dysplasia

Question 1

For patients 25 and older, what are the risk considerations for next steps?

Answer 1

If immediate CIN 3+ risk is greater than or equal to 4%

• risk 60-100% = expedited treatment preferred
• risk 25-29% = expedited treatment or colposcopy acceptable
• risk 4-24% = colposcopy recommended

If immediate CIN3+ risk less than 4%. Then look at 5 year CIN3+ risk:

• if 0.55% or greater = return in 1 year
• if 0.15-0.54% = return in 3 years
• if < 0.15% = return in 5 years

Question 2

what is work-up for AGC?

Answer 2

atypical endometrial cells:

• endometrial and endocervical sampling
• if negative -> colposcopy

all other subcategories:

• colposcopy with endocervical sampling if not pregnant
• endometrial sampling if not pregnant

Question 3

AGC-NOS or AEC-NOS, management based on initial results

Answer 3

• no CIN 2+, AIS, or cancer -> cotest at 1 and 2 years. if any abnormality, colposcopy, if both negative then cotest 3 years later
• CIN 2+ but no glandular neoplasia -> ASCCP 2019 guidelines
• No AIS or cancer by colposcopy or biopsy/ but initial cytology favored neoplasia -> diagnostic excisoinal procedure