IFCPC Symposium

IPV Meeting

Berlin

September 2011

The new IFCPC Nomenclature

Normal findings

General Assessment

• Adequate or not (inflammation, bleeding, fibrosis etc

• Squamo-columnar junction visible fully, partially or not

• Transformation zone Type is 1 or 2 or 3, as before

Abnormal colposcopic findingsgeneral principles

• Location of the lesion

– Inside or outside the TZ

– At which position (Clockface)

• Size of the lesion

– Percentage of the cervical surface

– Number of quadrants

Grade 1 or minor lesions

• Thin aceto-white epithelium

• Irregular geographical border

• Fine mosaic

• Fine punctation

Grade 2 or major lesions

• Dense aceto-white epitheilium

• Rapid aceto uptake

• Cuffed crypt openings

• Coarse mosaic or punctate vessels

• Sharp borders

• Inner border sign

• Ridge sign

Non specific

• Leukoplakia (keratosis, hyperkeratosis), “erosion”

• Lugol’s iodine uptake or Schiller’s test

– Stained

– Unstained

– Partially stained

Suspicious for invasion

• Atypical vessels

• Fragile vessels, irregular surface, exophyticlesion, necrosis, ulcertation (necrosis) tumouror gross neoplasm

Miscellaneous findings

• The congenital transformation Zone

• Condyloma, polyp, endo or ecto cervical

• Inflammation

• Stenosis

• Congenital anomaly

• Post treatment consequences

• Endometriosis

The Transformation Zone

• Types 1,2 and 3 as before

• Now types 1,2 and 3 excision types

– So much confusion in terminology in the literature

– Dimensions in publications not standard

– Little evidence for effect of excision extent

Type I TZ Type II TZ Type III TZ

• completely ectocervical• fully visible• can be small or large

• has some endocervical component• fully visible• ectocervical component may be small or large

• has endocervical component• not fully visible• ectocervical component may be small or large

Excision specimen dimensions

Thickness of specimen

Length of specimen

Perimeter of specimen

The dimensions of the Excised T Z specimen

Thickness = surface to stromal marginLength = endo to ectocervical marginCircumference = A to B of opened specimen

Endocervicalmargin

Ectocervical margin

SurfaceMargin

Stromalmargin

A

Proposal for excised TZ dimensions nomenclature

• The distance from the surface to the stromal margin is the thickness of the specimen

• The distance from the endocervical to ectocervical margin is the length

Proposal to classify TZ excisional treatment

• Type 1 Excision (large or small)

– Excision of an ectocervical TZ

• Type 2 Excision (large or small)

– Excision of a type 2 TZ

• Type 3 Excision (large or small)

– Excision of a type 3 TZ

– Excision of suspected CGIN or micro or for a previously incomplete excision

Type 1 Excision

•Excision pathway

•Upper limit of visibility

•Path of excision

•Upper limit of visibility

Type 2 Excision

Type 3 Excision

•Upper limit visibility

•Excision path

Type 3 Excision

•Excision path

a

b

Volume and thickness of excised TZ is predictive of premature labour

Conclusion

• Simple nomenclature system

• Will be adding

– Image correlation

– Vulvar and vaginal nomenclature

• Publication imminent