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38 Cards in this Set

  • Front
  • Back
How many biopsies should be taken at time of colopsocpy
2 or more
when should an endometrial biopsy be performed?
Woman with atypical glandular cells on her pap smear
when the transformation zone is NOT visible

and she is over 45 with high grade cytology
You should routinely test for HR-HPV on all samples. True or False
False
If a woman has persistent ASCUS/LSIL or ASCUS HR-HPV on her pap smear, what is the next right step?
should be referred to colposcopy
A lesion on colposcopy should be biopsied. TRUE or FALSE
True
What should you do if you have an ASC-H on the pap smear?
Need to do colposcopy to rule out CIN 2 or3
Don't have to do a diagnostic excision for all people - if the colposcopy is negative
What should women with HSIL do?
go for colposocpy
if no lesion seen - then need to do endometrial curettage and directed biopsies
- if the transformation zone is not seen and ECC and biopsy are negative, then you should do a diagnostic excision procedure
what to do if you have AGC-NOS, AGC-N, AIS?
Needs colposcopy
NEEDs ECC
if woman greater than 35 with hx of abnormal bleeding, then need endometrial biopsy
If a woman has AGC-N then what should be the next step?
should have a diagnostic excision procedure
What to do if you have overt SCC on that pap smear?
need to repeat colpo and do biopsies

NEED for the clinical staging of SCC
What do you do for the patient with the abnormal HPV test, but NORMal cytology
- women with HR-HPV BUT less than 30 years old SHOULD NOT have HPV testing --> but if you did have testing, then you should follow --> they don't need colposcopy
what to do if you're 30 years old and you have +HPV but normal cytology?
have hpv and cytology repeated in 12 months

if persistent HPV then need colposcopy
How do you manage the following in pregnancy?
ASC-US / LSIL
HSIL, ASC-H, AGC
ASC-US / LSIL - repeat cytology at 3 months postpartum
HSIL, ASC-H, AGC - should have colposcopy within 4 week

SHOULD not do ECC in pregnancy
when should pap smear screening be initiated for women?
after age 21 at least
If less than 21 yo, but has ASC-US or LSIL, then what to do?
should repeat cytology - per provincial guidelines
If less than 21 but has AGC, ASC-H, HSIL
Then needs to go for colposcopy
How do you manage CIN I?
1. observe with repeat assessment in 12 months (with cytology - can be colpo too)

2. then manage according to cytology result after that

3. if CIN I, but it was initially HSIL or AGC -then should have cytology/histology reviewed --> if still discrepant then consider an excisional biopsy
What do you do with CIN 2/3 in when over 25 years?
1. CIN 2/3 should be treated - excisional procedures preferred for CIN 3
2. if margins are positive, then follow-up colposcopy, directed biopsies, and/or ECC
3. if you have recurrent CIN 2/3, then need repeat excision
what to do if you have CIN 2/3 less than 25 years?
1. have pathologist review histology - is it CIN 2 OR CIN 3
2. if CIN 2 -then observe for 6 months - up to 24 months before treatment is considered
3. CIN 3 - should be treated
How do you treat AIS- adeno-carcinoma in - situ?
1. you should do diagnostic excision - or type 3 transformation zone excision
2. if margins are positive, then should do 2nd excision
3. if after treatment for AIS and childbearing is finished - should do hysterectomy
4. if you Dx AIS after LEEP is performed for CIN in a woman who hasn't completed her child-bearing, but margins are negative, then don't need to do more treatment
What to do if you find CIN 2 or 3 in pregnancy?
repeat colopscopy

treatment should be delayed until 8-12 weeks after delivery
what should you do for follow-up post-treatment of CIN 2 /3

can do either option
1. women should follow with cytology testing and colposcopy at 6-month intervals for 2 visits --> if cytology and biopsies are negative then can return to normal screening

2. HPV testing at 6 months combined with cytology testing --> if both are negative, then can return to normal screening
Do immuno-compromised women require colposcopy?
No
They should be screened normally
How do you triage patients coming into colposcopy?
2-weeks - SCC
4 weeks - HSIL
6-weeks- ASC-H or AGC
12 weeks - all other abnormal results
Why is taking 2 biopsies better?
it improves the sensitivity of colposcopy to 81.8% (compared to 68.3% with only 1 biopsy)
What is the NNT needed for ECC to detect one additional case of CIN2?
99

best for older women with high grade cytology
In what circumstances is an ECC helpful?
- unsatisfactory colposcopy
-AGC smear
-older women with high-grade cytology
When is a good time to discuss the HPV vaccine?
it's good to discuss at the time of colpo, even if they are HPV +
If you have ASCUS or LSIL - what is the chance that you have CIN 2 or 3?
ASCUS - CIN 2 -10%, CIN 3 - 6%
LSIL - CIN2 - 17%, CIN 3 - 12%
If you have ASC-H - what is the chance that you have CIN 2, CIN 3
70% of cases

but invasive carcinoma was only 2.9% or 1.7%
What is the rate of CIN 2-3% if you have HSIL?
53-66% - up to 90% if immediate LEEP is performed
what is the rough breakdown of pathology if you have an atypical glandular lesion?

ie: AGC-NOS, AGC-N, AIS?
7% - CIN 1
36% - CIN 2/3
20% - AIS
9% - SCC of Cervix
29% - endometrial pathology
what is the percentage of regression for ASC-US and LSIL in women less than 21?
93%
what is the rate of progression to cancer for

CIN 1, 2, and 3?
CIN 1 - 1%
CIN 2 - 5%
CIN 3 - > 12%
what is the progression to CIN 3 from

CIN 1 or 2?
CIN 1 - 11%
CIN 2 - 22%
What are some criteria for using ablative therapy on the cervix?
Ablative methods can only be used for Type I and II transformation zones

THERE can be NO suspicion of invasive disease
no suspicion of glandular disease
and no previous treatment

CANNOT be CIN 3
What is the invasion risk of untreated CIN3?
31% in 30 years (think 30 and30)

documented CIN3 for 2 years leads to 50% risk of invasive disease
what is a prognostic factor for managing adenocarcinoma in situ?
margin status