Columbus: Abnormal paps

Question 0

What percentage of newly diagnosed cervical cancer patients have never had a Pap smear?

Answer 0

50%

Question 1

How many new cases of cervical cancer in US per year?

What is the lifetime risk?

Answer 1

12,340

1 in 128

Question 2

What is the false-negative rate for Pap smears?

What is the specificity?

Answer 2

15-20%

98% (very few false positives)

Question 3

What is the negative predictive value of HPV testing for CIN 2, 3?

Answer 3

99-100%

Question 4

What are the advantages of liquid-based cytology?

Disadvantages?

Answer 4

Co-test for HPV, GC and chlamydia
Fewer unsatisfactory results

Higher cost
Decreased specificity if not combined with HPV reflex

Question 5

What are the screening guidelines by age?

When should screening be stopped?

Answer 5

Less than 21: no screening
21-29: pack every three years
30 and above: Pap plus HPV every five years

No screening after age 65 with 3 consecutive prior negative Pap test or two negative HPV test in prior 10 years

Question 6

When and how should ASCUS Pap with negative HPV be followed up?

Answer 6

Age 30 and above: co-testing in 3 years

21-29: Pap alone in 1 year

Question 7

How should a negative Pap with positive HPV be followed up?

Answer 7

Co-testing in one year or typing for HPV 16 or 18 with colposcopy is positive

Question 8

When should cytology be repeated if endocervical cells are lacking?

When if unsatisfactory?

What if unsatisfactory x2?

Answer 8

Routine follow-up

2-4 months

Colposcopy

Question 9

What is the incidence of cervix cancer for women 21-24 years?

Answer 9

1.4 per 10,000

Question 10

How should LSIL with HPV negative be managed?

HSIL with HPV negative?

AGC with HPV negative?

Answer 10

Co-test in 1 year preferred or colposcopy

Colposcopy

Colposcopy with endometrial sampling if indicated

Question 12

How should ASCUS be managed in women 21-24 years old?

LSIL?

Answer 12

Both should repeat Pap yearly x2.

Colposcopy for HSIL at year 1 or ASCUS or greater at year 2

Question 13

What is the preferred management for CIN2 in women age 21-24?

Answer 13

If colposcopy is adequate with negative ECC, observation is preferred but treatment is acceptable.

In CIN2,3 observation or treatment is acceptable.

Question 13

How should ASC-H or HSIL be managed in women age 21-24?

Answer 13

Colposcopy. If CIN1 or less repeat colposcopy and cytology every 6 months for 2 years or until two consecutive negative Pap results. LEEP if CIN 2,3 persists for 1 year or LEEP at 2 years for persistent HSIL.

Question 14

How should CIN1 be managed in women age 21-24 years if preceded by ASCUS or LSIL?

Answer 14

Observation with annual cytology; repeat colposcopy if ASC or greater at 2 years.

Question 15

What percentage of HGSIL Pap smears will have cancer?

Without treatment, what percentage will develop cancer?

Answer 15

2-6%

7%

Question 16

In the ASCCP guidelines, how is “young women” defined?

Answer 16

Any woman who after counseling considers the risk to future pregnancies from treating cervical abnormalities to outweigh risk for cancer during observation of those abnormalities.

Question 17

What percentage of Pap smears will show AGC?

What percentage will have CIN, AIS, or cancer?

What percentage will have cancer?

Answer 17

0.4%

9-38%

3%

Question 18

What follow-up is necessary for endometrial cells on Pap for premenopausal women?

Postmenopausal women?

Answer 18

None.

Endometrial assessment.