A 40 year old woman with CIN 2, next step of management
High-Yield Explanation
Pap Class systemReagen (WHO classification)Rucha classificationBethesda classificationClass 1Negative for malignantNegativeWithin the normal limitClass 2Inflammation/squamous atypia/koilocytes-Atypical squamous cells of unknown significance(ASCUS)Class 3Mild dysplasia(1/3rd of the sample)CIN1LSILClass 4Moderate dysplasia(1/3rd to 2/3rd of sample)Severe dysplasia(>2/3rd of sample)Carcinoma insituCIN2,3HSILClass 5Invasive cancerInvasive cancerInvasive cancerPap smear is only a screening test. Any abnormality encountered in it should be confirmed by colposcopic biopsy.Features of abnormal Pap cytologyMosaicismPunctuationsAbnormal dense nucleiGranular cytoplasmIndications for colposcopy biopsyNon-visualization of the transformation zoneObvious fungation in transformation zoneMismatch between colposcopy and pap smearStage IA-1(microinvasive)(Refer: Shaw&;s Textbook of Gynaecology, 15th edition, pg no: 402, 405)