Colposcopy Flashcards
What HPV vaccine schedule is recommended in HIV?
Three dose schedule because of decreased immune response.
What are the progression/regression rates of CIN?
CIN1: Progression 1%, Regression 57%
CIN2: Progression 5%, Regression 43%
CIN3: Progression 10-30%. Regression 32%
What should you do with an abnormal pap test in pregnancy?
1) LSIL/ASC - repeat 3/12 postpartum.
2) ASC-H, AGC, HSIL - needs colposcopy within 4/52.
What is the management of LSIL?
1) LSIL/ASC x 2 or ASC - return to screen if no CIN at repeat colposcopy.
2) If CIN1 on biopsy then repeat colposcopy + cytology in 12 months.
What is the management of ASC-H?
1) Refer to colposcopy for biopsy.
2) Follow-up every 6/12 and up to 1 year if biopsies negative.
3) Treatment should be offered for CIN2 or greater.
What is the management of HSIL?
1) Immediate colposcopy and biopsy preferred.
2) If no lesion found and colposcopy satisfactory, follow-up every 6/12 x 2.
What is the management of AGC?
1) Refer to colposcopy, ECC and if age > 35 years old or AUB then for EMB also.
2) If colposcopy negative then colposcopy every 6/12 for 2 years.
3) If HPV negative then 1 year of follow-up.
What is the management of AGC-N?
1) Colposcopy, ECC and EMB.
2) If colposcopy negative with diagnostic excisional procedure.
What is the management of CIN1?
Observation is preferred - 60-80% regress over 2-5 years.
What is the management of CIN2/3?
Can be either excision or ablation. After treatment, follow-up at 6/12 with colposcopy and HPV test. If treatment margins positive, follow-up with biopsy +/- repeat excision.
How should women under 25 be managed?
1) Reserve excision for CIN3.
2) For CIN2 perform colposcopy every 6/12 for 24 months prior to excision.
How should AIS be managed?
Treatment with excision. Following treatment, colposcopy and ECC every 6/12 for 5 years.
Consider hysterectomy if excision margins persistently positive or fertility not desired.
What is the risk of progression with vaginal HSIL?
10%
