Case Management of Abnormal Pap Smears and Colposcopies

55 Pages·2013·10.44 MB·English

by  Vaishali Patel

Workshop: Case Management
of Abnormal Pap Smears and
Colposcopies
Rebecca Jackson, MD
Professor
Obstetrics, Gynecology &
Reproductive Sciences and
Epidemiology & Biostatistics
I have no financial
interests to disclose.
Case Based Problems
Emphasis on 2012 guidelines by ASCCP

(American Society of Colposcopy and Cervical
Pathology) and how they differ from last
Changes for <25yos

Who needs colposcopy vs who can be

managed expectantly?
Next steps after colposcopy

Treatment options: cryotherapy, laser,

LEEP and cone biopsy
Post-treatment surveillance

Recommended Guidelines

ASCCP guidelines 2012

– For work-up of abnormal cytology and treatment of
CIN: ( )
or just search ASCCP guidelines
http://www.asccp.org/Portals/9/docs/Updated%20ASCCP%20
Algorithms%204%2011%2013%20-%20PDF.pdf

Rationale behind guidelines:

– ObstetGynecol: 2013; 121(4); 829–846

SFGH 2010 guidelines in your syllabus (developed by

Dr. George Sawaya, very similar to ASCCP but not yet
updated with the new 2013 recommendations)
$7.00
$9.99 $9.99
Laminated cards with tabs Either enter pt info and it gives you the
at top so can find the recommendation and assoc algorithm OR you
algorithm you need can simply view the algorithms
Good news: most prior guidelines

reaffirmed, easier to read, guidance for
no ECC’s on pap & discordant co-test
results
Bad news: even more complex than

prior guidelines
What’s New
(2012 ASCCP)

**Extend adolescent (age <21)

management guidelines to women < age
25:
there are now 2 pathways for most
algorithms—One for<25 and one for >25
Less aggressive w/u of ASC-US

How to manage discordant cotest results:
 (HPV+/PapNl;
unsatisfactory cytology and missing
HPV-/Pap ≥ ASC-US),
endocervical or t- zone cells
Post-colpo management now includes co-testing, even

in <25 yo
Treat CIN1 on ECC as CIN1
 (not as +ECC)
Histology Primer
Cervical intraepithelial neoplasia (CIN)
Graded based on proportion of epithelium involved
CIN 1: indicates active HPV infection; treatment

discouraged since spontaneous resolution is high
CIN 2: most are treated, but about 40% resolve over 6

month period; treatment may be deferred in young
women
CIN 3: the most proximal cancer precursor, also known

as carcinoma in situ always treat
Adenocarcinoma in situ (AIS): widely considered a

cancer precursor always treat
CIN 1
CIN 3