- B Shakuntala Baliga, MD FICOG, Professor, and, Visiting, Senior Consultant Gynecologist and Colposcopist, Mazumdar-Shaw Cancer Center and, Narayana Hrudayalaya Multispecialty Hospital, Bangalore, India
Colposcopy has an established role in the management of intraepithelial lesions and early cancers of the lower female genital tract. Following the invention of the colposcope by Hans Hinselmann in 1925, many pioneers have advanced the understanding and use of colposcopy in gynecologic practice. Returning readers will recognize that I have chosen to leave the content and arrangement of the majority of chapters completely or largely unchanged. Several colpophotographs have been added. The primary mission of this work remains the same: explain and narrate the basics and principles of colposcopy to the beginning colposcopist. Chapter 3, “The Papanicolaou Smear”, addresses important guidelines and cytological classification to help the gynecologist make optimal use of cytology. It includes new microphotographs of the Pap smear provided by the co-authors, Professor Manjula Jain and Dr Charanjeet Ahluwalia. Digital photographs of various colposcopy instruments, kindly provided by CooperSurgical, USA, have been included in Chapter 4, “The Colposcopy Unit”. Chapter 6 has new text and colpophotographs to enhance information regarding “Assessment and Interpretation of Abnormal Colposcopic Appearances of the Cervix”. Colposcopic diagnosis of microinvasive carcinoma of the cervix and adenocarcinoma in situ (AIS) and adenocarcinoma continue to be a challenge to the colposcopists. Dr. Quek Swee Chong from Singapore has kindly provided detailed text and colpophotographs of the colposcopic appearances of biopsy proven AIS. Dr Cornelia Scheungraber from Germany, who proposed the “ridge sign” and “inner border sign” of high-grade cervical intraepithelial neoplasia (CIN), has kindly provided representative colpophotographs. Recent changes in the guidelines for “Management of Abnormal Cervical Cytological Smears” and “Cervical Intraepithelial Neoplasia: Management Options” are included in Chapters 17 and 18, respectively. These important topics have been co-authored by Dr J Anupama, Consultant Gynecologist and Obstetrician in New Delhi, and me. Additionally, three new chapters (Chapters 20, 21 and 22) have been included to address innovations and dilemmas in the practice of colposcopy, and the essentials for the safe and efficient management of a colposcopy clinic. Chapter 20, “Gray Areas in Colposcopy”, narrates the author’s position on various controversial management options and colposcopic patterns that challenge lesion interpretation. Chapter 21, “Immunocytochemistry for Proliferative Markers and New Technologies”, summarizes the advances in biotechnology and innovations in instrumentation and software for colposcopy that have occurred in the last six years. Immunostaining of cytological smears with proliferative markers has been shown to improve method sensitivity for cervical cancer screening. Representative microphotographs of cervical smears with immunostaining kindly provided by Professor Geetashree Mukherjee of Kidwai Memorial Institute of Oncology, Bangalore, are included in this chapter. Professor Costas Balas, inventor of the dynamic spectral imaging system (DySIS), has kindly provided text and representative photographs of the instrument and cases that are included in this chapter. Chapter 22 addresses the day-to-day processes within the colposcopy clinic: reprocessing and sterilization of instruments, equipment maintenance and infection control measures. Finally, meticulous attention to detail and evidence-based, ethical principles in managing every patient, is the sine qua non of a good colposcopy practice.