Pap Smear Management

Question 1

Management of ASC-H regardless of HPV status or age?

Answer 1

Colposcopy!

Question 2

Management of CIN3?

Answer 2

Always excisional procedure

Question 3

Management of AIS

Answer 3

Excision is ALWAYS needed to rule out invasive cancer!!!!

Pos margins = re exicision
Neg margins = benign hyst

If Neg margins + wants fertility = hyst after childbearing

If invasive cancer on excision = referral to onc

Question 4

ASCUS, HPV Neg

Answer 4

Co-testing in 3 years

Question 5

LSIL, HPV Neg

Answer 5

Co-testing in 1 year

Question 6

LSIL or ASCUS w/ HPV POS

Answer 6

COLPOSCOPY

Question 7

ASCUS w/ HPV Unkown

Answer 7

Age 25-29 = co-testing in 3 years

Age 30+ = co-testing in 1 year

Question 8

LSIL w/ HPV Unknown

Answer 8

COLPOSCOPY

Question 9

Management of CIN 2

Answer 9

Typically excisional procedure but can do observation (especially if < 25)

If observing: Repeat colpo and co-testing in 6 and 12 months

Question 10

Management Atypical Glandular cells

Answer 10

Colposcopy w/ ECC

Endometrial sampling if Age > 35 or under 35 w/ risk factors (AUB, chronic anovulation, obesity)

Question 11

Management Atypical Endometrial cells

Answer 11

Endometrial sampling w/ ECC recommended
Colposcopy can also be performed. Generally colposcopy should be performed, because if the other samplings are negative, colposcopy would then be warranted at that point

Question 12

When would you NOT excise CIN2?

Answer 12

If age 21-24 OR

Pt desires not to

If electing to “observe” repeat COLPO + CYTOLOGY at 6 and 12 months

Question 13

Most oncogenic HPV strain?

Answer 13

HPV 16

Question 14

Risk Factors for Cervical Cancer

Answer 14

HPV 16
HPV 18
Early age coitarche
Multiple partners
Absence of pap smears
Hx of STIs
cigarette smoking

Question 15

CKC (as compared to LEEP) puts you at higher risk for what?

Answer 15

PROM
Preterm Birth
Birth Weight < 2500 g

Question 16

Which HPV strain is most commonly associated with adenocarcinoma?

Answer 16

HPV 18 (50% of cases)

HPV 16 is responsible for 60% of SSC cases

Question 17

HPV E6 oncoprotein is responsible for affecting which genes?

Answer 17

p53

Question 18

What are pap smear guidelines based on?

Answer 18

Management based on present risk of CIN 3 or higher

If >/= 4% colposcopy
If 25-60% colposcopy or treatment
If > 60% expidited treatment prefered

Question 19

General pap smear screening guidelines?

Answer 19

No screening under 21
Age 21 start screening cytology Q3 yrs (no co-test)
Age 30-65 co-testing Q5 yrs
Discontinue screening age 65

Question 20

When is expedited excisional treatment ok?

Answer 20

If immediate risk of CIN3 is 25-60% or more

If > 60% expedited treatment preferred*

Question 21

Pap smear screening after hysterectomy for treatment of high grade cytology (CIN2/3/AIS)?

Answer 21

Annual screening for 3 years
After 3 negative annual screens, continue screening every 3 years for 25 years

Question 22

Risk of a LEEP?

Answer 22

Cervical stenosis
Increased risk of SAB if < 12 month interval
Increased risk of second tri loss/PTB (~1%) but not great evidence

Question 23

CIN2 risk of progression?

Answer 23

50% regress
30% stay CIN2
20% progress to CIN3+

Question 24

Dosing for HPV vaccine?

Answer 24

Approved ages 9-46
If 9-15 get 2 doses (0, 6 months)
If > 15 then 3 doses (0, 2, 6 months)

Question 25

HPV strains covered by HPV vaccine 9 valent?

Answer 25

6, 11, 16, 18, 31, 33, 45, 52, 58