Jeffrey M. Thurston MD FACOG
I was trained by Ray Kauffman, at Baylor College of Medicine, in the late 1970s. He was widely acknowledged as one of the best colposcopists in the world. The subtle changes in cellular appearance after exposure to 3% acetic acid were varied and often easily missed. We were drilled repeatedly to recognize the areas most appropriate to biopsy.
Recently, I had a 40 year old patient referred to me for pelvic pain, but in the course of a concomitant annual exam, performed a Pap smear. The result was HGSIL, HR HPV detected. She was instructed to come in for a colposcopy.
In recent years we have replaced our traditional binocular mechanical colposcopy with a computerized DYSIS monocular. In this instance, I detected only minimum WE at 0100 and 0500, but once the DYSIS displayed the mapping, a bright yellow irregular patch could be seen from 0400-0600. Biopsies were performed at both the 0100 area and the 0500 area.
I had thought from my visual colposcopy that the Pap had surely been over-read! The 0100 biopsy did indeed show moderate to severe dysplasia, but the 0500 bx, lit up brightly by the DYSIS, revealed CIS with endocervical gland involvement. A subsequent LEEP with negative internal and external margins proved curative.
While I was lucky to have seen the subtle changes in the affected areas, a less experienced physician might well have missed them. But with DYSIS, the area was impossible to miss!! Every day my partners and I have more and more reason to feel justified in the decision to incorporate DYSIS into our every day practice!