OGCO-E1 Colposcopy services

Question 1

Management for below:
Normal cytology, HPV 16 or 18 +ve ASC-US + HRHPV
ASC-US for twice or LSIL

Answer 1

Colposcopy +/- Biopsy
Then refer out for follow-up smear at 6 months

Question 2

Management for below:
HSIL

Answer 2

Colposcopy +/- Biopsy or LLETZ
Review the cytology if high grade lesion is not evident
LLETZ/cone for all patient unless the initial cytological diagnosis is overruled, if so, the patient should be managed accordingly

Question 3

Management for below:
ASC-H

Answer 3

Colposcopy +/- Biopsy
If no lesion found, review the cytology
If review assures ASC-H, repeat cytology 6 monthly for twice, then return to routine screening

Question 4

Management for below:
AGC-NOS

Answer 4

Colposcopy, endocervical and endometrial samplings are advised except when the smear showed AGC-NOS favours endometrial origin, endometrial sampling should be performed first.
If ECC, EA, CxBx all negative or Bx shows LSIL follow up with CS+ECB 6 monthly for 4 times, then routine screening if all normal
If ECC, EA negative, CxBx shows HSIL
 LLETZ, then FU CS 6 monthly for 3 times, then yearly CS for 10 years, then routine screening Slide review is not necessary
After two consecutive normal smears, refer out for follow-up.

Question 5

Management for below:
AGC-favor neoplasia

Answer 5

Colposcopy, endocervical and endometrial samplings are advised.
If no lesion was found, advise LLETZ/cone ± hysteroscopy ± USS pelvis

Question 6

Who should be referred for colposcopy?

Answer 6

1. Patients with abnormal cervicovaginal cytology (should be referred according to the
   HKCOG Guidelines on the management of an abnormal cervical smear).
2. Patients with an ‘eroded’ cervix where malignancy cannot definitely be ruled out despite a
   negative smear.
3. Patients with symptomatic cervical erosion (e.g. postcoital bleeding).