Pap Smears

Question 1

LSIL in pregnancy

Answer 1

Colposcopy is preferred
 Deferring colposcopy to 6 weeks postpartum
is acceptable
 Endocervical curettage is unacceptable
 No evidence of CIN2+ at initial colposcopy,
postpartum follow‐up is recommended
 Additional colposcopic and cytologic
evaluation during pregnancy is unacceptable

Question 2

CIN 2/3 in pregnancy

Answer 2

Evaluate with repeat colposcopy and cytology no
more frequently than every 12 weeks.
 Repeat biopsy only if cytology or lesion is
suspicious for cancer.
 Acceptable to defer re‐evaluation until at least 6
weeks postpartum (cytology and colposcopy).
 Excisional procedure only if invasion is suspected
(do not treat if invasion not suspected).

Question 3

screening

Answer 3

start at 21
21-30 every 3 with cytology
30-65 every 5 years with cotesting
65-75 stop testing if 3 normal paps in the past 10 years/two cotests normal/ and no high risk factors

no screening for benign hyst without history of CIN2-3

Question 4

Cytology negative and HPV +

Answer 4

repeat both tests in 1 year
if unchanged colpo
If both negative screen in 3 years

Question 5

ASCUS

Answer 5

HPV + - colpo
HPV- repeat cytology in 12 months
no HPV- repeat cytology at 6 and 12 months - with any anomaly colpo- both negative routine screening

Colpo negative- HPV positive- cytology at 6/12 and HPV at 12 (standard colpo f/u)

Colpo negative- no HPV cytology at 12 months

Question 6

ASCUS or LSIL In adol

Answer 6

repeat in 12 months - less than HSIL- repeat again in 12 months

• negative- routine screen
• any abnormality- colpo

Question 7

ASCH

Answer 7

Colpo

No CIN- Cytology @ 6/12 and HPV at 12 (standard colpo f/u)

Question 8

LSIL

Answer 8

Colpo with ECC if not satisfactory and lesion identified

Standard colpo f/u

Question 9

HSIL

Answer 9

Immediate excision ok
Colpo
- if unsatisfactory- excisional
- if satisfactory- colpo and cytology at 6/12 months vs. excision vs. review material - if HSIL again immediate excision

Question 10

Adol with HSIL

Answer 10

Colpo

• colpo and cytology at 6 and 12 months
• only after 24 months of HSIL can you excise
• once two negative paps return to routine screening

Question 11

AGC

Answer 11

Colpo with HPV testing and EMB (if greater than 35)

atypical endometrial - ECC and EMB than if normal Colpo

Repeat cytology and HPV every 6-12 months depending on HPV status

Question 12

AIS or AGC- favor neoplasia

Answer 12

if no invasive disease is found on colpo, ECC or EMB than an extensional procedure is needed.

Question 13

How to Treat CIN 1 preceded by

Answer 13

Treat like LSIL

Question 14

How to treat CIN 1 preceded by HSIL or AGC-NOS

Answer 14

Treat Like HSIL

Question 15

How to treat CIN 1 in Adol

Answer 15

Treat like LSIL

Question 16

Follow-up after excisional procedure for CIN2

Answer 16

cytology and colpo at 6 month intervals - 2 negative go back to routine screening

must be screened for the next 20 years

Question 17

Treatment for CIN 2/3 in adol

Answer 17

Excision- CIN 3 or non-satisfactory

Otherwise monitor similar to HSIL with colpo and cytology every 6 months and biopsy with every concern and if it persists for 24 months excision is needed

Question 18

Treatment for AIS

Answer 18

Hysterectomy

If unable to do a hyst due to desire for fertility excision with negative margins with long term follow-up