{"paper_id":"a4e758a4-24f1-4a67-8fe2-77b171ced2fc","body_text":"Introduction\n!\nThe new and thus currently valid coloscopic no-\nmenclature was published on 1 July 2012 in the\njournal “Obstetrics & Gynecology ” [1]. This had\nbeen preceded by the appointment of a nomen-\nclature committee in 2008 on the occasion of the\nworld congress in Oakland, New Zealand.\nAfter extensive literature searches, several meet-\nings and detailed discussions in the website of\nIFCPC, the new version of the nomenclature was\naccepted at the world congress in Rio de Janeiro\nin July 2011.\nThe new nomenclature 2011 consists of 3 parts:\n1. Nomenclature concerning the cervix uteri\n(l\n\" Tab. 1) including an appendix on the defini-\ntion of types of excision ( l\" Table 2).\n2. Nomenclature for the vagina.\n3. Nomenclature for the vulva which was formu-\nlated in cooperation with the International So-\nAbstract\n!\nIn July 2012 a revised terminology on colposcopic\nexaminations of the cervix uteri was adopted by\nIFCPC. Central aspect is a description of character-\nistics that should aid in the definition of the dis-\nease entity cervix uteri. The nomenclature is built\nup in such a way that the examiner can evaluate\ncolposcopic criteria according to a specific\nscheme. Firstly it is assessed whether the colpos-\ncopy is representative. Then it should be clarified\nwhether or not the findings are normal. If the\nfindings are not normal but rather abnormal the\nseverity of the lesion is classified according to the\nso-called grade 1 (minor change) and grade 2\nfindings (major change). Specific abnormal find-\nings such as leukoplakia, erosion and Lugolʼs find-\ning are also not defined at this point. Characteris-\ntics suspicious for an invasion are described sepa-\nrately, in particular, atypical vessel patterns are\nmentioned here. As already held in the previous\nrevised nomenclature (Barcelona), various find-\nings are described in a last group: congenital\ntransformation zones (CTZ), congenital anoma-\nlies, condylomas (papillomas), endometriosis,\npolyps (ectocervical, endocervical), inflamma-\ntion, stenosis, postoperative changes (scarred\nportio, vaginal stump).\nZusammenfassung\n!\nIm Juli 2012 wurde eine überarbeitete Nomenkla-\ntur zur kolposkopischen Untersuchung der Cervix\nuteri durch die IFCPC verabschiedet. Im Mittel-\npunkt steht die Beschreibung von Merkmalen,\ndie helfen sollen, Krankheitsbilder an der Cervix\nuteri zu definieren. Die Nomenklatur ist so auf-\ngebaut, dass der Untersucher nach einem be-\nstimmten Schema kolposkopische Kriterien beur-\nteilt. Zunächst wird geprüft, ob die Kolposkopie\nrepräsentativ ist. Dann soll geklärt werden, ob\nein Normalbefund vorliegt. Liegen keine Normal-\nbefunde, sondern abnorme Befunde vor, wird die\nSchwere der Läsion in sog. Grad-1- (minor\nchange) und Grad-2-Befunde (major change) fest-\ngelegt. Es werden auch nicht spezifische abnorme\nBefunde – die Leukoplakie, die Erosion und die\nLugol-Probe – definiert. Gesondert werden Merk-\nmale beschrieben, die verdächtig auf eine Inva-\nsion sind, insbesondere wird hier auf die atypi-\nschen Gefäßmuster hingewiesen. Wie schon in\nder letzten überarbeiteten Nomenklatur (Barce-\nlona) werden in einer letzten Gruppe verschiede-\nne Befunde beschrieben: kongenitale Transforma-\ntionszone (KTZ), kongenitale Anomalie, Kondylo-\nme (Papillome), Endometriose, Polypen (ektozer-\nvikal, endozervikal) Entzündung, Stenose, post-\noperative Veränderung (vernarbte Portio, Schei-\ndenblindsack).\nExplanation and Use of the Colposcopy Terminology\nof the IFCPC (International Federation for Cervical\nPathology and Colposcopy) Rio 2011\nErläuterung und Anwendung der kolposkopischen Nomenklatur der IFCPC\n(International Federation for Cervical Pathology and Colposcopy) Rio 2011\nAuthors J. Quaas 3, O. Reich 1, B. Frey Tirri 2, V. Küppers 3\nAffiliations 1 für den Vorstand der Arbeitsgemeinschaft Kolposkopie (AGK, Österreich)\n2 für den Vorstand der Arbeitsgemeinschaft für Kolposkopie und Zervixpathologie (AGKOL, Schweiz)\n3 für den Vorstand der Arbeitsgemeinschaft für Kolposkopie und Zervixpathologie (AGCPC, Deutschland)\nKey words\nl\" colposcopy\nl\" cervix uteri\nl\" nomenclature\nl\" IFCPC Rio de Janeiro 2011\nSchlüsselwörter\nl\" Kolposkopie\nl\" Cervix uteri\nl\" Nomenklatur\nl\" IFCPC Rio de Janeiro 2011\nBibliography\nDOI http://dx.doi.org/\n10.1055/s-0033-1350824\nGeburtsh Frauenheilk 2013; 73:\n904–907 © Georg Thieme\nVerlag KG Stuttgart · New York ·\nISSN 0016‑5751\nCorrespondence\nDr. Jens Quaas\nSekretär der Arbeitsgemein-\nschaft Zervixpathologie\n& Kolposkopie\nGrünthal 22\n18437 Hansestadt Stralsund\ndr@jquaas.de\nwww.ag-cpc.de\nPriv.