Referrals and waiting time standards for colposcopy

Question 1

3 consecutive inadequate samples referral time

Answer 1

Offered an appointment with a colposcopist within 6 weeks

Question 2

Borderline change/ HR-HPV positive referral time

Answer 2

Offered an appointment with a colposcopist within 6 weeks

Question 3

Low-grade/ HR-HPV positive referral time

Answer 3

Offered an appointment with a colposcopist within 6 weeks

Question 4

High-grade (moderate) referral time

Answer 4

Offered an appointment with a colposcopist within 2 weeks of referral

Question 5

High-grade (severe) referral time

Answer 5

2 weeks colposcopy

Question 6

?Invasive squamous carcinoma referral time

Answer 6

2 weeks colposcopy

Question 7

Abnormal cervix or symptomatic outside screening referral time

Answer 7

2 weeks colposcopy

Question 8

% reduction risk of cervical ca after negative smear

Answer 8

61 to 84% reduction risk

Question 9

% of CIN with high grade moderate dyskariosis

Answer 9

74% CIN 2/3

Question 10

% CIN with high grade severe dyskariosis

Answer 10

80-90% CIN 2/3

Question 11

? Glandular neoplasia and risk of invasion

Answer 11

• 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

Question 12

Benign endometrial cells in cervical screening samples

Answer 12

• 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

Question 13

Info post colposcopy tx

Answer 13

• 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%)

Question 14

Common cytological and colposcopic findings in

cases of missed disease included one or more of the following

Answer 14

• 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

Question 15

The following genital tract infections may be noted during microscopy of a conventional cervical smear

Answer 15

• Actinomyces-like organisms (ALOs)
• Trichomonas vaginalis
• Candida species
• Herpes simplex virus (HSV)

Question 16

Depth of excision in colposcopy tx: Type I cervical transformation zone

Answer 16

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

Question 17

Depth of excision in colposcopy tx: Type II cervical transformation zone

Answer 17

Excisional techniques should remove tissue to depth/length of 10mm to 15mm, depending on the position of the squamocolumnar junction within the endocervical canal

Question 18

Depth of excision in colposcopy tx: Type III cervical transformation zone

Answer 18

• 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

Question 19

CIN with incomplete margins

Answer 19

• 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

Question 20

Glandular abnormality of endometrial type on smear

Answer 20

• No colposcopy

- Endometrial biopsy

Question 21

Management of cytology reported as ‘?glandular neoplasia of endocervical type’

Answer 21

• 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

Question 22

Conservative management of confirmed HG-CGIN

Answer 22

• Young women who wish to conserve fertility

- If margins of the excisional specimen are negative and invasion is excluded.

Question 23

Management of incompletely excised CGIN

Answer 23

MDT