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Obstetrics & Gynecology


Answer 3
  1. Colposcopy with cervical biopsy and endocervical assessment. Seventy percent or more of HSILs are classified as cervical intraepithelial neoplasia 2 or 3, and 1% to 2% of women with HSILs have invasive cancer.7,8 If a patient has HSIL, as in this case patient, the American Society for Colposcopy and Cervical Pathology (ASCCP) recommends management with colposcopy with cervical biopsy and endocervical assessment or an immediate loop electrosurgical excision.8 In either case, a tissue sample can be obtained to rule out invasive cervical cancer. Cryotherapy does not yield a sample for pathologic testing and thus invasive cervical cancer cannot be ruled out. Additionally, if the cervical lesion extends into the endocervical canal, ablation with cryotherapy may also make future colposcopy with cervical sampling more difficult due to cervical stenosis. Reflex HPV typing is used for identifying high-risk HPV types and for the cytologic diagnosis of atypical squamous cells of undetermined significance. Pap smears are used as a screening tool and would not provide any diagnostic information; there is no benefit from delaying diagnostic evaluation by colposcopy.

    REFERENCES
    7. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin number 66, September 2005. Management of abnormal cervical cytology and histology. Obstet Gynecol 2005;106:645–64.

    8. Wright TC Jr, Massad LS, Dunton CJ, et al; 2006 American Society for Colposcopy and Cervical Pathology–sponsored Consensus Conference. 2006 Consensus guidelines for the management of women with abnormal cervical cancer screening tests. Am J Obstet Gynecol 2007;197:346–55.

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