Management of abnormal smears PDF
Preview Management of abnormal smears
Management of abnormal smears Basic Colposcopy Workshop 17 Dec 2011 Karen Chan Dept of O&G University of Hong Kong In Hong Kong ,Cervical smears ‐Target population • 25 ( or later when become sexually active )‐65 years old • Do smears for > 65 if – Not had 3 consecutive normal smears – Never had a smear • 2 annual smears, if normal , every 3 years Screening frequency Screening frequency Reduction in cervical cancer 1-2 yearly 93% 3 yearly 91% 5 yearly 84% Recommended : 3 yearly screening after 2 normal annual smears For smears done for women registered with the government cervical screening programme, DH between 2004‐2010 : 92% normal 7 % abnormal Unsatisfactory Endometrial cells in 0.3% >40 yrs – 0.5% http://www.cervicalscreening.gov.hk/english/sr/sr_statistics_as.html What abnormalities ? • Cytological Abnoramlities ( Bethesda system) – Squamous cells – • ASCUS‐ atypical squamous cells of undetermined significance • LSIL – low grade squamous intraepithelial lesion • HSIL‐ high grade squamous intraepithelial lesion • ASC‐H atypica glandular cells, cannot exclude HG – Glandular cells • Atypical glandular cells NOS, AGC ‐ FN • Unsatisfactory smears ? • Others – infection etc How common are these abnormalities? ASCUS‐ 64% ASC‐H 1.2% LSIL – 30.8% Others –0.6 % Adenocarcinoma HSIL – 3.3% – 0.1% SCC – 0.02 % http://www.cervicalscreening.gov.hk/english/sr/sr_statistics_as.html Management Rationale 1 • Smears – only a screening tool, needs more diagnostic tests to confirm the pathology • Pap smears – wide range of sensitivity ( eg 47‐ 62% for detecting CIN 2‐3 ) • Limited by – Results dependent on high quality sampling – Interpretation of smears – subjective • Cytological terms LSIL and HSIL correlates with CIN 1 and CIN2&3 respectively but not diagnostic Management Rationale ‐ 2 • Despite a normal smear or smears with very slight abnormalities – cannot exclude a serious problem entirely % high grade leson (CIN 2-3 ) ASCUS 5-17% ASC-H 24-94% LSIL 15-30% HSIL 70-75 % ( 1-2% invasive ) Needs colposcopically directed biopsy • Decision of when to refer depends on the likelihood that the patient has a CIN 2/3 % CIN 2-3 Action ASCUS 5-17% Repeat in 6 months or HPV testing ASC-H 24-94% Colposcopy within 12 weeks LSIL 15-30% Colposcopy within 12 weeks HSIL 70-75 % ( 1-2% Colposcopy within 6 invasive ) weeks
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