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Lynn, thanks so much! Another question...Re: abnormal pap/normal biopsy
From: amanda (anonymous@obgyn.net)
Fri, 29 Dec 2000 11:27:35 -0600 (CST)
>From what you said, my doctors seem too agressive. Do you think I
should switch doctors, or be thankful they are not too conservative? I
have had 2 different doctors perform colps, do you think that is good or
bad concerning conflicting opinions?
At Fri, 29 Dec 2000, Lynn D. Montgomery, MD wrote:
>
>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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