Colposcopy

Question 1

What percentage of ASCUS is high grade dysplasia (CIN2/3)?

LSIL?

Answer 1

ASCUS: CIN2 10%, CIN3 6%
LSIL: CIN2 17%, CIN3 12%

Question 2

Treatment Of ASC-H?

Answer 2

Colpo within 6 weeks ideally to rule out CIN2-3 or cancer
Biopsy any lesion
If neg colpo, repeat colpo, pap, HPV if avail q6/12 x 2 years, if still neg then RTRS
ASC-H with negative colpo does not warrant EDP

Question 3

Treatment of hsil?

Answer 3

Colpo, ideally within 4/52
If colpo negative, do ecc and biopsy q6/12 x 2 times
If TZ not visible in entirety and ecc/bx negative, may need EDP
If done childbearing, just do EDP

Question 4

Atypical glandular cytology on pap. Manage.

Also AGC-N and AGC-NOS.

Answer 4

Definitely needs colpo and ECC
If over 35 and having abn pvb needs embx
If agc-n and no lesion, needs EDP
Can actually be caused by lesions of ovary, Fallopian tube, endometrium…
AGC-nos without lesion: colpo, pap, ecc q6mx2y

Question 5

Manage SCC or adenocarcinoma on pap

Answer 5

Need colpo and bx

Need embx

Question 6

Abnormal HPV with normal cytology

Answer 6

If less than 30yo, don’t do anything unless cytology abnormal
If over 30, HPV+, and negative pap then repeat in a year
If persistent HPV+, aka 2 tests in a row (annual) this warrants colpo

Question 7

Abn cytology and pregnancy

1. ASCUS or LSIL
2. Hsil, ASC-h, or AGC

Answer 7

1. Low grade, RPT 3m PP
2. Need colpo within 4 weeks, can biopsy but cannot do ecc
   If colpo unsatisfactory, repeat after 20w when TZ becomes more visible

Question 8

CIN1 manage

Regression rate

Answer 8

Prefer to observe and repeat assessment in 1y with repeat cytology
IF PT HAS CIN1 after hsil pap…. Discordant and may need EDP
Regresses in 60-80% within 2-5y

Question 9

CIN 2/3

Management in 25yo

Answer 9

25: treat cin3 with EDP. If margins positive, follow with colpo and ecc. If recurs, need another EDP.

Question 10

What are cin2 regression and progression rates?

Answer 10

Regress: 43%
Progress: 27%

Question 11

What are cin3 regress/progress/persist rates?

Likelihood of invasion over 30 years if untreated?

Answer 11

Regress: 33%
Persist: 52%
Progress: 12%

Risk invasion if untreated is 30% over 30y. If have Cin3 for more than two years, risk becomes 50%

Question 12

Treatment for ASCUS or new LSIL

Answer 12

If persistent ASCUS HPV+ or LSIL, refer to colpo
Ideally see within 12 weeks
Biopsy lesions, if no lesion then maybe take one from TZ

Question 13

How would you treat adenocarcinoma in situ?

Answer 13

EDP or type 3 TZ excision
If margins positive, need second EDP
If finished childbearing, consider hysterectomy
If dx came from LEEP, and margins are negative, don’t do another EDP
Need colpo, ECC, cytology q6-12m x 5y

Question 14

Histological abnormalities and pregnancy - how would you treat?
WhAt is the risk of progression in pregnancy?

Answer 14

If cin2 or 3 suspected or diagnosed, repeat colpo and delay treatment to 8-12w PP
Little risk progression in pregnancy
Regresses to cin1 or normal in 31-47%

Question 15

How would you follow up after treatment for cin2/3?

Answer 15

Two options:
Cytology and colpo q6m x 2, if negative can return to routine screening
Or
HPV at 6m combined with cytology, if negative can return to routine screening

Question 16

How to treat histologic abn in women at high risk?

Answer 16

Immunocompromised status does not warrant screening colposcopy. Send to colpo per usual guidelines.

Question 17

What are risks of LEEP? (NOT DONE PLEASE UPDATE)

Answer 17

Preterm delivery in 1/143
More likely to be later preterm
If depth is less than 10mm, risk less

Question 18

Define CIN 1, 2, and 3

Answer 18

Cin1: mild atypical cell changes, in lower 1/3 of epithelium only
Cin2: moderate atypical cell changes in lower 2/3 of epithelium
Cin3: severely atypical changes >2/3 of epithelium including full thickness

Question 19

What cell changes happen in cervical dysplasia?

Answer 19

Nuclear enlargement, multinucleation, hyperchromasia, perinuclear cytoplasmic clearing aka halo

Question 20

Who is the ideal candidate for ablative treatment?

Answer 20

Transformation zone fully visible
Biopsy taken from worst area
No suspicion of invasive disease or glandular disease
No cytological vs histological disparity
No previous treatment
Cryo is contraindicated in cin3