Introduction

The history of colposcopy is an example of the adaptation of an observation technique

The rebirth of colposcopy to its object. Using the colposcope, Hinselmann hoped to detect micro-carcinoma, a small invasive carcinoma invisible to the naked eye, which was believed at that time to be the earliest form of carcinoma of the uterine cervix. He encountered such lesions only rarely but discovered in the cervix abnormalities of squamous epithelium which he described under the narre atypical epithelium, some of which correspond to what we now know as dysplasias. For a long time, colposcopy was the only method of detection of dysplasias of the uterine cervix. It was not fully accepted at first owing to the difficulties of training and for 25 years was used almost exclusively in German-speaking countries. Schiller’s test, invented at the same time as colposcopy, is more widely known as it is easier to carry out but it has not given the hoped-for results because of its Jack of specificity. With the appearance of exfoliative cytology, it was thought for a time that colposcopy and Schiller’s test were condemned to disappear. In fact, the opposite occurred. These two methods have merely changed their objective. They are no longer methods of detection but have become methods for the topographical study of lesions of the uterine cervix and vagina. Performing colposcopy is no longer a question of discussing whether a lesion is a zone of mosaic or punctation, it is rather the determination of its site, size and extent. It is to decide whether a reliable histological diagnosis may be obtained by target biopsies or whether a cone biopsy is necessary. For a long time limited to the examination of the surface of the mucosa, colposcopy can now explore the connective tissue in depth using the diathermy loop. Such colposcopy of connective tissue has added a new and promising field of application to the method.

In the diagnosis and treatment of dysplasias, the colposcopist has greater responsibility than the pathologist, as the time has passed when treatment was decided on the basis of histological diagnosis alone. Local and non-mutilating treatment is performed under colposcopic control.

At the same time, the colposcope has been adapted to its new rote. Initially conceived as a type of sub-microscope with a limited field of vision and a fairly high degree of magnification, the colposcope now has several magnifications, the lowest of which gives an overall view of the cervix and vagina. It becomes more and more closely related to the apparatus used in microsurgery.

This new colposcopy has a well-defined role in pathology of the uterine cervix and vagina. It is no longer a routine examination, to be performed in a few minutes by all gynaecologists for each of their patients. It is a selective examination, reserved only for those patients who need it, and carried out under conditions designed to ensure maximum reliability. The importance of this role is such that this examination should be carried out only by a specialised colposcopist with a knowledge of histopathology and a clinical experience which can match the level of the responsibility which he is undertaking.