MANAGEMENT OF THE ABNORMAL PAP SMEAR.ppt

MANAGEMENT OF THE ABNORMAL PAP SMEAR 2001 Bethesda System Squamous Cell Atypical squamous cells (ASC) Of undetermined significance (ASC-US) Cannot exclude HSIL (ASC-H) Low-grade squamous intraepithelial lesions (LSIL) Encompassing human papillomavirus (HPV), mild dysplasia, and cervical intraepithelial neoplasia (CIN) 1 High-grade squamous intraepithelial lesions (HSIL) Encompassing moderate and severe dysplasia, carcinoma in situ, CIN 2, and CIN 3 Squamous Cell carcinoma Glandular Cell Atypical glandular cells (AGC) (specify endocervical, endometrial, or not otherwise specified) Atypical glandular cells, favor neoplastic (specify endocervical or not otherwise specified) Endocervical adenocarcinoma in situ (AIS) Adenocarcinoma THE BAD NEWS HPV is VERY COMMON, occurring at least once over a 3-year period in 60% of young women Lifetime cumulative risk is at least 80% The longer HPV is present and the older the patient, the greater the risk of CIN Smoking DOUBLES the risk of progression to CIN 3 in HPV positive patients THE GOOD NEWS Vast majority clear the virus or suppress it to levels not associated w/ CIN 2/3+, and for most women this occurs promptly The duration of HPV positivity is shorter and the likelihood of clearance is higher in younger women Only 1 in 10 to 1 in 30 HPV infections are associated w/ abnormal cervical cytology MORE GOOD NEWS Only 15% of women w/ negative cytology reports and positive HPV will have abnormal cytology within 5 years The risk of cervical cancer in women who do not harbor oncogenic HPV is extremely low The time course from CIN 3 to invasive cancer averages between 8.1 and 12.6 years STILL MORE GOOD NEWS Likelihood of regression to normal: CIN 1: 60% CIN 2: 40% TYPE OF TESTING Cytology vs. Cytology + HPV testing Cytology alone low sensitivity Cytology + HPV testing much higher sensitivity HPV testing especially helpful in patients 30 years old Colposcopy Always biopsy any visible lesion Up to 10% of lesions more sever than an