Version June 2024
| Category | Features/criteria | Details |
| General assessment | Visualization of the cervix | Fully visualized |
| Not fully visualized due to: ____ | ||
| Visualization of the SCJ | Fully visualized | |
| Not fully visualized | ||
| Acetowhite changes | Any degree of whitening after application of 3 to 5% acetic acid | Yes/no |
| Normal colposcopic findings | Original squamous epithelium: mature, atrophic | |
| Columnar epithelium | ||
| Ectopy/ectropion | ||
| Metaplastic squamous epithelium | ||
| Nabothian cysts | ||
| Crypt (gland) openings | ||
| Deciduosis in pregnancy | ||
| Submucosal branching vessels | ||
| Abnormal colposcopic findings | Lesion(s) present (acetowhite or other) | Yes/no |
| Location of each lesion | Clock position | |
| At the SCJ (yes/no) | ||
| Lesion visualized (fully/not fully) | ||
| Satellite lesion | ||
| Size of each lesion | Number of quadrants the lesion involves | |
| Percentage of surface area of TZ occupied by lesion | ||
| Low-grade features | Acetowhite:
| |
Vascular patterns:
| ||
Margins/border:
| ||
| High-grade features | Acetowhite:
| |
Vascular patterns:
| ||
Margins/border:
| ||
Contour:
| ||
| Fused papillae | ||
| Suspicious for invasive cancer | Atypical vessels | |
| Irregular surface | ||
| Exophytic lesion | ||
| Necrosis | ||
| Ulceration | ||
| Tumor or gross neoplasm | ||
| A suspicious lesion may not be acetowhite | ||
| Nonspecific | Leukoplakia | |
| Erosion | ||
| Contact bleeding | ||
| Friable tissue | ||
| Lugol staining | Not used | |
| Stained | ||
| Partially stained | ||
| Nonstained | ||
| Miscellaneous findings | Polyp (ectocervical or endocervical) | |
| Inflammation | ||
| Stenosis | ||
| Congenital TZ | ||
| Congenital anomaly | ||
| Posttreatment consequence (scarring) | ||
| Colposcopic impression (highest grade) | Normal/benign | |
| Low grade | ||
| High grade | ||
| Cancer |
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