COLPOSCOPY IN MODERN GYNECOLOGY AND OBSTETRICS KOLPOSKOPIA W NOWOCZESNEJ GINEKOLOGII I POŁOŻNICTWIE

SUMMARY A screening for a uterine cervix carcinoma is entering a new era. Instead of searching for abnormal pathological changes in the cells of uterine cervix, more and more frequently we are looking for factors evoking these changes, i. e. oncogenic types of HPV. In this way we are swiftly running away from a screening based on a cytology and colposcopy towards the one which depends on hybridization tests. One should, however, remember that screening conducted in this manner allows indeed for a precise distinguishing of a group of women with a risk of becoming ill from cervical carcinoma, but both the colposcopy and cytology are essential for establishing a proper strategy in a clinical management. It is difficult to imagine that only a fact of the infection of the uterine cervix epithelium with papil loma viruses, without morphological abnormalities detected in the epithelium, would be an indication for cervix treatment. At present, we are witnessing an intense development of modern techniques in the colposcopy. Proposals to improve the colposcopy are aiming at rendering objective an inspection of colposcopy images and enhancing a precision of diagnosis. However, the mentioned techniques are not available for each gynecologist. He does not always have to have an access to them because, as it appears from available literature, these modern procedures influence only in a small degree the increase in sensitivity and specificity of the rewieved method, and so far have mainly a scientific significance. In this situation, an essential practical importance has still a routine diagnosis using a colposcope with the application of routine colposcopy methods. Undeniable progress in the colposcopy represents a conviction that this method allows for a diagnosis of subclinical HPV infection of the uterine cervix. The colposcopic diagnosis of the subclinical HPV infection of the uterine cervix, supplemented with cytological examinations, is highly precise and finds a confirmation with hybridization methods for HPV DNA. A progress in the approach to the colposcopy mainly comes down to recognize this diagnostic method as the essential one in the process of deciding about a nature of morphological changes in the uterine cervix. This approach falls into a concept of targeted rescreening. While using the colposcopy one should, however, remember about limitations of the method. Unquestionable benefit of the colposcopy diagnostics is that the result of investigation is available immediately. If we simultaneously employ a cytological assessment of the uterine cervix in the phasecontrast microscope, we could save the patient a negative psychical stress associated with a relatively long-lasting expectation for the results of cytological examinations.