This document provides information about different types of biopsies. It defines a biopsy as a procedure to remove tissue or cells from the body for laboratory analysis. The main types discussed are excisional biopsy, incisional biopsy, punch biopsy, exfoliative cytology, aspiration biopsy and brush biopsy. Indications, procedures, advantages and disadvantages are described for each type. Potential dangers of biopsies mentioned include spreading infection, hemorrhage, infection, operative trauma and wounding of cancer tissue. The document serves to inform about various biopsy procedures.
Biopsy in oral and maxillofacial surgery by Dr. Shreya DasShreya Das
This document discusses biopsy techniques used in oral and maxillofacial surgery. It defines a biopsy as the removal of tissue for microscopic examination to establish a diagnosis. There are several types of biopsies described including incisional, excisional, punch and cytology biopsies. The document outlines the indications, techniques and principles of each biopsy method. Fine needle aspiration cytology is emphasized as it allows sampling of deep seated lesions under radiological guidance such as ultrasound or CT. The various biopsy methods allow surgeons to obtain tissue samples to accurately diagnose oral lesions.
This document discusses biopsy procedures. It defines biopsy as the surgical removal of tissue for examination and diagnosis. Various types of biopsies are described including incisional, excisional, core needle and image-guided biopsies. The importance of proper patient evaluation prior to biopsy and careful biopsy technique are emphasized to minimize complications and obtain diagnostic tissue.
The document discusses the treatment of cervical dysplasias and cervical intraepithelial neoplasia (CIN). It states that treatment based solely on cytology or colposcopy findings can lead to incorrect diagnoses. For mild dysplasia/CIN1, follow up is usually sufficient as it often resolves on its own. For moderate to severe dysplasias (CIN2/3), local destructive methods like cryotherapy or excisional methods like LEEP are recommended. Conservative treatments are only advised if the entire lesion is visible and there is no invasion. The document also discusses vaccination as a preventive measure against HPV, which causes most cervical cancers.
This document discusses principles and techniques of biopsy. It outlines the steps in evaluating a patient with an oral lesion, including health history, lesion history, clinical and radiographic exams, and laboratory tests. It describes different types of biopsies and provides guidance on surgical principles like anesthesia, hemostasis, and handling specimens. Intraosseous biopsies require special considerations for access and removal. Overall it provides a comprehensive overview of best practices for oral biopsies.
The document discusses different types of biopsies used in maxillofacial fields including incisional, excisional, fine-needle aspiration, and frozen section biopsies. It provides details on techniques, indications, and principles for successful outcomes for each type of biopsy. Key principles include obtaining a representative tissue sample, proper handling and fixation of specimens, and avoiding techniques that could distort tissues.
ORAL BIOPSY:
Introduction
Definition
History
Uses of Oral Biopsy
Indication for Oral Biopsy
Contraindication of Oral Biopsy
Precaution in Oral Biopsy
Armamentarium
Types of Oral Biopsy
Special consideration
Biopsy Arifact
Obtaining a Good Oral Biopsy
Complication of Oral Biopsy
Conclusion
This document provides information about different types of biopsies. It defines a biopsy as a procedure to remove tissue or cells from the body for laboratory analysis. The main types discussed are excisional biopsy, incisional biopsy, punch biopsy, exfoliative cytology, aspiration biopsy and brush biopsy. Indications, procedures, advantages and disadvantages are described for each type. Potential dangers of biopsies mentioned include spreading infection, hemorrhage, infection, operative trauma and wounding of cancer tissue. The document serves to inform about various biopsy procedures.
Biopsy in oral and maxillofacial surgery by Dr. Shreya DasShreya Das
This document discusses biopsy techniques used in oral and maxillofacial surgery. It defines a biopsy as the removal of tissue for microscopic examination to establish a diagnosis. There are several types of biopsies described including incisional, excisional, punch and cytology biopsies. The document outlines the indications, techniques and principles of each biopsy method. Fine needle aspiration cytology is emphasized as it allows sampling of deep seated lesions under radiological guidance such as ultrasound or CT. The various biopsy methods allow surgeons to obtain tissue samples to accurately diagnose oral lesions.
