子宫内膜病理陈隆 New Guidelines for Pap screen.ppt

Screening:When to stop ACS: at 70 yoa if 3 neg PAP in the preceeding 10 yrs. US Preventive Task Force: 65 y ACOG: between 65 – 70 yoa of 3 neg Pap in preceeding 10 yrs, w assessment of risk factors annually Management of HPV+ only women Management of ASCUS women Management of younger women with ASC-US or LSIL Initial management of AGC Subsequent management of AGC Management of LSIL Management of ASC-H Management of younger women with ASC-H or HSIL CIN3 Management of HSIL Management of biopsy-confirmed CIN2-3 Conclusion Adolescents: Conservative approach * * * * * * * * * * Despite the demonstrated success of cervical ca screening, it is estimated that 50% of women with cervical ca have never had a Pap….. * HPV affects the transition zone which is active during adolescence and early adulthood. In young women, HPV is commonly cleared by the immune system within 1-2 yrs without producing neoplastic changes. The risk of neoplastic transformation increases in those w persistent infections. * Cervical Ca in 15-19 age group: ‘Too few to report’. 2/1M cases * Infection with HPV is a necessary factor in the development of SIL. Vast majority of HPV infections spontaneously clear within 2 yrs after infection and are of little long-term clinical significance. Therefore, performing colposcopy for minor cytologic abnormalities are discouraged in adolescents because it can potentially result in harm through unnecessary treatment. * * * Using both conventional and liquid-based cytology are acceptable. Liquid-based cytology: disadvantages: increased cost and decreased specificity advantage: ability to test for HPV, GC, Chlamydia directly from the residual sample, easier to ‘read’. * * Background rate for primary vaginal cancer: very low at 7 per 1million women per year. No transition zone in the vaginal mucosa. * * * * * * All 3 approaches are safe and effective approaches to managing women with ASC-US. However, ‘reflex’ testing is the preferred approach: eliminates the