Levine_Handbook for Principles and Practice of Gynecologic O

88 Handbook for Principles and Practice of Gynecologic Oncology Use of Colposcopy Over the last 25 years, colposcopy combined with colposcopically directed cervical biopsies has become the primary modality by which women with abnormal Pap smears are evaluated. Colposcopy consists of viewing the cervix with a long-focal-length, dissecting-type microscope after a solution of dilute (4%) acetic acid has been applied. The acetic acid solution acts to remove and dissolve the cervical mucus and causes CIN lesions to become whiter than the surrounding epithelium (acetow hite) by dehydrating the cells. This coloration allows the colposcopist to identify and biopsy epithelial lesions. In addition to identifying ace towhite areas, colposcopy also allows for the detection of blood vessel patterns that can indicate high-grade CIN lesions and invasive cancers. Colposcopy and appropriately directed biopsy have greatly facilitated the management of patients with preinvasive lesions of the cervix because it allows the clinician to rule out invasive cancer and determine the limits of preinvasive disease. Key Points ● Complete recommendations and management algorithms are available at www.asccp.org. ● Over 90% of LSIL will spontaneously clear in adolescents. ● A diagnosis of HSIL confers a significant risk for CIN 2,3 and invasive cervical cancer. ● Due to their high rate of clearance of HPV infections and cervical dysplasia, women aged 21 to 24 are considered a “special popula tion,” and they are managed less aggressively than older women with the same findings. In 2006, the ASCCP sponsored a consensus workshop to update the 2001 Consensus Guidelines for the Management of Women with Cytological Abnormalities and Cervical Cancer Precursors. In 2012, the ASCCP worked with 23 other national organizations on a revision of the 2006 guidelines for management of abnormal screening tests and CIN/AIS. These guide lines are widely used in the United States and are evidence based, with each recommendation accompanied by a grading of both the strength of the recommendation and the strength of the data supporting the recom mendation. The complete recommendations and management algorithms are available at www.asccp.org. New Risk-Based Management Consensus Guidelines are expected to be published in 2020. Atypical Squamous Cells of Undetermined Significance A vexing group of patients for both clinicians and cytologists are those with atypical cervical cytology (i.e., not normal) but who lack the Management of Cytologic Abnormalities and CIN

Copyright © 2020 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.