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Re: Can another doctor please answer this more clearly?Re: abnormal pap/normal biopsy

From: Lynn D. Montgomery, MD (anonymous@obgyn.net)
Fri, 29 Dec 2000 06:24:18 -0600 (CST)

I attempted to answer this before, but I will break it down further for you.

At Thu, 28 Dec 2000, amanda wrote: >
>At Thu, 28 Dec 2000, amanda wrote:
>>
>>Hi there, I had a slightly abnormal pap for the first time after the
>>birth of my first child 16 mos ago. A colp/biopsy was done, the biopsy
>>showed nothing, negative.

First, the standard of care is not to do a colposcopy for a one time "slightly abnormal pap smear". But, since on was done and nothing was identified, the standard would be to simply repeat the pap in 3-6 months, which should have been done in the first place after the slightly abnormal pap instead of the colposcopy.

I had a repeat pap 4 mos afterwards with the >>same abnormal results, no dysplasia. After another colp/biopsy that was
>>negative again, I had to switch doctors.

At this point, you describe a pap that is abnormal, but no dysplasia. I am assuming that this means the pap showed ASCUS, which is atypical cells, but not to the degree of dysplasia. Having gotten a persistently abnormal pap at this point, most gynecologists would now proceed to colposcopy. At the time of coloposcopy, if the evaluation was done by a competent individual, the exam was "satifactory" and the cervical canal was sampled to assure there were not abnormal cells within the canal and the result returned without identifying dysplasia, then simply following the pap in 6 months is perfectly acceptable.

I had a pap done with my new >>doctor, which showed slightly abnormal, favoring mild dysplasia, CIN1.
>>It was suggested to me to have a cone biopsy done

You do not give a time line here. In other words, I do not know how long after the second colposcopy with your first physician that you had this pap done with your new physician. That said, now having a mildly dysplastic pap smear, the approaches can vary from simply again repeating the pap in 3-6 months versus proceeding with colposcopy again. Proposing simply proceeding to cone is way to aggressive in this case without identifying the lesion causing the mild dysplasia. Its like proposing removing the lower leg for an ingrown toenail. A repeat colposcopy is required prior to a cone for two reasons. First, you have to identify the lesion and assure that there is nothing worse there and that the biopsy results correlate with the abnormality seen on the pap. Second, the lesion, if demonstrated to be truly mild dysplasia may only require follow-up pap smears or a much simpler therapy than a cone.

but then I became >>pregnant again, so I couldn't go through with it.

I certainly agree. I don't think your results warrant a cone anyway and I certainly don't think they warrant a cone during pregnancy.

My doctor also said >>that the lab that interpretted my pap did not have my prior paps to
>>compare them to, therefore might have assessed it worse than it really
>>was, since there was no dysplasia just 1 month before from my old
>>doctor.

This is crazy. The pathologist/cytologist should be able to look at any pap without reference to a previous one and assess the degree of dysplasia, if present. We rely on that interpretation daily. If there was a reliance on previous paps all the time, we would be in big trouble.

I have had one more colp done while i was pregnant, no need for >>a biopsy, she said it still looked the same.

This is very appropriate to perform a colposcopy during the pregnancy in a patient with cervical dysplasia. If there is no obvious evidence of a change, then just follow-up following delivery-6 weeks.

What is your take on this? >>Does it sound like I have cancer hiding somewhere?

As long as your many colposcopies have been performed by individuals who know what they are looking at and know what they are doing, it is extremely unlikely that you have anything worse than mild dysplasia.

Could this be from >>giving birth?

NO

Could I not have dysplasia due to the lab not comparing my >>pap to previous ones?

NO

As I stated earlier, following the pregnancy, you need one of two things done. You could simply have a repeat pap done at the 6 week postpartum visit or you could have a colposcopy around the 6 week postpartum time frame. This will be left to the judgement of your physician. If, at the time of the evaluation, there is persistent mild dysplasia, then treatment may be indicated, but not necessarily a cone. If there is something worse identified, then the treatment will have to be determined based on the degree of abnormality. Finally, if the repeat pap comes back normal or the colposcopy returns without any dysplasia, I would simply repeat the pap in 6 month... Lynn 

--
Lynn D. Montgomery, MD
Director, Maternal-Fetal Medicine
Rocky Mountain Perinatal Center
Missoula, Montana


**Note:  Opinions expressed here are for educational purposes only and, as such, do not constitute a physician-patient relationship.  This information is not intended to supplant the need for you to consult with your physician prior to choosing therapeutic options and/or interventions.


**Private e-mails cannot be entertained due to time constraints, consequently no private e-mails will receive a response.


**Thank you for your understanding ;-)



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