-Doz. Dr. med. Volkmar\nKüppers, Facharzt für Frauen-\nheilkunde und Geburtshilfe\nZytologisches Labor –\nDysplasie-Sprechstunde\nKönigsallee 64\n40212 Düsseldorf\ninfo@dysplasie-praxis.de\n904\nQuaas J et al. Explanation and Use … Geburtsh Frauenheilk 2013; 73: 904 –907\nGebFra Science\n\n\nciety for the Study of Vulvovaginal Diseases (ISSVD). These\nwere published in a second publication.\nThe aim of the following explanations is to create a relationship\nbetween the new nomenclature and the daily routine of colpo-\nscopic examinations.\nAt the same time, the authors want to point out that a common\nfoundation for the use of the now internationally valid colpo-\nscopic nomenclature of cervix uteri in the German-speaking\ncountries has been published [9].The boards of AGK, AGCPC and\nAGKOL have thus recognised the validity of the colposcopic no-\nmenclature 2011 and recommend their members to use them in\ntheir daily routine.\nWe appeal to all interested colleagues to send their comments\nand ideas to their management boards. These will then be intro-\nduced at the next meeting of the nomenclature commission of\nthe IFCPC.\nIt should be emphasised that the aim of the nomenclature com-\nmission is to develop an evidence-based terminology. It is also\napparent that the commitment of the IFCPC was to promote a\ncloser relationship to therapeutic procedures. Examples of this\nare the introduction of a grading for the visibility of the colum-\nnar-squamous epithelium boundary and the types of excision\nmentioned in the appendix ( l\n\" Table 2 ). In the authors ʼ opinion\nthis step is to be welcomed as it leads to a clearer position with\nregard to individualised therapy planning and performance. See\nalso the corresponding German-language groundwork (e.g.,\nKühn 2011 [7], Kühn et al. 2012 [8]). Overall, the new colposcopic\nnomenclature more clearly emphasises the significance of colpo-\nscopic examinations than did the preceding version.\nEspecially gratifying is the fact that two current publications\nfrom Germany-speaking countries (Scheungraber et al. [3, 4])\nhave been duly incorporated in the revision of the nomenclature.\nIt should also be mentioned that the practically important differ-\nentiation between the localisation of lesions inside and outside of\nthe transformation zones has been explicitly described in the no-\nmenclature and also that the significance of the surface expan-\nsion of dysplasia in cervix uteri has been scientifically confirmed\nby publications from German-speaking countries [10, 11].\nIn the following paragraphs those aspects are mentioned that\nhave changed in comparison to the previously valid terminology\n(Barcelona 2002 [6]) or, respectively have been included for the\nfirst time.\nTable 2 Addendum to colposcopic nomenclature for cervix uteri (IFCPC\n2011), after [9].\nIFCPC\n2011\nColposcopic nomenclature Cervix uteri\naddendum\nExcision types type 1 – flat\ntype 2 – medium\ntype 3 – steep\nDimensions\nof conisation\nspecimens\nheight (length):\ndistance from cervical to vaginal\nresection border (see Fig. below)\nwidth:\ndistance from stromal resection\nborder to epithelial surface\ncircumference (optional):\nperimeter of the opened cone\nspecimen\nred: height (length) of the conisation specimen, blue: thickness of the cone\nTable 1 Colposcopic nomenclature of cervix uteri (IFCPC 2011), after [9].