Gynecology Book

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Colposcopy Protocol

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  1. See Also
    1. Colposcopy
    2. Colposcopy Findings
  2. Indications for first Colposcopy
    1. Cervical Intraepithelial Neoplasia (CIN)
    2. ASCUS Pap Smears
      1. More than one Pap Smear showing ASCUS
      2. ASCUS with HPV positive for high risk type
      3. ASCUS-H (ASCUS and cannot rule-out HGSIL)
    3. Atypical Glandular Cells (AGC)
      1. All subtypes except atypical endometrial cells
      2. Endometrial Biopsy for atypical endometrial cells
  3. ASCUS pap and Colposcopy not CIN or cancer
    1. HPV Negative or unknown: Repeat Pap Smear in 12 months
    2. HPV Positive for High Risk Type or ASCUS-H
      1. Pap Smear at 6 and 12 months or HPV DNA at 12 months
      2. If ASCUS or CIN Pap Smear or HPV, repeat Colposcopy
  4. LGSIL pap and satisfactory Colposcopy not CIN or cancer
    1. Pap Smear at 6 and 12 months or HPV DNA at 12 months
    2. If ASCUS or CIN Pap Smear or HPV, repeat Colposcopy
  5. LGSIL on Satisfactory Colposcopy
    1. Option 1 (preferred)
      1. Pap Smear at 6 and 12 months or HPV DNA at 12 months
      2. If ASCUS or CIN Pap Smear or HPV, repeat Colposcopy
        1. See protocol under Option 2
    2. Option 2: Colposcopy and Pap Smear at 12 months
      1. ASCUS or less: Annual Pap Smear
      2. CIN 1: Consider ablation or excision (see below)
      3. CIN 2-3: LEEP (see below)
    3. Additional thoughts
      1. Consider ablation or excision if HPV high risk type
      2. Consider closer surveillance for age <22 years
        1. Pap Smear every 4-6 months for 2 years
  6. HGSIL pap and Colposcopy confirms CIN 2 or 3
    1. Diagnostic excisional procedure (LEEP) in most cases
      1. Delay LEEP until after pregnancy (see HGSIL)
    2. Two options for follow-up after LEEP
      1. Repeat Colpo and pap or pap alone at 4-6 months or
        1. If testing negative x3, then annual Pap Smear
        2. Repeat Colposcopy for ASCUS findings or greater
      2. HPV DNA testing at 6 months after treatment
        1. HPV negative for high risk: Pap Smear annually
        2. HPV positive for high risk: Repeat Colposcopy
  7. Procedures for Diagnostic Excision
    1. Indications
      1. Colposcopy with CIN 2 or 3 on biopsy
      2. Persistent CIN 1
      3. Unsatisfactory Colposcopy with CIN Pap Smear
    2. Techniques
      1. LEEP
      2. Laser
      3. Cold-knife conization
  8. Procedures for ablation
    1. Indications: LGSIL on satisfactory Colposcopy
      1. LGSIL on initial biopsy: Observation is preferred
      2. LGSIL persistent: Diagnostic excision is preferred
    2. Contraindications
      1. Invasive cancer not ruled out (Unsatisfactory colpo)
    3. Acceptable Techniques of ablation
      1. Cryotherapy
      2. Electrofulguration
      3. Laser ablation
      4. Cold Coagulation
    4. Unacceptable Techniques
      1. Podophyllin or similar products
  9. References
    1. Wright (2003) Am J Obstet Gynecol 189:295

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