Before Your First: Colposcopy and LEEP

Abnormal Pap? This episode covers the colposcopy and LEEP procedures from start to finish – why we do them (ASCCP guidelines (https://www.asccp.org/guidelines) ), the histology and staining principles behind acetic acid and Lugol's iodine, what cervical dysplasia looks like through the colposcope, and how LEEP and cold-knife cone excisions differ. Show Outline: • Why – ASCCP guidelines (https://www.asccp.org/guidelines) (there's an app!) • Cervical Dysplasia – Caused by HPV. CIN I → CIN III is a progression. Risk factors: smoking, other STIs including HIV, immunodeficiency. • Histology – Increased nuclear-to-cytoplasmic ratio in abnormal cells • Staining Principles • Acetic acid: higher N:C ratio cells reflect more light and appear white (acetowhite) • Lugol's iodine: reacts with glycogen in normal squamous cells (appear dark); non-staining cells are abnormal • Colposcopic Findings – Increased vascularity, punctations, mosaicism, surface contour changes • LEEP – Stain the abnormality, know where the abnormal biopsy was taken. Single pass is ideal – tag a side for orientation. +/- Top Hat depending on ECC result. • Cold-Knife Cone (CKC) – For pathology higher in the cervical canal; more complications. No electricity – okay if pregnant. About the Speaker: Jennifer Doorey, MD, MS – Academic Ob/Gyn at The Johns Hopkins University School of Medicine. As the founder of MedReady (https://procedureready.com) , Dr. Doorey seeks to advance clinical medical education by developing resources for medical students and clinical educators. Procedure Ready: Ob/Gyn is a podcast aimed at medical, PA, and NP students entering their clinical rotation in Ob/Gyn. The views expressed are the speaker's own and do not constitute medical advice.