\nIFCPC\n2011\nRio de\nJaneiro\nColposcopic nomenclature\nfor cervix uteri\nGeneral: adequate/inadequate: reason:\n(e.g., inflammation, bleeding, scars)\ncolumnar – squamous epithelium – border\n(CSB): completely/partially/not visible\ntransformation zone (type 1, 2, 3)\nNormal\nfinding\noriginal squamous epithelium:\n\" mature\n\" atrophic\ncolumnar epithelium\n\" ectopy\nmetaplastic squamous epithelium\n\" ovula Nabothii\n\" excretory ducts of glands\ndeciduosis in pregnancy\nAbnormal\nfinding\ngeneral: localisation of the lesion:\ninside or outside the epithelium,\ngiven according to clock face\nsize of the lesion:\nnumber of affected quadrants\npercent of the cervix\ngrade 1\n(minor\nchange)\ndelicate acetic-white epithelium,\ndelicate mosaic, delicate puncturing\ngrade 2\n(major\nchange)\nintensive acetic-white epithelium\ncoarse mosaic, coarse puncturing\nprominent excretory ducts of glands\nsharp borders\ninner border sign, ridge sign\nrapid acetic acid reaction\nnot\nspecific\nleukoplakia (keratosis, hyperkeratosis),\nerosion\nLugolʼs reaction (Schiller test)\nSuspected\ninvasion\natypical vessels\nadditional findings: vessels that bleed on\ncontact, irregular surfaces, exophytic lesion,\nnecrosis, ulcer, tumour\nMiscellane-\nous findings\ncongenital transformation zones (CTZ),\ncongenital anomalies, condylomas (papillo-\nmas), endometriosis, polyps (ectocervical,\nendocervical)\ninflammation, stenosis, postoperative\nchanges (scarred portio, vaginal stump)\n905\nQuaas J et al. Explanation and Use … Geburtsh Frauenheilk 2013; 73: 904 –907\nStatement\n\n\nNomenclature of Cervix Uteri\n!\nSome basic preliminary remarks of fundamental importance\nneed to be made about the colposcopic nomenclature for cervix\nuteri and the vagina. Is the colposcopic examination “adequate”\nor “inadequate with reasons ”? This replaces the term “satisfac-\ntory/unsatisfactory colposcopy ”. This change should emphasise\nthat in the case of an inadaquate coposcopy due to, e.g., inflam-\nmation, a control examination has to be performed after therapy.\nMoving the evaluability and general significance of a colposcopic\nexamination to the beginning of the nomenclature emphasises\nthe relative values.\nThis applies especially to the visualisation of the columnar-squa-\nmous epithelium border and thus the classification of the trans-\nformation zones into types 1 –3. The two classifications certainly\noverlap but represent two differerent aspects. The columnar-\nsquamous epithelium border is the “inner” border for the trans-\nformation zone (mature columnar epithelium border) and can,\naccordingly, be “completely”, “partially” or even “not visible ”.I n\nthe transformation zones 1 and 2 the columnar-squamous epi-\nthelium border is completely visible. As mentioned above it was\nthe intention of the IFCPC nomenclature committee to make the\nplanning of possibly necessary therapeutic options better. Evalu-\nation of the above two aspects does make this better, e.g., for the\ntargeted excision of abnormal areas (excision type).\nFor normal findings, an extension has also been made: atrophic\nsquamous epithelium, changes in pregnancy (deciduosis) and\nFig. 1 Regular acetic-\nwhite mosaic on cyto-\nlogical PAP II, histologi-\ncal sign of cervicitis.\nFig. 2 Opaque acetic-white epithelium on the anterior lip of the cervical\nos at 12 oʼclock with coarse mosaic (major change), transformation zone 1.\nFig. 3 Pronounced acetic-white epithelium with “inner border” at\n1o ʼclock ectocervical in histologically confirmed CIN 2.\nFig. 4 Pronounced acetic-white epithelium on the anterior lip of the cer-\nvical os with typical “ridge sign” (major change) in histologically confirmed\nCIN 3, transformation zone 1.\nFig. 5 Acetic-white elevated mound of excretory ducts of the cervical\ngland on the posterior lip of the cervical os (major change) in histologically\nconfirmed CIN 3.\n906\nQuaas J et al. Explanation and Use … Geburtsh Frauenheilk 2013; 73: 904 –907\nGebFra Science\n\n\nmetaplasia. It should be noted critically that making the diagno-\nsis of metaplasia actually necessitates a prior histological clarifi-\ncation in order to prove the existence of the metaplasia and ex-\nclude other functional findings, e.g., hyperplastic or polypous ec-\ntopy.\nIn abnormal colposcopic findings, the localisation of the lesion –\ninside or outside the transformation zone – has been re-included\nin the nomenclature and supplemented with the terms “inner\nborder” (border within the acetic-white epithelium) and “ridge\nsign” [3, 4].\nThe size of the lesion has been incorporated in the nomenclature\nwhereby the dimensions of the lesion are to be given as number\nof afflicted quadrants or, respectively, as percentage of the cervix.\nThe grading into “minor” and “major changes” that was already\ndefined in the Rome 1991 nomenclature [5] has been retained.\n“Minor changes ” can also be described as grade 1 changes\n(l\n\" Fig. 1)a n d“major changes” as grade 2 changes ( l\" Figs. 2 to 5).