This document discusses biopsy procedures. It defines biopsy as the surgical removal of tissue for examination and diagnosis. Various types of biopsies are described including incisional, excisional, core needle and image-guided biopsies. The importance of proper patient evaluation prior to biopsy and careful biopsy technique are emphasized to minimize complications and obtain diagnostic tissue.
The document discusses the treatment of cervical dysplasias and cervical intraepithelial neoplasia (CIN). It states that treatment based solely on cytology or colposcopy findings can lead to incorrect diagnoses. For mild dysplasia/CIN1, follow up is usually sufficient as it often resolves on its own. For moderate to severe dysplasias (CIN2/3), local destructive methods like cryotherapy or excisional methods like LEEP are recommended. Conservative treatments are only advised if the entire lesion is visible and there is no invasion. The document also discusses vaccination as a preventive measure against HPV, which causes most cervical cancers.
This document discusses principles and techniques of biopsy. It outlines the steps in evaluating a patient with an oral lesion, including health history, lesion history, clinical and radiographic exams, and laboratory tests. It describes different types of biopsies and provides guidance on surgical principles like anesthesia, hemostasis, and handling specimens. Intraosseous biopsies require special considerations for access and removal. Overall it provides a comprehensive overview of best practices for oral biopsies.
The document discusses different types of biopsies used in maxillofacial fields including incisional, excisional, fine-needle aspiration, and frozen section biopsies. It provides details on techniques, indications, and principles for successful outcomes for each type of biopsy. Key principles include obtaining a representative tissue sample, proper handling and fixation of specimens, and avoiding techniques that could distort tissues.
ORAL BIOPSY:
Introduction
Definition
History
Uses of Oral Biopsy
Indication for Oral Biopsy
Contraindication of Oral Biopsy
Precaution in Oral Biopsy
Armamentarium
Types of Oral Biopsy
Special consideration
Biopsy Arifact
Obtaining a Good Oral Biopsy
Complication of Oral Biopsy
Conclusion
This document discusses biopsy techniques and procedures. It covers indications for biopsy, contraindications, different biopsy methods including excisional, incisional, punch and needle biopsies. Potential dangers of biopsy like hemorrhage and infection are mentioned. Considerations for specific lesions in the oral cavity and techniques to avoid errors are provided. The document aims to guide dentists on proper biopsy methods.
The document discusses principles of oral biopsy for dentists. It describes how dentists can play a key role in early detection of oral cancer through thorough exams and biopsies of suspicious lesions. It covers indications for biopsy, different biopsy types like incisional and excisional, proper biopsy technique, handling of specimens, and potential errors. The goal of biopsy is to diagnose lesions histopathologically and help determine prognosis and appropriate treatment.
Biopsy is the removal and examination of tissue to diagnose a condition. It can be excisional, removing the entire lesion, or incisional, removing part of a lesion. Indications include persistent lesions without a clear cause, suspected tumors or malignancies, and lesions interfering with function. Contraindications are poor health and acute infection. Types include punch, frozen section, aspiration, and exfoliative cytology. Care must be taken in design, handling, and potential dangers like spreading or infection. Biopsy provides diagnostic and treatment guidance.
Tissue diagnosis involves examining tissues through biopsy to identify conditions such as cancer, infections, and inflammatory disorders. There are four main types of tissue - connective, epithelial, muscle and nervous. Biopsies are usually done using fine needle aspiration, core needle biopsy, or excisional biopsy. The tissue is examined under a microscope to look for features of malignancy like abnormal growth, invasion of surrounding areas, and metastasis. Tissue diagnosis is an important tool for medical diagnosis and treatment planning.
A biopsy is a surgical procedure to obtain tissue samples for microscopic examination and diagnosis. The main types of biopsies are cytology, aspiration, incisional, and excisional. Cytology examines individual cells but cannot provide histologic details, while aspiration uses a needle to remove fluid or cells. Incisional biopsies remove a portion of tissue, while excisional biopsies completely remove small lesions. Proper biopsy techniques aim to obtain representative tissue samples while avoiding thermal or mechanical damage. Careful documentation and handling of specimens aids pathological examination and diagnosis.
