In 1990 the International Federation of Cervical Pathology and Colposcopy approved a modified version of the basic colposcopic terminology at its 7th world congress in Rome. This terminology is more descriptive than the old classification and can be applied to the entire lower reproductive tract. It incorporates minor and major grading parameters within its framework.

The New Colposcopic Terminology has five major divisions. Click on an item below to jump to a particular division.

1. Normal findings
2. Abnormal findings (either within or outside of the tranformation zone)
3. Colposcopically suspect invasive cancer
4. Unsatisfactory colposcopy
5. Miscellaneous findings

I. Normal findings

• Original squamous epithelium (OSE)
  Smooth, pink tissue
  

  Click on the image to enlarge. Original squamous epithelium in reproductive period. From Burghardt E et al: Text and atlas: colposcopy—cervical pathology, New York, 1991, Thieme.

• Columnar epithelium (CE)
  Irregular tissue with papillae, clefts, and gland openings
  

  Click on the image to enlarge. Ectopy before acetic acid application. From Burghardt E et al: Text and atlas: colposcopy—cervical pathology, New York, 1991, Thieme.

  
  

• Transformation zone (TZ)
  Geographic area between the original squamous epithelium (at the original squamocolumnar junction [SCJ]) and the columnar epithelium (at the functional SCJ) where squamous metaplasia has occurred.
  

  Click on the image to enlarge. Transformation zone with residual island of columnar epithelium. From Burghardt E et al: Text and atlas: colposcopy—cervical pathology, New York, 1991, Thieme.

  Click on the image to enlarge. Partial transformation. From Burghardt E et al: Text and atlas: colposcopy—cervical pathology, New York, 1991, Thieme.

  
  

• Other normal findings
  
  
  • Squamocolumnar junction (SCJ)
    The visible line on the ectocervix that marks the boundary between endocervical columnar and ectocervical squamous epithelium.
    Two SCJs: original versus new or functional

    Click on the image to enlarge. Border between columnar and squamous epithelium. From Burghardt E et al: Text and atlas: colposcopy—cervical pathology, New York, 1991, Thieme.

    
    

• Squamous metaplasia
  The normal process of change from columnar to metaplastic squamous epithelium.
  It appears faintly white when acetic acid is applied.
  

  Click on the image to enlarge. Metaplasia, incomplete transformation, and gland openings. From Burghardt E, et al: Text and atlas: colposcopy—cervical pathology, New York, 1991, Thieme.

  Click on the image to enlarge. Transformation on anterior lip. From Burghardt E et al: Text and atlas: colposcopy—cervical pathology, New York, 1991, Thieme.

  
  

• Normal vessels
  Treelike branching pattern
  

  Click on the image to enlarge. Long, regular branching blood vessels,coursing over Nabothian follicle. From Wright VC et al: Basic and advanced colposcopy: a practical handbook for diagnosis and treatment, ed 2, Komoka, Ont, Canada, 1995, Biomedical Communications.

  
  

  Diagram of arborization. From Wright et al: Basic and advanced colposcopy: a practical handbook for diagnosis and treatment, ed 2, Komoka, Ont, Canada, 1995, Biomedical Communications.

  Diagram of arborization. From Wright et al: Basic and advanced colposcopy: a practical handbook for diagnosis and treatment, ed 2, Komoka, Ont, Canada, 1995, Biomedical Communications.

  
  

II. Abnormal findings (either within or outside of the TZ [ectocervix, vagina]):

• Acetowhite epithelium (AWE)
  Focal abnormal tissue seen after acetic acid application
  Acetowhite epithelium is a transient phenomenon
  It is seen in areas of increased nuclear density–either flat and regular, or micropapillary or convuluted with papillary projections or brainlike patterns
  Increased density and sharp borders are associated with more advanced disease

  Click on the image to enlarge. Acetowhite epithelium. From Burghardt E, et al: Text and atlas: colposcopy—cervical pathology, New York, 1991, Thieme.

