WOMENS-HEALTH Messages for August, 1997: Re: Cervical Dysplasia

Re: Cervical Dysplasia

From: Kelly (anonymous@obgyn.net)
Sat, 2 Aug 1997 21:16:04 -0500 (CDT)

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At Fri, 1 Aug 1997, Jen wrote: >
>I am very confused. After experiencing some spotting after sexual
>intercourse, I went to see my gynecologist. He did a Pap smear which
>came out normal. He also did a biopsy on a bit of tissue from my cervix
>that looked abnormal under a Vinegar test which he did. The biopsy came
>back with mild dysplasia. Now, why did the Pap come back normal, and
>the biopsy come back abnormal? Should I be as concerned as I am?

A pap smear is merely a screening test in which cells are scraped off the cervix and smeared on a slide. If an abnormal area is not "hit" with the spatula, it is on the slide to be evaluated. Also there are thousands and thousands of cells on the slide and if only a few are abnormal they can be missed (hence, the popularity of the new computerized rescreening tests like Papnet that project the 128 most abnormal looking cells the computer "sees" onto a screen for the human cytotechnologist and pathologist to review).

A biopsy is much more definitive because it shows not only individual cells, but also how these cells are arranged next to one another. That is how hte pathologist determines dysplasia. I like to use the analogy of a brick wall: if a master mason builds a brick wall, the bricks are nice and neat and orderly -- that's normal. If his new apprentice builds the wall, the bricks may be a little out of line -- that's mild dysplasia. If I build the wall, the bricks are going to be way crooked -- that's moderate dysplasia, and if the brick company just dumps a pile of bricks on the sidewalk -- that's severe dysplasia.

We make recommendations for treatments based on biopsy results, not on pap smears. If a pap smear is abnormal, the next step, depending on just what the abnormality is, is to do a colposcopy (look at the cervix with a microscope) and do biopsies of abnormal looking areas.

You should talk to your doctor and discuss your treatment options with mild dysplasia.

-- Kelly Shanahan, MD, FACOG S. Lake Tahoe, CA

note: Opinions here are for educational purposes only. This information is not intended to supplant the need for you to consult with your own physician. It cannot take the place of a face to face consultation and examination.

Next message: Kelly: "Re: Update and Clomid Question"
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