This document discusses various biopsy techniques used in oral surgery. It describes techniques like incisional, excisional, punch and needle biopsies. For each technique it provides details on the procedure, indications, contraindications and examples. It also discusses special considerations like using lasers or electrosurgery and adjuncts like cytology. The document provides a comprehensive overview of biopsy methods to sample oral lesions.
Biopsy is the removal of tissue from the living body for diagnostic purposes. It has a long history dating back to the 16th century. There are various biopsy techniques depending on the location and size of the lesion. The goal is to provide a representative tissue sample while minimizing patient discomfort. Common techniques include incisional, excisional, punch and needle biopsies. Indications are to confirm clinical impressions, determine treatment plans, and assess malignancy. Contraindications include certain vascular or pigmented lesions.
This document discusses oral biopsy procedures. It begins by defining biopsy as examining living tissue microscopically for diagnosis. Reasons for biopsy include suspicious lesions persisting over 2 weeks without cause, characteristics of malignancy, or non-responsive inflammation. Biopsy types discussed are incisional, excisional, punch, fine needle aspiration and brush. Key steps of biopsy procedures are also outlined. The document emphasizes the importance of complete patient data, history and specimen description for accurate diagnosis. Fine needle aspiration cytology is described as a useful screening tool for oral lesions.
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine
Al-Azhar University. Oral biopsy; why, when, and how? Biopsy is the removal of the tissue from the living organism for the purpose of microscopic examination and diagnosis. Looking for a definitive diagnosis is the aim of biopsy. Types of Biopsy include incisional, excisional, drill, fine needle and frozen section biopsy.
The document provides guidelines for oral biopsies, including definitions, types of biopsies (excisional, incisional, punch, aspiration, brush biopsy), indications and contraindications. It discusses principles of biopsy including obtaining adequate tissue and margins. Information to include with biopsy specimens and interpreting biopsy reports is also outlined. Complications and appropriate use of biopsies for diagnosing conditions like cancer or leukoplakia are summarized. The document provides an overview of performing and evaluating oral biopsies.
This document discusses principles and techniques of biopsy. It outlines the steps involved in evaluating a patient with an oral lesion including taking a health history, examining the lesion history, performing a clinical and radiographic exam, and potentially obtaining laboratory tests. It describes different types of biopsies including incisional, excisional, and intraosseous biopsies. Principles of biopsy such as anesthesia, hemostasis, handling specimens, and closure techniques are also outlined. The goal is to obtain sufficient tissue for accurate histopathologic evaluation.
This document discusses brain biopsies, including their history, indications, and procedure. Brain biopsies are used to determine the cause of diffuse or multifocal brain diseases when the specific diagnosis cannot be established by other means. Key indications include infections, vasculitides, pediatric neurodegenerative diseases, and atypical dementias. The procedure involves making a burr hole in the skull under general anesthesia and removing a small sample of brain tissue for analysis. Potential complications include hemorrhage, swelling, neurological deficits, seizures, and infections. A multidisciplinary team approach is recommended for planning and evaluating brain biopsies.
Laboratory examinations are used to supplement physical examinations by confirming or ruling out possible diagnoses. The selection of laboratory tests should be based on the clinical information they can provide. Biopsies are commonly used to establish diagnoses in cases of suspected neoplastic disease by removing tissue samples for microscopic examination. Proper handling and preparation of biopsy specimens is important for accurate microscopic analysis and diagnosis.
This document provides an overview of biopsy procedures. It defines a biopsy as the removal of tissue from a living organism for microscopic examination and diagnosis. The history of biopsies is discussed, noting their introduction in the late 19th century as an essential diagnostic tool. Different types of biopsies are described, including incisional, excisional, punch and fine needle aspiration biopsies. Indications for biopsies and contraindications are outlined. The document provides details on performing biopsies, including selecting the biopsy area, preparing the surgical field, using local anesthesia, handling specimens, and suturing wounds. Potential artifacts and complications of biopsies are also reviewed.
