Abnormal Pap Testing Flashcards
What are the criteria for stopping Pap testing after a hysterectomy or when a patient turns 65?
1) No history of cervical cancer
2) No CIN2 or higher in the last 20 years
(As of 4/23/2020)
What are the two possible Pap screening schedules for 30-65yo patients?
Preferred: co-testing w/ HPV every 5 years
Acceptable: cytology alone every 3 years
(As of 4/23/2020)
What are the two acceptable management options for a NILM/HPV+ Pap?
1) Repeat co-testing in one year
2) HPV genotyping> if positive for 16 or 18, colposcopy. Otherwise repeat co-testing in one year
(As of 4/23/2020)
What is the preferred management of a 21-24yo patient with an ASCUS Pap?
Repeat cytology in one year (if negative for HPV [testing is acceptable in this group] then repeat cytology in 3 years)
(As of 4/23/2020)
What is the management for a 21-24yo patient with an LSIL Pap?
Repeat cytology in one year
As of 4/23/2020
What is the preferred management for a patient 25yo or older with an LSIL/HPV- Pap?
Repeat co-testing in one year (colposcopy acceptable)
As of 4/23/2020
What is the management for a patient whose Pap shows atypical endometrial cells?
Endometrial AND endocervical sampling, colposcopy if pathology is negative
(As of 4/23/2020)
What is the management for a patient whose Pap shows AGUS?
Colposcopy with ECC (add EMB if patient is >=35yo, has unexplained vaginal bleeding, and/or risk factors for endometrial neoplasia)
(As of 4/23/2020)
What is the management for a patient whose Pap shows unsatisfactory cytology?
Repeat cytology in 2-4 months
As of 4/23/2020
What is the preferred management for a pregnant patient with LSIL?
Colposcopy (acceptable to defer until 6w postpartum)
As of 4/23/2020
If a 21-24yo patient has an HSIL Pap followed by a negative colposcopy, what is the next recommended step in management?
Colposcopy and cytology at 6mo intervals for 2y
As of 4/23/2020
In what one context is HPV testing acceptable for 21-24yo patients?
Reflex testing to triage ASCUS Pap (preferred to repeat cytology in 12mo)
(As of 4/23/2020)
If a 21-24 yo patient has an ASCUS Pap followed by an LSIL Pap one year later, what is the recommended management?
Repeat cytology at 12mo (for initial ASCUS, repeat cytology at 12mo> if neg, ASCUS, or LSIL; repeat cytology again in 12mo> If >=ASCUS, colposcopy)
If a patient 25yo or older has an ASCUS Pap followed by an ASCUS Pap one year later, what is the recommended management?
Colposcopy (initial HPV triage preferred, repeat cytology acceptable with colposcopy for anything other than NILM)
What is the preferred management for a patient 25yo or older with an ASCUS Pap?
HPV genotyping; if negative then repeat co-testing in 3y, if positive then colposcopy
