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Re: Lynn, thanks so much! Another question...Re: abnormal pap/normal biopsy
From: Lynn D. Montgomery, MD (anonymous@obgyn.net)
Fri, 29 Dec 2000 12:36:58 -0600 (CST)
At Fri, 29 Dec 2000, amanda wrote:
>
>>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?
My concern is not really the aggressiveness with the colps, it is more
the aggressiveness with the idea of a cone biopsy. Cone biopsies,
although very effective in treating dysplasia, carry with them some
risk, especially for future pregnancy. If there is an insistance for a
cone, I would suggest seeking another opinion...
Lynn
>
>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 ;-)
>>
--
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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