Abnormal pap

[randomlogik]

Is it common practice to follow up every abnormal pap with a colposcopy? I know I shouldn't really be worried about it. Afterall, we just finished the neoplasia block in pathology, so I know all about it now. I just can't help but be a bit concerned. My follow up exam isn't for another month.
*sigh*

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[minime]

Is it common practice to follow up every abnormal pap with a colposcopy? I know I shouldn't really be worried about it. Afterall, we just finished the neoplasia block in pathology, so I know all about it now. I just can't help but be a bit concerned. My follow up exam isn't for another month.
*sigh*

Yes, it is common practice to go straight to Colposcopy. A few people will follow ASCUS with serial paps every 3 months, but if it ever comes up abnormal, then you're back to colposcopy which you could have already gotten over with. Most also think that it is probably safer just to do the colp, get some directed biopsies and treat from that.

 

[randomlogik]

Thanks for the reply. Now, I just have to keep telling myself that there is no use worrying about it. I know it really shouldnt be that big of a deal. Just things like this tend to upset me. For that matter, I really hate going to the doctor and hate the thought of any medical procedures being done on myself. Kinda ironic that I'm going to end up being a doc myself if I think about it.

 

[starayamoskva]

Thanks for the reply. Now, I just have to keep telling myself that there is no use worrying about it. I know it really shouldnt be that big of a deal. Just things like this tend to upset me. For that matter, I really hate going to the doctor and hate the thought of any medical procedures being done on myself. Kinda ironic that I'm going to end up being a doc myself if I think about it.

Was reflex HPV testing done? If the test doesn't return high risk HPV there is no need for colposcopy. If HR HPV is present colpo is warranted.

 

[deeq]

I think the decision to do colposcopy is based on what kind of abnormality. The reccommendations I've read state to follow ASCUS results with reflex HPV testing and if negative will then perform repeat pap in one year. If HPV is positive then proceed to colposcopy. If the results are more worrisome, like ASC-H/LGSIL/HGSIL, then go directly to colpo. Probably the reason that many doctors go straight to colpo. is the reliability of their patients to actually come back for follow-up. My knowledge thus far, as a fourth year, has been based largely on Beckmann's 'Obstetrics and Gynecology' text, but I know guidlines seem to change a lot.

 

[Diane L. Evans]

I think the decision to do colposcopy is based on what kind of abnormality. The reccommendations I've read state to follow ASCUS results with reflex HPV testing and if negative will then perform repeat pap in one year. If HPV is positive then proceed to colposcopy. If the results are more worrisome, like ASC-H/LGSIL/HGSIL, then go directly to colpo. Probably the reason that many doctors go straight to colpo. is the reliability of their patients to actually come back for follow-up. My knowledge thus far, as a fourth year, has been based largely on Beckmann's 'Obstetrics and Gynecology' text, but I know guidlines seem to change a lot.

This is still correct. You need to know what your HPV Typing is if high risk is is common to perform colposcopy. Colposcopy is when you cervix is viewed under microscope to see any abnormal areas if a large area is foung a LEEP may be performed ( loop excision by cautery) to remove the abnormal area. This procedure can be curative also runs the risk of cervical incompetance and subsequent pregnancy loss in pregnancy.

Don't worry about the results until you have more information.

 

[randomlogik]

They have not tested for HPV yet. I just got a copy of the pap results today. It reports:
atypical squamous cells cannot exclude HSIL (ASC-H)
atypical glandular cells of undetermined significance, of endocervical origin

My understand is the glandular cell finding is somewhat uncommon and usually not related to HPV? The doctor said that finding is the reason she is recommending the colposcopy.

 

[DrBloodmoney]

No they are doing the colpo for the Asc H. I am a pathologist. We call Asc- H when the pap looks bad but we feel like hedging on calling it high-grade. Interpretation: the pathologist thought it looked high-grade, but didn't have enough to really call it.