Management of CIN 1 (LSIL) ??? - USMLE Forums
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Old 03-14-2013
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Default Management of CIN 1 (LSIL) ???

Hi guys. Can someone please explain me the steps of managing CIN1 and LSIL?
I find this topic highly confusing as its different in sifferent resources.

For example, MTB3 says that you should do a colposcopy for every ABNORMAL PAP smear(LSIL/CIN1, HSIL) whereas Uworld says you repeat Pap in 6 and 12 months

I would be thanful if someone could clear my confusion. Thanks in advance
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Old 03-14-2013
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ok here you go:
pap smear is cytology it will tellyou if there are abnormal cells (result can be ASCUS,ASCH or SIL) then you need to confirm it with: colposcopy and biopsy to do histology:CINs.(so CIN is not an abnormal pap CIN is a histology obtained by colposcopy)
Management of abnormal pap smear is as follow:
*for ASCUS & ASCH:either 1)repeat every 4-6 months till you have 2 consecutive normal pap smear,if ASCUS again or worse do coloposcopy or biopsy.OR2)HPV DNA.
*for LSIL , HSIL & cancer:colposcopy and biopsy.
Ifhistology reveals CIN 1:
you can either Observe and follow-up:
by reapeating Pap in 6 and 12 month or colposcopy and repeat Pap in 12 months or HPV DNA test.
ORdoAblative therapy or Excisional procedure.

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Old 03-14-2013
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Default mtb 3 for ck

what is mtb 3?? is it da mtb we use for step 3 ???
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Old 03-14-2013
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Default MTB

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Originally Posted by chachchu View Post
what is mtb 3?? is it da mtb we use for step 3 ???
Yes its master the boards for step 3.
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Quote:
Originally Posted by numbndumb View Post
Hi guys. Can someone please explain me the steps of managing CIN1 and LSIL?
I find this topic highly confusing as its different in sifferent resources.

For example, MTB3 says that you should do a colposcopy for every ABNORMAL PAP smear(LSIL/CIN1, HSIL) whereas Uworld says you repeat Pap in 6 and 12 months

I would be thanful if someone could clear my confusion. Thanks in advance
Management of LSIL largely depends on the age of the patient.
For most patients next step will largely involve doing a colposcopy.
However you can repeat pap in 6-12 months if the patient is an adolescent since the risk of cervical cancer at this age is low.

Bottomline is look at the patient's age when deciding your next step
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Old 03-17-2013
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Default Hope this helps

I will try and explain all possible cervical cancer screening scenarios here:

  1. A 17 year old girl comes to you and you order a pap....Ans. Stop right there. Pap is a screening test for women above age 21. It is not a diagnostic test. Cervical cancer screening of adolescents (defined as ages 13 to 20 according to the American Society for Colposcopy and Cervical Pathology [ASCCP] guidelines) is NOT recommended by the American College of Obstetricians and Gynecologists (ACOG).
  2. A 17 year old girl comes to you and she already has a pap done showing ASC-US. What do you do? send her home saying see you again in 12 months! If a pap test is inadvertently done in an adolescent and shows LSIL or ASC-US, then colposcopy is not required and cytology should be repeated in 12 months. The rationale for this approach is that LSIL and ASC-US generally represents a transient HPV infection in adolescents and both the infection and LSIL usually resolve over time. Furthermore, the rate of invasive cervical cancer in this age group is near zero.
  3. You see the previous patient again in 12 months and her pap this time shows ASC-US. What do you do? See her again in 12 months!
  4. The previous patient again comes back to you with pap showing ASC-US. What do you do? See her again in 12 months is the wrong answer! In this case she has persistent ASC-US for more than 24 months. This is no longer a transient infection. So what do I do? Colposcopy. Why not HPV-DNA? This is a girl who has had ASC-US for 2 years. You are already suspicious. Go directly to Colposcopy. HPV-DNA testing will not change the outcome. In short HPV-DNA is always the wrong answer below 21 years of age. Another point to note is that most adolescents suffer from transient HPV-DNA infections. HPV-DNA testing has no value in this age group as far as cervical cancer screening is concerned.
  5. A 21 year old with pap showing ASC-US. What do you do? HPV-DNA testing. If HPV-DNA is positive for high risk HPV, then do colposcopy. (If HPV-DNA is negative then follow up with cervical cytology every 3 years in patients 21-29 years old; and every 5 years with cervical cytology and HPV-DNA testing in patients above 30 years of age)
  6. In the previous case, colposcopy shows CIN1. What do you do? Follow up yearly with cervical cytology. Why? CIN 1 spontaneously regresses in most cases. Do not treat. Yearly follow up is recommended just to be alert for those few cases that might progress to CIN2 and CIN3.
  7. In case 3, colposcopy shows CIN2 (or CIN3). What do you do? Treat
  8. A 21 year old with pap shows LSIL. What do you do? Colposcopy. Why not HPV-DNA? LSIL is very high risk for CIN2 and CIN3. A negative HPV-DNA will not be of any use. Colposcopy is needed.
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