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Re: Gyn: CISFrom: Andrew Folley (agfolley@hotmail.com)Tue Sep 25 13:52:46 2007
Basically the same problem for both. For the 23 yo I would recheck with pap and colpo and vigorous ecc in 3 months. Often the margins are positive on leep but the remainder of cervix is free of disease. For the 33 yo with TL I would at least offer the option for vag. hyst. agf> Date: Tue, 25 Sep 2007 12:25:38 -0500> From: garrys@mindspring.com> To: ob-gyn-l@dns.obgyn.net> Subject: Gyn: CIS> > Two cases:> > 23 YO P0 with HGSIL pap, office biopsy CIN II or III (can't remember).> > OR LEEP: CIN III, no invasion, positive endocervical margin. A nice> specimen was obtained with a 20 X 15 mm loop.> > Would you:> > 1. Re-LEEP after 6 weeks?> 2. Reassess in the future (3 months)? If so, how, i.e.> a. Pap and colpo> b. Pap and colpo and ECC regardless of findings> c. Other> > 33 YO P2002, S/P TL, with HGSIL pap, office biopsy CIN III/can't rule> out invasion.> > OR LEEP--large transition zone, two passes, one central and one superior> with 20 X 15 loop to encompass entire non-staining zone.> > Pathology: postive endocervical and ectocervical margins, no invasion,> glandular involvement.> > What would you do here?> > 1. Re-LEEP after 6 weeks> 2. Reassess in the future (3 months)? If so, how, i.e.> a. Pap and colpo> b. Pap and colpo and ECC regardless of findings> c. Other> 3. TVH?> > Garry> > --> Garry E. Siegel, M.D.> Private Practice> Roswell, GA
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