  
  

• Punctation (P)
  Vertical, single-loop capillaries viewed end-on
  More pronounced punctation seen with increased vessel caliber and spacing
  

  Click on the image to enlarge. Prominent punctation: carcinoma in situ. From Burghardt E et al: Text and atlas: colposcopy—cervical pathology, New York, 1991, Thieme.

  Click on the image to enlarge. Quite coarse punctation and coarse mosaicism: carcinoma in situ. From Burghardt E et al: Text and atlas: colposcopy—cervical pathology, New York, 1991, Thieme.

  
  

• Mosaicism (M)
  Tilelike pattern of vessels around blocks of white epithelium caused by neovascular changes
  Coarser patterns and vessels indicative of higher grade lesions
  

  Click on the image to enlarge. Coarse mosaicism intermingling with coarse punctation on posterior lip: carcinoma in situ. From Burghardt E et al: Text and atlas: colposcopy—cervical pathology, New York, 1991, Thieme.

  Click on the image to enlarge. Fairly fine mosaicism and sharply defined acetowhite epithelium. From Burghardt E, et al: Text and atlas: colposcopy—cervical pathology, New York, 1991, Thieme.

  
  

• Leukoplakia (L)
  Hyperkeratosis or parakeratosis
  Elevated white epithelial plaque seen without use of acetic acid
  Essentially a benign process, but may obscure underlying atypical or neoplastic changes
  Biopsy is recommended
  May be identified both inside and outside the TZ
  

  Click on the image to enlarge. Ground of leukoplakia. Where keratin layer is peeled off, punctation appears. From Burghardt E et al: Text and atlas: colposcopy—cervical pathology, New York, 1991, Thieme.

  Click on the image to enlarge. Pronounced leukoplakia with carcinoma in situ lesion in the 11 o'clock position. From Burghardt E, et al: Text and atlas: colposcopy—cervical pathology, New York, 1991, Thieme.

  
  

• Iodine-negative epithelium
  No cellular iodine uptake noted
  Normal squamous epithelium stains mahogany-brown
  

• Abnormal or atypical vessels
  Irregular vessels that demonstrate marked variations in caliber or course with bizarre branching
  Abnormal vasculature stimulated by tumor angiogenesis factor
  Various configurations include commas, corkscrews, question marks, starbursts, and hairpins
  No normal treelike branching pattern
  

  Click on the image to enlarge. Normal and atypical vascular patterns on the cervix. A, hairpin-shaped capillary loops. B, comma-shaped capillaries. C, blood vessels showing regular branching. D, long regularly branching vascular tree, with gradual decrease in caliber. E, staghorn-like vessels, seen especially in inflammation. F, regular vascular network, simultaning mosaic. G, long parallel-coursing blood vessels, showing some variation in caliber.H, irregular corkscrew vessels that vary only slightly in caliber. I, bizarre, tortuous, atypical vessels, showing marked variation in caliber. J, atypical blood vessels with gross variation in caliber and arrangement and abrupt changes in direction. K, irregular crazy vessels with great fluctuation in caliber. From Burghardt E, et al: Text and atlas: colposcopy—cervical pathology, New York, 1991, Thieme.

  Click on the image to enlarge. Invasive cancer with corkscrewlike vessels. From Wright VC et al: Basic and advanced colposcopy: a practical handbook for diagnosis and treatment, ed 2, Komoka, Ont, Canada, 1995, Biomedical Communications.

  
  

• Others
  
  • Erosions
    Denuded epithelium
    

    Click on the image to enlarge. True erosion from speculum in postmenopausal patient. From Wright VC et al: Basic and advanced colposcopy: a practical handbook for diagnosis and treatment, ed 2, Canada, 1995, Biomedical Communications.

    Click on the image to enlarge. Extensive erosion and island of severe dysplasia. From Burghardt E et al: Text and atlas: colposcopy—cervical pathology, New York, 1991, Thieme.

    
    

III. Colposcopically suspect invasive cancer

• Obvious invasive cancer not evident on clinical examination
• Lesion usually raised with irregular surface contour and abnormal vessels

Click here for a further description of the anatomy of the cervix.