BACKGROUND: Following the publication of the European consensus statement on standards for essential colposcopy in 2020, the need for standards relating to more complex and challenging colposcopy practice was recognised. These standards relate to colposcopy undertaken in patients identified through cervical screening and tertiary referrals from colposcopists who undertake standard colposcopy only. This set of recommendations provides a review of the current literature and agreement on care for recognised complex cases. With good uptake of human papillomavirus (HPV) immunisation, we anticipate a marked reduction in cervical disease over the next decade. Still, the expert colposcopist will continue to be vital in managing complex cases, including previous cervical intraepithelial neoplasia (CIN)/complex screening histories and multi-zonal disease. AIMS: To provide expert guidance on complex colposcopy cases through published evidence and expert consensus. MATERIAL & METHODS: Members of the EFC and ESGO formed a working group to identify topics considered to be the remit of the expert rather than the standard colposcopy service. These were presented at the EFC satellite meeting, Helsinki 2021, for broader discussion and finalisation of the topics. RESULTS & DISCUSSION: The agreed standards included colposcopy in pregnancy and post-menopause, investigation and management of glandular abnormalities, persistent high-risk HPV+ with normal/low-grade cytology, colposcopy management of type 3 transformation zones (TZ), high-grade cytology and normal colposcopy, colposcopy adjuncts, follow-up after treatment with CIN next to TZ margins and follow-up after treatment with CIN with persistent HPV+, and more. These standards are under review to create a final paper of consensus standards for dissemination to all EFC and ESGO members.

Aberdeen Centre for Women's Health Research University of Aberdeen UK

Corfamed Woman's Health Center Kluczborska Wroclaw Poland; Department of Pathology and Clinical Cytology University Hospital in Wroclaw Poland

Department of Gynaecology Georgian National Screening Center Tbilisi Georgia

Department of Gynecological and Breast Surgery and Oncology Pitié Salpêtrière Assistance Publique des Hôpitaux de Paris University Hospital Paris France

Department of Obstetrics and Gynaecology CUF Sintra Hospital Sintra Portugal

Department of Obstetrics and Gynaecology State University of Medicine and Pharmacy Referral Center of Colposcopy Chisinau Moldavia

Department of Obstetrics and Gynaecology University of Medicine and Pharmacy Grigore T Popa Iasi Romania

Department of Obstetrics and Gynecology Medical Academy Lithuanian University of Health Sciences Kaunas Lithuania

Department of Obstetrics and Gynecology University of Helsinki and Helsinki University Hospital

Department of Oncology and Radiology Danylo Halytsky Lviv national medical university Lviv Ukraine

Diakonessenhuis Bosboomstraat 1 3582 KE Utrecht the Netherlands

Faculty of Medicine University of Belgrade Clinic of Obstetrics and Gynaecology Clinical Center of Serbia Belgrade Serbia

Frauenheilkunde and Geburtshilfe Zytologisches Labor Dysplasie Sprechstunde Düsseldorf Germany

Frauenklinik Baselland Switzerland

Gynaecology Centre North Estonia Medical Centre Estonia

Institute for the Care of Mother and Child Prague 4 Czech Republic; 3rd Faculty of Medicine Charles University Prague 10 Czech Republic; Institute of Postgraduate Education in Health Care IPVZ Prague 10 Czech Republic

Institute of Nursing and Obstetrics Faculty of Health Sciences Jagiellonian University Medical College Krakow Poland

IRDB MDR and Surgery and Cancer Faculty of Medicine Imperial College London UK

Karolinska Institutet Stockholm Sweden

The Israeli Society of Colposcopy and Cervical and Vulvar Pathology Peretz Berenstein St Haifa Israel

West London Gynaecological Cancer Centre Imperial College NHS Trust UK; Department of Obstetrics and Gynaecology Ysbyty Gwynedd Betsi Cadwaladr University Health Board Wales UK

References provided by Crossref.org