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GYNECOLOGICAL ONCOLOGY . . . CONT.

Notes

Table 7. Cytological Classification

Bethesda Grading System

Classic System/CIN Grading System

• within normal limits • infection

• normal • inflammatory atypia (organism)

  • reactive and reparative changes

• squamous cell abnormalities • atypical squamous cells of undetermined significance

  • squamous atypia of uncertain significance

• low grade squamous intraepithelial lesion (SIL)

• HPV atypia or mild dysplasia

• high grade squamous intraepithelial lesion (HIL)

moderate dysplasia severe dysplasia carcinoma in situ

CIN I CIN II CIN III

  • squamous cell carcinoma

  • adenocarcinoma

squamous cell carcinoma

diagnosis (colposcopy) (see Colour Atlas D6) • using acetic acid to uncover white lesions • endocervical curettage (ECC) if entire lesion not visible or no lesion visible • cervical biopsy cone biopsy if • unsatisfactory colposcopy • abnormal endocervical curettage • discrepancy between pap smear results and punch biopsy • Pap smear shows adenocarcinoma in situ • microinvasive carcinoma complications (low incidence) • hemorrhage • infection • cervical stenosis or incompetence • infertility

Pap Smear Result and Appropriate Action

repeat now or

repeat in

in 3 months

1-3 year

inadequate

normal

atypical

ASCUS/CINI mild dysplasia

CINII/CINIII/CIS moderate-severe dysplasia

invasion

specific infection

HPV changes

no lesion visible

visible lesion

yes

no

repeat in 4-6 months

treat, repeat in 4 months

persists

resolved

persists

repeat in 6 months-1 year Colposcopy

Figure 9. Decision Making Chart for Pap Smear

biopsy

follow-up

treatment

CIN

invasion

staging

endometrial cells present

no lesion

endometrial

visible

biopsy

colposcopy

Gynecology 40

MCCQE 2000 Review Notes and Lecture Series

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