Referrals and waiting time standards for colposcopy Flashcards
3 consecutive inadequate samples referral time
Offered an appointment with a colposcopist within 6 weeks
Borderline change/ HR-HPV positive referral time
Offered an appointment with a colposcopist within 6 weeks
Low-grade/ HR-HPV positive referral time
Offered an appointment with a colposcopist within 6 weeks
High-grade (moderate) referral time
Offered an appointment with a colposcopist within 2 weeks of referral
High-grade (severe) referral time
2 weeks colposcopy
?Invasive squamous carcinoma referral time
2 weeks colposcopy
Abnormal cervix or symptomatic outside screening referral time
2 weeks colposcopy
% reduction risk of cervical ca after negative smear
61 to 84% reduction risk
% of CIN with high grade moderate dyskariosis
74% CIN 2/3
% CIN with high grade severe dyskariosis
80-90% CIN 2/3
? Glandular neoplasia and risk of invasion
- The natural history of this condition remains unclear
- Women referred to colposcopy with a single cervical cytology sample reporting glandular neoplasia are
associated with high levels of invasive (40% to 43%) and pre-invasive (20% to 28%) disease
Benign endometrial cells in cervical screening samples
- 40, normal endometrial cells are significantly more likely to be found in the cervical sample up to the 12th day of the menstrual cycle. Still no need for action
- > 40, after the 12th day of the cycle, may mean endometrial pathology
- Exceptions: oral contraceptives, HRT, tamoxifen,
where an IUCD has been fitted
Info post colposcopy tx
- To avoid using tampons for four weeks following treatment
- To abstain from vaginal intercourse for four weeks following treatment
- To avoid swimming for two weeks following treatment
- That single conisation, cervical diathermy, and loop excision measuring less than 10mm in length/depth is not associated with any increase in the incidence of
preterm labour and preterm pre-labour rupture of membrane - That single conisation, cervical diathermy, and loop excision is not associated with any increased risk of infertility but may increase the risk of mid-trimester
miscarriage - Menstrual bleeding following loop excision may be heavier (19% to 48%), more sustained, and more painful (15% to 41%)
Common cytological and colposcopic findings in
cases of missed disease included one or more of the following
- High-grade cytological abnormality
- Endocervical extension of lesions, even when the upper limit of the these was thought to be visible
- Large, complex lesions with raised irregular surfaces
- Underevaluation of lesions by colposcopically directed biopsy
The following genital tract infections may be noted during microscopy of a conventional cervical smear
- Actinomyces-like organisms (ALOs)
- Trichomonas vaginalis
- Candida species
- Herpes simplex virus (HSV)
Depth of excision in colposcopy tx: Type I cervical transformation zone
For treating ectocervical lesions, excisional techniques should remove tissue to a depth/length of more than 7mm (95%), though the aim should be to remove
Depth of excision in colposcopy tx: Type II cervical transformation zone
Excisional techniques should remove tissue to depth/length of 10mm to 15mm, depending on the position of the squamocolumnar junction within the endocervical canal
Depth of excision in colposcopy tx: Type III cervical transformation zone
- Excisional techniques should remove tissue to a depth/length of 15mm to 25mm
- Absolute risk of premature delivery was 8% for excisions between 10mm and 14mm, rising to
18% for excisions over 20mm in depth/length
CIN with incomplete margins
- Risk of recurrence if CIN in endocervical margins
- Do not repeat LLETZ but only test of cure as long as
there is no evidence of glandular abnormality
there is no evidence of invasive disease
the woman is under 50 years of age - > 50 repeat to try and clear the margins
Glandular abnormality of endometrial type on smear
- No colposcopy
- Endometrial biopsy
Management of cytology reported as ‘?glandular neoplasia of endocervical type’
- Younger women and/or women who wish to conserve their fertility who have a visible SCJ, a cylindrically-shaped cervical excisional biopsy, including the whole TZ and at least 1cm of endocervix above the SCJ is
appropriate - In older women, or where the SCJ is not visible at colposcopy, a cylindrical biopsy should be taken that includes all of the visible TZ and 20mm to 25mm of the endocervical canal
Conservative management of confirmed HG-CGIN
- Young women who wish to conserve fertility
- If margins of the excisional specimen are negative and invasion is excluded.
Management of incompletely excised CGIN
MDT
