Management of Pap Smear; Low-grade Squamous Intraepithelial Lesion - USMLE Forums
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  #1  
Old 04-22-2012
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ObGyn Management of Pap Smear; Low-grade Squamous Intraepithelial Lesion

A 33-year-old gravida III, para III female presents to her physician for her annual health maintenance examination. She has no present complaints, but she continues to smoke 1 pack per day and has done so for the past 15 years. Her menstrual cycle is regular, the interval between the first day of menstrual periods is 26 days and the flow is dark red without clots. She had seven male sexual partners beginning at age 14 before entering her current relationship, which has lasted for 2 years and has been strictly monogamous. She has been using the oral contraceptive pill (OCP) continuously and compliantly since the birth of her last child 7 years ago. She has no history of sexually transmitted diseases (STDs) or pelvic inflammatory disease. Her last Papanicolaou (Pap) smear was performed 3 years ago. During the pelvic examination, the physician notes a clear, viscous discharge without odor and then performs a standard Pap smear. The Pap smear results reveal mild to moderate dysplasia that is consistent with a low-grade squamous intraepithelial lesion. On colposcopy, the transition zone and an area of white-appearing epithelium are fully visualized. Endocervical curettage and punch biopsies confirm the presence of a low-grade squamous intraepithelial cervical lesion. What is the next best step in the management of this patient?

A. Carbon dioxide laser ablation
B. Cone biopsy
C. Expectant management and re-evaluation in 6 months
D. Loop electrodiathermy excision procedure (LEEP)
E. Simple total hysterectomy
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  #2  
Old 04-22-2012
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C. Expectant management and re-evaluation in 6 months
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The question is worded strangely, since a path report on a biopsy should be in terms of CIN rather than LSIL, but I will assume CIN I and agree with pakigal: C. Expectant management and re-evaluation in 6 months. Definitely not hysterectomy. If the biopsy had shown CIN II or III, the answer would be either LEEP or laser ablation (I think that these days most everyone does LEEP, so that would be the likely answer in that case), or if you couldn't visualize the whole lesion or the transition zone then a cone biopsy.
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Old 04-22-2012
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im sorry but you have to do a cone biopsy
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Old 04-22-2012
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According to BETHESDA CLASSIFICATION, LSIN is equavalent to CIN.
As the biopsy shows presence of low cervical leison.
Management could be
Observation and repear after 6-12 mnths
or
LEEP
Now which one is correct first line mgmt......................not sure
I would go with observation and repeat after 6 mo. b/c it takes 8-10 yrs to advance so..waiting six months will not do any harm.
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Old 04-22-2012
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Quote:
Originally Posted by ingridb84 View Post
im sorry but you have to do a cone biopsy
Why do you say cone biopsy? Because the question seems to infer that pathology on the ECC was positive?
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according to Hacker's textbook:

active treatment is indicated in CIN II & III while CIN I is managed expectantly. we observe the patient without active treatment.

check page 405, fifth edition.

THE ANSWER IS " C ".
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ans is C.
thanks guys for wonderful expln !
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According to BETHESDA CLASSIFICATION, LSIN is equavalent to CIN.
As the biopsy shows presence of low cervical leison.
Management could be
Observation and repear after 6-12 mnths
or
LEEP
Now which one is correct first line mgmt......................not sure
I would go with observation and repeat after 6 mo. b/c it takes 8-10 yrs to advance so..waiting six months will not do any harm.
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Old 04-23-2012
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Expectant management and re-evaluation in 6 months
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