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), 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 (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, 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.