Cervicoscopy is an endoscopic method for diagnosing cervical canal pathology based on direct visualization of the endocervix using optical systems. The study is performed with a rigid mini-hysteroscope (office cervicoscopy) or a fibrogysteroscope. Diagnostic cervicoscopy is used to detect polyps, papillomas, cysts, hyperproliferation, endometriosis, endocervicitis, dysplasia and cervical cancer. The sequence of actions during cervicoscopy: treatment of the perineum and vagina with antiseptic, insertion of a hysteroscope into the cervical canal, examination of the mucous membrane. Depending on the nature and prevalence of the detected pathology, targeted biopsy, removal of focal formations or endocervical curettage are performed according to indications.
The first examination of the cervical canal and the uterine cavity was performed in 1925 with a cystoscope. The introduction of mini-hysteroscopes began at the beginning of the XXI century. From that moment on, it became possible to perform cervicohysteroscopy on an outpatient basis without general anesthesia and additional instruments. Office cervicoscopy allows you to assess the condition of the epithelium of the cervical canal and, if necessary, to conduct appropriate therapy. Diagnostic cervicoscopy is the final stage of a comprehensive instrumental examination of the cervix. The lack of visualization of the cervical canal mucosa during colposcopy, obtaining false negative or false positive results in an oncocytological smear and the uninformativity of ultrasound examination in assessing the cellular composition of the endocervix contributed to the widespread introduction of cervicoscopy into clinical practice.
Outpatient cervicoscopy is performed with a minihysteroscope, the working part of which has a diameter of up to 4mm together with a channel for working mechanical or electrosurgical instruments. The advantages of the method are the ability to remove focal endocervix formations at the diagnostic stage, take a targeted biopsy in the distal part of the canal and expand the scope of the study to hysteroscopy when the pathological process spreads to the uterine walls. The pain syndrome during cervicoscopy is minimal and comparable to the sensations that occur when inserting or removing vaginal mirrors.
Indications and contraindications
Cervicoscopy is indicated when polyps emanating from the cervical canal are detected. The study makes it possible to determine the leg of the formation and perform simultaneous removal using mechanical forceps or an electrosurgical loop inserted through the operating channel of the instrument. The expansion of the cervical canal cavity, which is detected during ultrasound scanning, may indicate mucosal hyperplasia. In this case, during cervicoscopy, the diagnosis is clarified and then endocervical curettage is performed or the scope of the operation is expanded to hysteroscopy with RDV.
By the method of cervicoscopy, the “eyes” of endometriosis on the cervix are easily detected, which are then coagulated with a button electrode inserted through a hysteroscope. Examination of the cervical canal mucosa allows you to diagnose a chronic inflammatory process and take biopsy material for morphological and bacteriological examination. Cervicoscopy is prescribed with positive results of oncocytology for the presence of dysplastic or atypical cells. The examination is supplemented with a targeted biopsy from suspicious areas of the cervical canal. Also, contact spotting at any age is an indication for conducting a diagnostic study. There is data in the literature on the successful removal of the fetal sac during cervical pregnancy during cervicoscopy.
Cervicoscopy is not performed with stenosis and obliteration of the cervical canal due to the inability to insert the instrument. Contraindications are also acute inflammatory diseases of the pelvic organs (colpitis, cervicitis, endometritis, adnexitis), pregnancy and extragenital pathology in the decompensation stage. A relative contraindication is considered to be widespread cervical cancer due to the possibility of screening out malignant cells into the uterine cavity.
Preparation for cervicoscopy
This procedure is part of a comprehensive examination of the cervix, an additional method that allows you to confirm or refute the presumed diagnosis. Before cervicoscopy, the patient is prescribed a general and biochemical blood test, a general urinalysis, RW and ECG. A therapeutic examination is carried out. Ultrasound examination of the pelvic organs is performed to exclude endometrial pathology and to determine the volume of intervention in advance. Before the examination, it is necessary to pass tests for sexual infections (chlamydia, trichomoniasis, genital herpes, HPV). The examination plan also includes a smear from the vagina for flora and a smear from the cervical canal for oncocytology. Before cervicoscopy, a simple and extended colposcopy is performed to assess the condition of the epithelium of the vaginal portion of the cervix.
Cervicoscopy is an outpatient procedure that does not require general anesthesia. Due to the fact that during the study it may be necessary to expand the scope of manipulations (biopsy, curettage, hysteroscopy), a woman is recommended to refrain from eating. Cervicoscopy is prescribed in the first phase of the menstrual cycle, when the physiological expansion of the cervical canal occurs under the action of estrogens, and the cervical mucus becomes transparent.
Methodology of conducting
To perform a cervicoscopy, the patient is placed on a gynecological chair. The area of the external genitals, perineum and vaginal walls are treated with an antiseptic solution. The use of high-resolution mini-endoscopes allows for atraumatic and non-contact insertion of instruments. The vaginoscopic method involves the introduction of a hysteroscope through the vagina into the cervical canal without the use of mirrors, fixation with bullet forceps and dilation of the cervix.
The tube of the mini-hysteroscope is inserted into the posterior arch of the vagina. A saline solution enters through the channel of the instrument, which straightens the walls of the vagina. To prevent a spasm of the uterine pharynx and reduce painful sensations, a solution heated to 36 ° C can be used. After examining the vaginal part of the cervix, the hysteroscope is moved into the cervical canal. Consistently assess the state of the endocervix, identify pathological neoplasms and growths, determine their localization in relation to the external pharynx (upper, middle or lower third). Examine the areas of the location of blood vessels, note their normal or atypical structure. According to the indications, surgical intervention is performed simultaneously (biopsy, coagulation or removal of focal pathology, curettage of the canal). The duration of diagnostic cervicoscopy is 10-15 minutes, during surgical treatment – 20-30 minutes.
This study is an outpatient procedure, does not require hospitalization. After a diagnostic examination, the patient may be disturbed by minor pulling pains in the lower abdomen. When performing surgical manipulations on the cervix for several days, scanty bloody discharge from the genital tract is noted. During this period, it is not recommended to visit baths and saunas, use vaginal tampons and douching. You should give up intimacy.
If a biopsy, removal of polyps or hyperplasia of the endocervix were performed, the result of a histological examination will be ready in 10-15 days, with which it is necessary to appear for a repeat appointment with the attending gynecologist. The data obtained during cervicoscopy allow the doctor to determine the further tactics of the patient’s management, to make an optimal treatment plan for widespread cervical lesions (excision, conization, etc. methods). Complications during or after cervicoscopy practically do not occur, since manipulation is carried out with thin atraumatic instruments.
Cervicoscopy is a highly informative method of diagnosing pathological conditions of the cervical canal, it is an additional screening for the examination of women, both in the presence of obvious cervical diseases and in their absence.