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Download colposcopy - Bon Secours Hospitals
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Colposcopy High Grade Intraepithelial Lesions HSIL Dr Barbara Kerkhoff Consultant Gynaecologist & Obstetrician 28.1.2012 Bon Secours GP Study Day High Grade Intraepithelial Lesion • • • • Preinvasive lesion Prevalence: 0.45% (USA) 70 – 75% HSIL CIN 2/3 1 – 2% HSIL Invasive cancer 28.1.2012 Bon Secours GP Study Day Treatment option 1 Excisional Techniques 1 2 LLETZ/ LEEP Laser/ Knife cone biopsy 2 Local destructive Techniques 1 2 3 4 Laser Vaporisation Cryotherapy Diathermy Cold Coagulation 3 Wedge biopsy (Pregnancy) 4 Hysterectomy 28.1.2012 Bon Secours GP Study Day Success of LLETZ Free of disease 5 yrs 1. Low risk 92% < 50yrs, complete excision 2. Medium risk 86% < 50yrs, incomplete excision > 50yrs, complete excision 3. High risk 58% > 50yrs, incomplete excision 28.1.2012 Bon Secours GP Study Day Causes of treatment failure Those women most likely to have persistent disease • • • • Large volume disease High grade disease Incomplete excision Immunosuppressed women 28.1.2012 Bon Secours GP Study Day Treatment failure For every 1000 women treated for CIN: - 4 will develop invasive cancer - 5.8% for women treatment for CIN 3 28.1.2012 Bon Secours GP Study Day Why test for HPV? • High-Risk HPV DNA testing is more sensitive in detecting high grade disease than smear test.1 • A positive high-risk HPV result is an objective risk indicator for the development of highgrade disease and cancer.2 1. Clavel et al Brit J Cancer 2001;89;1616-1623 2. Lorenz A, Arch Pathol Lab med 2006;127;959-968 28.1.2012 Bon Secours GP Study Day Test of cure? Post Tx CIN 2/3 Sensitivity HPV Sensitivity Smear Specificity HPV Specificity Smear 3 month 93% 58% 86% 91% 6 month 90% 62% 92% 91% 12 month 90% 72% 96% 95% 24 month 93% 93% 99% 96% Double negative (Smear and HPV DNA) over 2 years CURE! Nobbenhuis et all, Brit.J. Cancer 2001;84:796-801 28.1.2012 Bon Secours GP Study Day LLETZ or ablation Follow up guidelines CIN or CGIN Invasion r/v 6 month cytology and HPV Cytopath or MDT YES Negative cytology or HPV Positive cytology or HPV 2. r/v in 18 month Repeat colposcopy +/- bx Negative cytology or HPV d/c to routine screening 28.1.2012 Repeat tx if required no Positive cytology or HPV Cytological surveillance annual smears for 10 years Bon Secours GP Study Day Core Messages to Patients • HPV is an infection, not a disease • HPV is not a marker for sexual behaviors, infidelity or timing of infection • HPV is very common • HPV is usually cleared by the immune system (90%) • HPV does not require tx in absence of CIN 28.1.2012 Bon Secours GP Study Day Cervical cancer should be considered a very rare complication of a very common virus. Thank you! Dr Barbara Kerkhoff Consultant Gynaecologist 28.1.2012 Bon Secours GP Study Day
