Download Management of LGSIL Pap - MD Anderson Cancer Center

Management of LGSIL Pap
MD Anderson Cancer Center
ECHO
LGSIL Pap
• Management strategies depend on age
• Age 21 to 25
• Above age 25
Management of Pap age 21 to 25
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ASCUS and LGSIL
No indication for HPV testing
No indication for colposcopy
The usual recommendation is for repeating
Pap in one year
Why not colpo?
Why do we do cervical cancer
screening?
• What do we hope to detect?
• What do we want to treat?
What happens to most LGSIL
What happens to most HPV infections?
• Most HPV infections are acquired with first
sexual contacts
• Most occur between in teens and twenties
• Most resolve spontaneously
• Thus a Pap or even HPV test performed in
teens or twenties will show a transient
infection
Natural History of HPV infection
Management of LGSIL over age 25
• HPV testing for both LGSIL and ASCUS is
acceptable
• If HPV negative repeat Pap in one year
• If Pap negative return to routine screening
• If HPV positive then colposcopy is acceptable
Management of ASCUS/LGSIL over age
25
• Colposcopy showed CIN 1 or less
• Repeat Pap and HPV in one year
• NO TREATMENT is necessary
Management of ASC/LGSIL 25 or older
• Colposcopy showed CIN 2
• Observation is acceptable, if patient can
return and is compliant and has no other risk
factors
• Otherwise ablation (cryotherapy with negative
ECC) or excision is advisable
Management of LGSIL age 25 or older
• Colposcopy shows CIN 3
• Ablation (with negative ECC and satisfactory
colposcopy)
• Excisional procedure (with positive
ECC/unsatisfactory colposcopy)
Management of LGSIL in pregnant
patients
• If HPV negative, defer colposcopy until 6 to 8
weeks postpartum
• If HPV positive, may defer until 6 to 8 weeks
postpartum
• Colposcopy is preferred
• Biopsies should only be performed if there is
suspicion for cancer
In Conclusion
• Most LGSIL can be watched
• Most low grade changes will resolve
spontaneously
• Rarely will low grade changes progress to
cancer
• DON’T PANIC and DON’T PANIC THE PATIENT!