency of management.

Miscellaneous findings

Congenital transformation zone, condyloma, polyp, inflammation, stenosis, congenital anomaly, post-treatment sequelae and endometriosis. Each goes on its own line, so as not to be mixed with the abnormal findings.

Biopsy and impression

When there is a biopsy, the report records how many specimens and from where. The colposcopic impression summarizes the highest-grade finding and its location, for example "grade 2 colposcopic findings in the transformation zone, from 3 to 6 o'clock". The histologic diagnosis is left to the pathology report.

Common errors

• Omitting whether the colposcopy was adequate and whether the SCJ was seen.
• Not stating the type of transformation zone.
• Describing the lesion without clock-face location and without extent.
• Using terms outside the terminology ("friable cervix", "suspicious lesion") without the findings that justify them.
• Concluding intraepithelial neoplasia from colposcopy, without histology.

How Laudário helps

In the Laudário colposcopy and hysteroscopy module:

• Colposcopy with the conclusion built from the IFCPC terminology.
• Image capture by foot pedal, Bluetooth controller, voice or smartphone, straight into the report.
• Recommendations in their own tab.

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