About the Congress
The first comprehensive overhaul of international colposcopic terminology in 15 years — currently in consultation.
19th IFCPC World Congress
On June 4–6, 2026, the International Federation of Cervical Pathology and Colposcopy (IFCPC) convened its 19th World Congress in Versailles, France. Proposed updates to international colposcopy terminology were unveiled — the first major revision since Rio de Janeiro in 2011.
Why Revise the Nomenclature
Over the past 15 years, substantial evidence has accumulated regarding colposcopic predictors of CIN2/3, adenocarcinoma in situ (AIS), and post-treatment outcomes. The proposals aim to standardize criteria and minimize inter-observer variability across global centers.
International Working Group
The international initiative was coordinated by Prof. Jacob Bornstein (Israel), alongside prominent IFCPC experts representing France, Turkey, Colombia, Argentina, Austria, Canada, China, Italy, the USA, and Germany.
Key Proposals: 9 Essential Updates
Core recommendations presented during the scientific sessions at Versailles.
Standardized Examination Methodology
A unified, sequential examination protocol was introduced. Clinicians adhering to a standardized examination pathway are expected to yield significantly more reproducible impressions, curbing diagnostic discordance.
Routine Vulvar Inspection as a Mandatory Step
Under the 2011 Rio framework, vulvar examination was discretionary. The updated proposal mandates vulvar inspection during every comprehensive examination, reflecting the frequent multifocality of HPV-related lower genital tract neoplasia.
Revised Classification of Examination Adequacy
In place of the traditional binary "adequate / inadequate" judgment, a clinically actionable dichotomy is proposed:
Redefining Transformation Zone Type 2
Rio 2011 defined Type 2 by the presence of a partially visible endocervical component. The new formulation defines Type 2 strictly by the physical necessity of employing an endocervical instrument (such as an endocervical speculum, forceps, or swab) to achieve visualization of the squamocolumnar junction.
Rag Sign and Umbilication Proposed as Grade 2 (Major) Predictors
Two highly specific signs with compelling diagnostic accuracy for high-grade cervical intraepithelial neoplasia (CIN2/3) have been recommended for formal inclusion under Grade 2:
🚩 Rag sign ("ragged / frayed border")
Irregular, shredded, frayed borders of dense acetowhite epithelium resembling torn fabric. Multiple cohorts demonstrate strong positive predictive value and specificity for high-grade CIN.
🎯 Umbilication
Central punctate depressions within mosaic polygonal tiles (particularly within multiple fields featuring central punctation). Shows high specificity for CIN2/3 across all age strata.
Refined Diagnostic Role of Lugol's Iodine (Schiller Test)
Iodine negativity on its own remains non-specific and demonstrates modest positive predictive value for CIN2+. However, when an iodine-non-staining area strictly coincides with a known Grade 2 acetowhite abnormality, the combined finding qualifies as true Grade 2 (Major).
Glandular Lesions Formally Integrated into IFCPC Nomenclature
A landmark expansion: all international colposcopy classifications since 1975 focused almost exclusively on squamous disease. Versailles introduced standardized colposcopic criteria for adenocarcinoma in situ (AIS):
- Irregular, whitened, or bulbous columnar villi;
- Pathologically dilated, elevated gland openings;
- Confluent acidophilic papillae presenting with a characteristic "wax-like" sheen.
Excisional Categories: Proposal of Type 4 (Cylinderectomy)
A fourth excisional category is proposed — cylinderectomy: circumferential resection of the endocervical canal parallel to the endocervical axis.
Anticipated indications: endocervical glandular neoplasia (AIS) and persistent or recurrent disease following a prior Type 3 excision.
Fertility preservation caveat: In reproductive-age women, excessive resection of endocervical stroma must be rigorously avoided to prevent cervical insufficiency.
Minimum Standardized Reporting Protocol
For the first time, mandatory clinical parameters for colposcopy reporting have been outlined. Ambiguous conclusions such as "unremarkable colposcopy" are deemed non-compliant with international quality standards.
Draft Reporting Protocol: 6 Core Parameters
Proposed mandatory data points for every formal colposcopy documentation.
Clinical Significance & Expert Perspectives
Anticipated implications of the proposals on everyday gynecological practice.
For the Colposcopist
The refined criteria provide distinct histological triggers for targeted biopsy (rag sign, umbilication). A standardized reporting protocol ensures inter-institutional consistency.
For the Referring Clinician
Triage pathways become transparent: determining which patients mandate immediate excisional biopsy versus conservative surveillance. Inclusion of Type 4 enables tailored surgical planning.
For the Patient
Procedural quality can be benchmarked against explicit criteria. Reports provide unambiguous clarity when seeking second medical opinions.
📌 Key Takeaways for Practitioners:
- The Versailles proceedings represent draft consensus recommendations, pending formal IFCPC ratification and journal publication.
- The prevailing official international standard remains the 2011 Rio de Janeiro nomenclature.
- The proposals are undergoing global peer review and prospective clinical validation.
- The Central Asian Society for Colposcopy and Cervical Pathology (CASCCP) continuously tracks official IFCPC updates to ensure timely dissemination across Kazakhstan and Central Asia.