Скачать презентацию Colposcopic Management Vesna Kesic EFC Colposcopy Course Скачать презентацию Colposcopic Management Vesna Kesic EFC Colposcopy Course

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Colposcopic Management Vesna Kesic EFC Colposcopy Course Colposcopic Management Vesna Kesic EFC Colposcopy Course

Colposcopic activities • Diagnosis • Selection for biopsy • Selection for treatment Colposcopic activities • Diagnosis • Selection for biopsy • Selection for treatment

Nomenclature 1 cm 2 cm Punch (Simple) Loop Extended Loop Nomenclature 1 cm 2 cm Punch (Simple) Loop Extended Loop

Biopsy considerations • Accuracy • Damage • Therapeutics • Effectiveness Biopsy considerations • Accuracy • Damage • Therapeutics • Effectiveness

Biopsy summary Punch Treatment Damage Accuracy Effectiveness Loop Extended X +/- + ++ +/- Biopsy summary Punch Treatment Damage Accuracy Effectiveness Loop Extended X +/- + ++ +/- ?

Golden rule: Colposcopy must be performed prior to treating CIN ! Golden rule: Colposcopy must be performed prior to treating CIN !

Treatment principles: • Treat the whole TZ • Treat to at least 7 mm Treatment principles: • Treat the whole TZ • Treat to at least 7 mm • Follow-up is vital

How: • Information, counselling and consent • Skilled pathologist • Analgesia • Documentation How: • Information, counselling and consent • Skilled pathologist • Analgesia • Documentation

Treatment methods: Excision Ablation LLETZ NETZ Knife Laser Hysterectomy Radical diathermy Laser Cold coagulation Treatment methods: Excision Ablation LLETZ NETZ Knife Laser Hysterectomy Radical diathermy Laser Cold coagulation Cryocautery

Beware ! • Entire TZ not visible • Evidence of glandular abnormality • Evidence Beware ! • Entire TZ not visible • Evidence of glandular abnormality • Evidence of invasion • Cytology / histology discrepancy

Ablation contraindicated ! Ablation contraindicated !

Indications for Extended Biopsy • Entire TZ not visible • Evidence of glandular abnormality Indications for Extended Biopsy • Entire TZ not visible • Evidence of glandular abnormality • Evidence of invasion • Cytology / histology discrepancy • Previous treatment

Scenarios Smear Colposcopy Punch Loop Extended Invasion X HG HG X Glandular LG X Scenarios Smear Colposcopy Punch Loop Extended Invasion X HG HG X Glandular LG X +/- HG Neg X LG LG +/- +/+/ +/?

General Principles: Don’t do anything unless you have to …. But if you do, General Principles: Don’t do anything unless you have to …. But if you do, do it properly!