How to manage an Abnormal Pap Smear on the USMLE exams.

by / Thursday, 05 August 2010 / Published in OB/GYN

Workup of an abnormal Pap

Step in the Workup When is this step warranted Next Step in management
Repeated PAP After first ASCUS find Repeat every 4-6 months until there are 2 consecutive negative Pap smears
HPV DNA testing After first ASCUS is found If HPV 16 or 18 identified perform colposcopy
Colposcopy and ectocervical biopsy Abnormal Pap smear

Two ASCUS Pap smears

Colposcopy,

Abnormal lesions sent for cytology

Endocervical curettage (ECC) All non-pregnant patients showing an abnormal Pap smears Non-pregnant pts undergoing colposcopy for abnormal Pap require ECC to rule out endocervical lesions
Cone Biopsy When Pap smear is worse than biopsy suggested,

When ECC is abnormal,

With endocervical lesion,

When biopsy shows microinvasive carcinoma of cervix

Management of abnormal histology

Step in Management Condition warranting this step Notes/Details
Observe and follow-up CIN1, CIN 2 or 3 after excision or ablation Follow-up tests q4-6 months for 2 years
Ablation CIN2 or CIN3 This is: cryotherapy, laser vaporization, electrofulguration
Excisional procedures CIN2 or CIN3 LEEP and Cold-knife colonization
Hysterectomy Recurrent CIN2/3

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