- A biopsy is the removal of tissue for diagnostic examination and includes oral cytology, aspiration biopsy, incisional biopsy, and excisional biopsy.
- It is important to properly prepare for and handle biopsy specimens to avoid altering the tissue and properly orient the pathologist.
- If biopsy results do not match the clinical impression, the biopsy should be repeated at an oral pathology expert to accurately diagnose the lesion.
This document provides an overview of biopsy procedures. It begins with definitions of biopsy and outlines its historical development. It then discusses various types of biopsies including incisional, excisional, punch, and frozen section biopsies. The document provides details on the indications, techniques, advantages and disadvantages of each biopsy type. It emphasizes that the goal of biopsy is to obtain a representative tissue sample for diagnosis while minimizing patient discomfort.
Oral biopsy is a surgical procedure to obtain tissue samples for microscopic examination to establish a diagnosis. There are several types of biopsies depending on the procedure, including incisional and excisional biopsies. Biopsies are indicated for suspected malignant, precancerous, or chronic lesions of unknown cause, while normal tissues, inflammatory lesions responding to treatment, and angiomatous lesions do not require biopsy. The biopsy procedure involves selecting the area, administering local anesthesia, making an elliptical incision to obtain a representative sample, handling the sample gently and placing it in fixative, and suturing the wound. Common errors to avoid include applying too much pressure, infiltrating anesthesia in the lesion, using insufficient
BIOPSY AND HEALING OF THE BIOPSY WOUND / dental crown & bridge coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
- Biopsy is recommended for lesions persisting over 2 weeks to evaluate through histopathological examination. It involves removing a tissue sample.
- The key steps of a biopsy are obtaining a health history, clinical exam, potential radiographs or labs, and surgically removing a sample for pathological analysis.
- The goals are obtaining a representative sample for diagnosis while minimizing patient discomfort. Proper technique and sample handling are important for accurate results.
This document provides information on biopsy and exfoliative cytology procedures. It defines biopsy as the removal of living tissue for examination to establish a diagnosis. Biopsies are categorized as excisional, incisional, or needle biopsies. Exfoliative cytology examines cells that exfoliate or abrade from body surfaces through microscopic analysis. It was pioneered by Dr. Papanicolaou in 1941 and provides a non-invasive method for examining superficial cells through smears. Both procedures provide important diagnostic information but biopsy is needed to confirm cytology findings.
This document discusses the management of cervical intraepithelial neoplasia (CIN). It covers who and when to treat CIN, treatment options including cryotherapy, laser vaporization, loop electrosurgical excision procedure, and conization. It provides guidance on treatment based on CIN grade, patient characteristics like pregnancy, and risk factors. The main treatment goals are prompt treatment of CIN 2-3 while allowing regression of many CIN 1 cases. Complications, reproductive outcomes, and prognosis after treatment are also reviewed.
This document discusses biopsy techniques and procedures. It covers indications for biopsy, contraindications, different biopsy methods including excisional, incisional, punch and needle biopsies. Potential dangers of biopsy like hemorrhage and infection are mentioned. Considerations for specific lesions in the oral cavity and techniques to avoid errors are provided. The document aims to guide dentists on proper biopsy methods.
The document discusses principles of oral biopsy for dentists. It describes how dentists can play a key role in early detection of oral cancer through thorough exams and biopsies of suspicious lesions. It covers indications for biopsy, different biopsy types like incisional and excisional, proper biopsy technique, handling of specimens, and potential errors. The goal of biopsy is to diagnose lesions histopathologically and help determine prognosis and appropriate treatment.
Biopsy is the removal and examination of tissue to diagnose a condition. It can be excisional, removing the entire lesion, or incisional, removing part of a lesion. Indications include persistent lesions without a clear cause, suspected tumors or malignancies, and lesions interfering with function. Contraindications are poor health and acute infection. Types include punch, frozen section, aspiration, and exfoliative cytology. Care must be taken in design, handling, and potential dangers like spreading or infection. Biopsy provides diagnostic and treatment guidance.
