OBGYN question - pap smear, wait vs colpo vs leep etc help!

[nope80]

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Any good/simple decision trees for this type of question. I always get confused, and this tends to be a very common question, about what to do with an abnormal pap or biopsy. Watchful waiting vs. hpv testing vs colpo vs leep etc. Any help would be appreciated as I always feel like I am guessing with these questions and not sure of the exact management! 🙂

 

[doctorpunter]

adolescent pt-----repeat pap smear in 12 months
premenopausal--do colposcopy

postmeno---reflex hpv followed by colposcopy

 

[doctorpunter]

OR IF U WANT A ELABORATED explanation then ---

[B]LOW GRADE SQUAMOUS INTRAEPITHELIAL LESION (LSIL) OR MILD DYSPLASIA OR CIN I on PAP SMEAR [/B]--- Management is according to age.
ADOLESCENT ---------------------- Repeat Pap in 12 months.

PREMENOPAUSAL WOMEN -------------- do Colposcopy.

POST MENOPAUSAL WOMEN ----------- do Reflex HPV testing -- If + ve than do Colposcopy.

* Cervical Intraepithelial Neoplasia Grade I (CIN I) : Manage according to type
CIN I preceded by Low Grade Abnormality (ASC - US, ASC - H, LSIL) ------ Repeat Cytology in 12 months;

If still Abnormal after 24 months Indicate Diagnostic Excisional Procedure.

CIN I preceded by High Grade Abnormality (HSIL, AGC - NOS) ------ Immediate diagnostic Excisional procedure (in post child bearing age) or
Closed Clinical follow up if women planning future pregnancy.

* CIN I with low Grade lesion in the low risk pt ------------ do annual Pap smear

 

[Golding]

It's interesting to note that Kaplan's QBook seems to contradict that USMLEWorld flow chart. On their question #6 of the 2nd OB/Gyn exam:

"A 25-year old woman comes to her physician on the same date each year for her examination and Pap smear. One week later, the Pap smear result is returned as atypical squamous cells of undetermined significance (ASCUS). Which of the following is the most appropriate next step in management?"

"ASCUS is a cytologic diagnosis used to describe abnormal cells that do not fit the criteria for low- or high-grade squamous intraepithelial lesion (LGSIL or HGSIL). Although most patients with ASCUS will have normal follow-up Pap smears, a significant proportion (approximately 25%) will have dysplasia. Thus, a patient with ASCUS should have a repeat Pap smear in 3-6 months. If the patient is not reliable and may be lost to follow-up, then colposcopy should be performed immediately. This patient is reliable and can therefore be followed with a repeat Pap smear in 3 months."

 

[doctorpunter]

u r right but i feel uw is goldstandard,even in kaplan ob/gyn lect notes they have written something else,but uw is most updated n authentic one so i will go with uw.

 

[Fuzuli]

@OP: http://www.asccp.org/pdfs/consensus/algorithms_cyto_07.pdf