Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
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
|