Transcript Cervical Intraepithelial Neoplasia

In the Name of God
Dr.F Behnamfar MD
Screening of Cervical
Cancer
Pap smear and colposcopy
F.Behnamfar
Gynecology Oncology Fellowship
Associate Professor
Isfahan University of medical Sciences
Epidemiology and Risk Factors
Second most common cancer among
women worldwide
83% of cases in developing countries
12,200 new cases and 4210 cancer
related deaths in USA,2010
50-60 million pap tests are performed in
the US each year,3.5 million abnormal and
2.5 million colposcopy each year
Natural History
External genital warts ,1%
Cervical intraepithelial neoplasia (CIN)
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Slow malignant transformation
long latency period for cervical cancer
CIN I,II,II
Papanicolaou Smear
Conventional
Thin layer,liquid based
Cytology report includes
Adequacy
General categorization
Epithelial cell abnormality
Glandular cell abnormality
Bethesda System
Within normal limits
Infection (organism should be specified)
Reactive and reparative changes
Squamous cell abnormalities
Atypical squamous cells
(0) of undetermined significance
(ASC-US)
(1) exclude high-grade lesions
(ASC-H)
Low-grade squamous
intraepithelial lesion (LSIL)
High-grade squamous
intaepithelial lesion (HSIL)
squamous cell carcinoma
Abnormal pap smear
ASCUS
LSIL
HSIL
Cytology report includes
• Adequacy
•General categorization
•Epithelial cell abnormality
•Glandular cell abnormality
Cytologic diagnosis
Pap test yeilds cytologic diagnosis
Diagnosis of CIN or cervical cancer
requiers a tissue sample for histologic
diagnosis
Pap Test
Screening test rather than diagnostic test
Sensitivity and specificity
Liquid based/ conventional pap smear
Effectiveness
No pap in last five years, risk of cervical cancer
is threefold
90% risk reduction
Follow up of abnormal cytology
ASCUS
ASC-H
AGC Risk for CIN 2-3 and AIS ,serious
precursor of adenocarcinoma
LSIL(CIN I- HPV infection)
HSIL
HPV test
High risk HPV,16-18…
Transient Infection
Screening
triage
Screening Parameters
Initial screening
Discontinuing screening
Frequency of screening
Perior hysterectomy
HPV Vaccination
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Management
HPV and CIN 1:Follow up(60-85% regress
spontaneously in 2 years)
CIN 2-3: LEEP (loop electro surgical
exision of T zone)
Cryo ,Laser,Hysterectomy
Pap smear
79% reduction in cervical cancer
47-62%sensitivity(30% of cervical cancers…)
Liquid based,80% sensitive
Auto prep
Inadequacy,repeat in 6-12 months
Generally:
negative for intraepithelial lesion
Epithelial cell abnormality
Other:glandular cell abnormalities
Screening
Beginning at 21y,or 3y after onset of
sexual activity
Can stop at 70
Yearly<30
2-3 years>30(if pap&HPV neg)
HPV>99%sensitive
Cervical Cancer
3rd most common gyn cancer in USA
Squamous most common
Adenocarcinoma increasing
Clinically staged
Risk factors
Evaluation(vaginal bleeding,post coital,irregular,
post menopausal)
Discharge
Obvious tumor
Suspicious ,colposcoy biopsy,conization
Staging
Stage I(1a1, 1a2 ,1b1, 1b2)
StageII
StageIII
StageIV
Surgery
Cone biopsy
Simple hysterectomy
Radical hysterectomy-Pelvic and
para-aortic lymphadenectomy