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Obstetrics & Gynecology


Answer 5
  1. Biopsy the cervical lesion. The Figure shows an exophytic squamous cervical lesion. When a cervical lesion is visualized on pelvic examination, a biopsy of the lesion should be obtained to determine if it is benign or malignant. Although the Pap smear has a sensitivity of 58% for identifying dysplastic cervical cells, it is designed as a screening tool and is not ideal when a lesion is already visible.7 Cryotherapy or laser ablation would not yield a tissue sample for pathologic evaluation and thus is inappropriate at this time. Cervical cone biopsy (conization) is used to evaluate and treat cervical dysplasia and microinvasive cervical cancer. However, histologic results must first be obtained to determine if a malignant condition exists before performing cervical cone biopsy, a procedure associated with potential morbidity (eg, bleeding, infection, pain, risk for cervical stenosis).

    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.

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