\nNewly taken into consideration is the interpretation of the dy-\nnamics of the acetic acid reaction in cervix uteri. It is pointed\nout that a rapid and intensive, positive acetic acid reaction must\nbe classified as “major changes”. It should be noted that the slow\ndevelopment of a positive acetic acid reaction, which in individu-\nal cases may require a reaction time of up to 3 minutes, belongs to\nthe “major changes” when the other “major change” criteria are\napplicable.\nAs already mentioned in the introduction, the committee could\nnot agree to classify the term leukoplakia into the groups of mi-\nnor or, respectively, major changes. Leukoplakia, erosion and Lu-\ngolʼs reaction (Schiller test) are classified as “non specific”. In par-\nticular, the classification of Lugol ʼs reaction as an unspecific ex-\namination method emphasises the necessity of the preoperative\napplication of an acetic acid text. Lugol ʼs reaction alone is not a\nsuitable measure for the preoperative planning of the excision\nline.\nAn extension is found in cases of suspected invasion in that atyp-\nical vessels are now merely defined as invasion characteristics in\ncontrast to previous neomclature suggestions. So far atypical ves-\nsels were assigned to the “major change” lesions. In addition, fur-\nther clinical aspects have been incorporated such as, for example,\nvessels that bleed upon contact.\nUnder the so-called miscellaneous findings we now find the\n“congenital transformation zone, CTZ ” and postoperative\nchanges such as “scarred portio ” (after conisation) or “vaginal\nstump”. An exact description of the term CTZ is still lacking and\nwill be subject of further discussion in the IFCPC nomenclature\ncommission.\nAddendum: Excision Types and Conisation Specimens\n!\nThree different excision types and also the dimensions of conisa-\ntion specimens have been added as an addendum ( l\n\" Table 2 ).\nThe excision types represent a practical relationship to the types\nof transformation zones and are intended to replace the further\nuse of widely differing excision terms by descriptions of the exci-\nsions performed and not the methods themselves.\nConflict of Interest\n!\nNone.\nReferences\n1 Bornstein J, Bentley J, Bösze P et al. 2011 colposcopic terminology of the\nInternational Federation for Cervical Pathology and Colposcopy. Obstet\nGynecol 2012; 120: 166 –172\n2 Bornstein J, Sideri M, Tatti S et al. 2011 terminology of the vulva of the\nInternational Federation for Cervical Pathology and Colposcopy. J Low\nGenit Tract Dis 2012; 16: 290 –295\n3 Scheungraber C, Glutig K, Fechtel B et al. Inner border–a specific and sig-\nnificant colposcopic sign for moderate or severe dysplasia (cervical in-\ntraepithelial neoplasia 2 or 3). J Low Genit Tract Dis 2009;13: 1 –4\n4 Scheungraber C, Koenig U, Fechtel B et al. The colposcopic feature ridge\nsign is associated with the presence of cervical intraepithelial neo-\nplasia 2/3 and human papillomavirus 16 in young women. J Low Genit\nTract Dis 2009; 13: 13 –16\n5 Stafl A, Wilbanks GD. An international terminology of colposcopy: re-\nport of the nomenclature committee of the International Federation\nof Cervical Pathology and Colposcopy. Obstet Gynecol 1991; 77: 313 –\n314\n6 Quaas J, Petry K-U, Heinrich J. Darstellung und Erläuterungen zur aktu-\nellen kolposkopischen Nomenklatur Barcelona 2002. Geburtsh Frauen-\nheilk 2007; 67: 1324 –1327\n7 Kühn W. Kolposkopie zur Früherkennung des Zervixkarzinoms. Patho-\nloge 2011; 32: 497-495\n8 Kühn W, Cichon G, Schneider A. Morphologische Aspekte zu früh-\ngeburtsvermeidenden Konisationstechniken. gyn 2012; 17: 262 –268\n9 Girardi F, Frey Tirri B, Küppers V et al. Neue kolposkopische IFCPC-No-\nmenklatur der Cervix uteri (Rio de Janeiro 2011). Frauenarzt 2012; 53:\n1064–1065\n10 Burghardt E, Pickel H, Girardi F. Colposcopy-cervical Pathology. 3rd ed.\nStuttgart: Thieme; 1998\n11 Fritsch H, Hoermann R, Bitsche M et al. Development of epithelial and\nmesenchymal regionalization of the human fetal utero-vaginal an-\nlagen. J Anat 2013; 222: 462 –472\nDeutschsprachige Zusatzinformationen online abrufbar unter:\nwww.thieme-connect.de/ejournals/toc/gebfra.\n907\nQuaas J et al. Explanation and Use … Geburtsh Frauenheilk 2013; 73: 904 –907\nStatement","source_license":"CC0","license_restricted":false}