Gynaecology Tests and Investigations

i) Swabs
This is a superficial test which involves taking a swab of the tissue to diagnose pathogens
– They can be taken vaginally, endocervical and cervically.
– The scrapings can be sent for culture of organisms or nucleic acid analysis to determine the pathogen:

 

Type of Swab

What does it test for?

Endocervical chlamydia swab (NAAT)

Chlamydia

Endocervical charcoal media swab

Gonorrhoea

High-vaginal charcoal media swab

Bacterial vaginosis, trichomonas vaginalis, candida and group B streptococcus.

ii) Ultrasound scan

This uses high frequency sound waves to visualise the pelvic structures. It is commonly done in two ways.

Trans-abdominal –> Used to visualise uterus, ovaries and adnexal structures, urogenital tract (e.g.obstruction, retention), assessment of foetal development.

 

– Transvaginal –> Best for viewing ovaries (enlarged due to cysts, tumours and follicular maturation), the uterus and measure endometrial thickness
– If the thickness is >4mm (post-menopausal) ➔ hysteroscopy to rule out endometrial cancer
– If thickness is >8mm ➔ must do follow-up ultrasound in 1-3 months

iii) Colposcopy
This is a type of microscopy used to visualise the cervix
– The vagina is opened with a speculum to view the ectocervix
– You then apply compounds to identify pre-malignant or cancerous lesions:

 

– Acetic acid ➔ stains white areas with high nuclear density
– If no white lesions, then can apply iodine to identify abnormal areas
– Brown = normal – Yellow = Abnormal

iv) Hysteroscopy
The inspection of the uterus using a fibreoptic scope through the cervix
– It is used to diagnose and treat uterine pathologies as it can be combined with uterine curettage
– Uterine curettage = scraping away endometrial tissue, a process used both diagnostically and therapeutically

Side effects – Pain, bleeding, perforation

v) Hysterectomy
This is the surgical removal of the uterus which is divided into 3 types:

a) Radical hysterectomy
– removal of uterus, cervix, upper vagina + parametrium
– It is usually indicated for endometrial cancer
– The lymph nodes, ovaries and fallopian tubes are also commonly removed

b) Total Hysterectomy
– removal of the uterus and cervix, with/without ovaries

c) Subtotal Hysterectomy
– removal of the uterus but leaving the cervix intact.
– In pre-menopausal women, the ovaries are usually left in to maintain hormonal balance. The tubes are removed as most ovarian cancers start in the oviducts.

vi) Mammogram
This is the investigation which uses low energy X-rays to visualise the breast tissue
– It is used to detect breast cancer, through detecting masses and calcifications.
– It has a false negative rate of >10% and it can be difficult to spot small tumours.

N.B. There is a national screening program for women aged 50-71
– They are offered a mammogram every 3 year

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