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The abnormal Pap smear--what to do next?

W T Creasman, D L Clarke-Pearson, C Ashe

    Cancer
    |July 15, 1981
    PubMed
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    Proper diagnostic evaluation is crucial for abnormal Papanicolaou smears to determine cervical abnormality. This involves colposcopy, biopsies, and curettage, with conization if needed to rule out invasive cancer.

    Area of Science:

    • Gynecology
    • Oncology
    • Pathology

    Background:

    • Papanicolaou (Pap) smear screening identifies preclinical cervical abnormalities.
    • Gross clinical evaluation alone is insufficient for definitive diagnosis of cervical disease.

    Purpose of the Study:

    • To outline the diagnostic and treatment pathways for patients with abnormal Papanicolaou smears.
    • To emphasize the importance of comprehensive evaluation for accurate diagnosis and management.

    Main Methods:

    • Outpatient diagnostic evaluation including colposcopy, colposcopic-directed biopsies, and endocervical curettage.
    • Pelvic examination as part of the diagnostic workup.
    • Cervical conization when outpatient procedures are unsatisfactory or cannot rule out invasive cancer.

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    Main Results:

    • Cytologic screening detects preclinical disease, necessitating further diagnostic steps.
    • Outpatient procedures are effective in ruling out invasive cervical cancer in many cases.
    • Treatment options like cryosurgery, electrocautery, or laser are suitable for cervical intraepithelial neoplasia when invasive disease is excluded.

    Conclusions:

    • A systematic diagnostic approach is essential for managing abnormal Papanicolaou smears.
    • Invasive cancer must be ruled out before considering less invasive treatments for cervical intraepithelial neoplasia.
    • Conization or hysterectomy may be required inpatient procedures for specific patient cases.