Office hysteroscopy in the diagnosis of Cervical Intra-epithelial Neoplasia.

Office hysteroscopy for evaluation of endocervix in cases with CIN The office hysteroscopic procedure is carried out with: 1. A 4-mm continuous-flow office operative hysteroscope with a 30-degree rod lens 1.9-mm optic. 2. A xenon light source of 175 W. Because the endocervix is generally small-sized, the light intensity should be as low as possible to avoid the reflection phenomenon, which may hamper the identification of the acetowhite areas. 3. A digital endo-camera 4. A high resolution monitor . 5. Distension of the endocervix is obtained using saline solution. The next step is the application of 2 mL of 5% acetic acid on the endocervix through the operative channel. a vaginoscopic approach may be used. The vagina may be distended by introducing the fluid distention medium through the hysteroscope placed into the lower vagina at the same pressure used for the subsequent distention of the uterine cavity. As soon as the external uterine orifice is visualized, the irrigation of saline is stopped and a syringe with 2 mL of 5% acetic acid is connected to the inflow channel of the hysteroscope. In this way the impregnation of the cervix may be directly and clearly visualized, provided that a few minutes elapse before reconnecting the continuous-flow irrigation to the hysteroscope the duration of patient observations depending on the results of gold standard histopathology (period from diagnostic hysteroscopy till results of histopathology) The observation period of the trial will be 6 months