A 53-year-old woman, gravida 1 para 1, comes to the office for a routine gynecologic examination. The patient says that she feels well. Menopause was at age 50. Medical problems include obesity and type 2 diabetes mellitus managed with a single oral medication. The patient is sexually active with a new partner of 6 months; her husband of 18 years died several years ago. She has a 30-pack-year smoking history but does not use alcohol or illicit drugs.
Vital signs are within normal limits. Pelvic examination reveals no abnormalities.
A Pap test is performed and the cervical cytology report specifies that there are "atypical squamous cells of undetermined significance."
Which of the following is the best next step in management of this patient?

Question

A 53-year-old woman, gravida 1 para 1, comes to the office for a routine gynecologic examination.  The patient says that she feels well.  Menopause was at age 50.  Medical problems include obesity and type 2 diabetes mellitus managed with a single oral medication.  The patient is sexually active with a new partner of 6 months; her husband of 18 years died several years ago.  She has a 30-pack-year smoking history but does not use alcohol or illicit drugs.
Vital signs are within normal limits.  Pelvic examination reveals no abnormalities.
A Pap test is performed and the cervical cytology report specifies that there are "atypical squamous cells of undetermined significance."
Which of the following is the best next step in management of this patient?

Quizplus · Accepted Answer

11ec193a_97dc_cc6f_853d_f3dd3251189e_MD0002_00 Atypical squamous cells of undetermined significance (ASCUS) is the most common abnormal Pap test result. ASCUS refers to a Pap test showing atypical cervical cells that demonstrate reactive changes but do not meet cytologic criteria for premalignant disease. To determine whether these atypical cells indicate an increased risk for cervical intraepithelial neoplasia (CIN) or cervical cancer, human papillomavirus (HPV) testing is performed. Patients age >25 with an ASCUS Pap test and a negative HPV test are at low risk for CIN and cervical cancer and can be followed with Pap and HPV co-testing in 3 years (Choice E). In contrast, patients age >25 with ASCUS and positive HPV testing are at increased risk for malignancy and require further evaluation. (Choices A and C) Colposcopy and endocervical curettage are diagnostic tests indicated for Pap tests consistent with an increased risk for CIN or cervical cancer (eg, high-grade squamous intraepithelial lesion). If this patient's HPV testing is positive, colposcopy is indicated. An endocervical curettage is performed during colposcopy if the cervical transformation zone is not completely visualizable. Colposcopy (Choice B) A diagnostic excisional procedure (eg, loop electrosurgical excision procedure, cold knife conization) is indicated for either a high-grade squamous intraepithelial lesion on Pap test or a grade 2/3 CIN on cervical biopsy (eg, colposcopy, endocervical curettage). loop electrosurgical excision procedure Educational objective: Patients with Pap test results showing atypical squamous cells of undetermined significance (ASCUS) require human papillomavirus (HPV) co-testing to determine the risk of cervical intraepithelial neoplasia or cervical cancer. A negative HPV test indicates no increased risk for malignancy. __________ References: American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. (http://www.ncbi.nlm.nih.gov/pubmed/22422631) Practice bulletin no. 168: cervical cancer screening and prevention. (http://www.ncbi.nlm.nih.gov/pubmed/27661651)

A 53-Year-Old Woman, Gravida 1 Para 1, Comes to the Office