A 42-year-old woman presents with postcoital bleeding and vaginal discharge. On examination, a suspicious lesion is noted on the cervix. A Pap smear shows atypical squamous cells of undetermined significance (ASCUS). What is the investigation of choice to confirm the diagnosis of cervical cancer?

## Investigation of Choice for Cervical Cancer Diagnosis ### Colposcopy with Directed Biopsy **Key Point:** Colposcopy with directed cervical biopsy is the gold standard for confirming cervical cancer when a suspicious lesion is visible on examination and cytology is abnormal. **High-Yield:** The combination of clinical suspicion (visible lesion) + abnormal cytology (ASCUS) mandates tissue diagnosis. Colposcopy allows magnified visualization of the cervix with application of acetic acid and Lugol's iodine to identify abnormal vascular patterns and acetowhite areas, guiding targeted biopsy. ### Why Colposcopy Is Superior | Feature | Colposcopy + Biopsy | Repeat Pap | HPV Testing | Cone Biopsy | |---------|-------------------|-----------|-------------|-------------| | **Provides tissue diagnosis** | Yes | No | No | Yes | | **Allows visualization** | Yes | No | No | No | | **Invasiveness** | Minimally invasive | Non-invasive | Non-invasive | Surgical | | **Indicated with visible lesion** | Yes | No | No | Only if colposcopy inconclusive | **Clinical Pearl:** When a grossly visible cervical lesion is present, the probability of malignancy is high enough that colposcopy with immediate biopsy is warranted—repeat cytology or HPV testing delays diagnosis unnecessarily. **Mnemonic:** ASCUS + Visible Lesion = **Colposcopy NOW** (not HPV, not repeat Pap, not cone).