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A Simplified Classification for Describing Colposcopic Vaginal Patterns

Indraccolo, Ugo MD, PhD1; Baldoni, Angelo MD2

Journal of Lower Genital Tract Disease: April 2012 - Volume 16 - Issue 2 - p 75–79
doi: 10.1097/LGT.0b013e318237ec82
Original Articles

Objective This study aimed to highlight that colposcopic vaginal patterns are not specific, unlike cervical colposcopic patterns, and to provide a simpler classification of vaginal colposcopic patterns.

Materials and Methods A total of 223 patients who underwent colposcopy with Schiller test were assessed (hierarchical log-linear model) retrospectively.

Results The greatest predictability for histologically confirmed warts and cancers is represented by colposcopic patterns of wart and cancer. Lugol-negative area is strongly predictive of koilocytosis, even if it is found in other vaginal lesions. Thickened epithelium seems to better predict a severe vaginal lesion, whereas thin white epithelium better suggests a mild vaginal lesion. Colposcopic patterns were simplified as follows: Lugol-negative area, white epithelia (thin white epithelium and white thickened epithelium), vascular lesions (regular and irregular mosaicisms and punctations), wart, and cancer. Thus, koilocytosis is predicted by the Lugol-negative area, whereas white epithelia patterns and vascular patterns are not specific, suggesting overall vaginal intraepithelial neoplasias. Wart and cancer patterns are pathognomonic for histologically confirmed warts and cancers.

Conclusions Vaginal colposcopy poorly predicts the severity of vaginal lesions. By including each type of white epithelium within a new category called “white epithelia patterns” and each type of vascular pattern within a new category called “vascular patterns,” it is possible to simplify vaginal colposcopy without compromising its accuracy.

Simplifying colposcopic vaginal patterns does not compromise vaginal colposcopy accuracy.

1Department of Surgical Sciences, University of Foggia, Foggia; and 2Operative Unit of Obstetrics and Gynecology, “Silvestrini” Hospital of Perugia, Azienda Ospedaliera di Perugia, Perugia, Italy

Reprint requests to: Ugo Indraccolo, MD, PhD, Via Montagnano 16, 62032 Camerino (MC), Italy. E-mail:

©2012The American Society for Colposcopy and Cervical Pathology