Abnormal Pap Smear
Abnormal Pap Smear
Abnormal Pap Smear
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<strong>Abnormal</strong> pap smear<br />
management – general<br />
Likelihood of<br />
CIN 2 or CIN 3<br />
General<br />
Management<br />
ASC-US<br />
7 – 12% HPV, pap x2,<br />
colpo<br />
ASC- H 26 - 68% Colposcopy<br />
LSIL 12 – 17% Colposcopy<br />
HSIL 84 – 97% Colposcopy<br />
Special<br />
populations<br />
Yes<br />
No<br />
Yes<br />
No<br />
Principles of Treatment<br />
• Prevent CIN from progressing to cervical cancer<br />
• without increasing complications from over-<br />
treatment<br />
• Decision to treat based on<br />
• Biopsy Diagnosis<br />
• Correlation with <strong>Pap</strong> smear and Colp findings<br />
• Patient age<br />
• Consensus guidelines and clinical judgment<br />
Wright, TC. J of Lower Genital Tract Dis. 2007<br />
Case 1<br />
Cases<br />
• An 18 year old woman presents to your office<br />
with questions about birth control.<br />
• She has been sexually active for three years,<br />
without consistent birth control.<br />
• She has never had a <strong>Pap</strong> smear. She denies<br />
symptoms of sexually transmitted infection.<br />
Case 1<br />
Case 1: <strong>Pap</strong> smear<br />
1. Is a <strong>Pap</strong> smear indicated, based on screening<br />
recommendations?<br />
A. Yes<br />
B. No<br />
“LSIL consistent with CIN 1/mild dysplasia with<br />
features of HPV”
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