Tissue diagnosis involves examining tissues through biopsy to identify conditions such as cancer, infections, and inflammatory disorders. There are four main types of tissue - connective, epithelial, muscle and nervous. Biopsies are usually done using fine needle aspiration, core needle biopsy, or excisional biopsy. The tissue is examined under a microscope to look for features of malignancy like abnormal growth, invasion of surrounding areas, and metastasis. Tissue diagnosis is an important tool for medical diagnosis and treatment planning.
A biopsy is a surgical procedure to obtain tissue samples for microscopic examination and diagnosis. The main types of biopsies are cytology, aspiration, incisional, and excisional. Cytology examines individual cells but cannot provide histologic details, while aspiration uses a needle to remove fluid or cells. Incisional biopsies remove a portion of tissue, while excisional biopsies completely remove small lesions. Proper biopsy techniques aim to obtain representative tissue samples while avoiding thermal or mechanical damage. Careful documentation and handling of specimens aids pathological examination and diagnosis.
This document discusses various biopsy techniques used in oral surgery. It describes techniques like incisional, excisional, punch and needle biopsies. For each technique it provides details on the procedure, indications, contraindications and examples. It also discusses special considerations like using lasers or electrosurgery and adjuncts like cytology. The document provides a comprehensive overview of biopsy methods to sample oral lesions.
Biopsy is the removal of tissue from the living body for diagnostic purposes. It has a long history dating back to the 16th century. There are various biopsy techniques depending on the location and size of the lesion. The goal is to provide a representative tissue sample while minimizing patient discomfort. Common techniques include incisional, excisional, punch and needle biopsies. Indications are to confirm clinical impressions, determine treatment plans, and assess malignancy. Contraindications include certain vascular or pigmented lesions.
This document discusses oral biopsy procedures. It begins by defining biopsy as examining living tissue microscopically for diagnosis. Reasons for biopsy include suspicious lesions persisting over 2 weeks without cause, characteristics of malignancy, or non-responsive inflammation. Biopsy types discussed are incisional, excisional, punch, fine needle aspiration and brush. Key steps of biopsy procedures are also outlined. The document emphasizes the importance of complete patient data, history and specimen description for accurate diagnosis. Fine needle aspiration cytology is described as a useful screening tool for oral lesions.
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine
Al-Azhar University. Oral biopsy; why, when, and how? Biopsy is the removal of the tissue from the living organism for the purpose of microscopic examination and diagnosis. Looking for a definitive diagnosis is the aim of biopsy. Types of Biopsy include incisional, excisional, drill, fine needle and frozen section biopsy.
The document provides guidelines for oral biopsies, including definitions, types of biopsies (excisional, incisional, punch, aspiration, brush biopsy), indications and contraindications. It discusses principles of biopsy including obtaining adequate tissue and margins. Information to include with biopsy specimens and interpreting biopsy reports is also outlined. Complications and appropriate use of biopsies for diagnosing conditions like cancer or leukoplakia are summarized. The document provides an overview of performing and evaluating oral biopsies.
This document discusses principles and techniques of biopsy. It outlines the steps involved in evaluating a patient with an oral lesion including taking a health history, examining the lesion history, performing a clinical and radiographic exam, and potentially obtaining laboratory tests. It describes different types of biopsies including incisional, excisional, and intraosseous biopsies. Principles of biopsy such as anesthesia, hemostasis, handling specimens, and closure techniques are also outlined. The goal is to obtain sufficient tissue for accurate histopathologic evaluation.
This document discusses brain biopsies, including their history, indications, and procedure. Brain biopsies are used to determine the cause of diffuse or multifocal brain diseases when the specific diagnosis cannot be established by other means. Key indications include infections, vasculitides, pediatric neurodegenerative diseases, and atypical dementias. The procedure involves making a burr hole in the skull under general anesthesia and removing a small sample of brain tissue for analysis. Potential complications include hemorrhage, swelling, neurological deficits, seizures, and infections. A multidisciplinary team approach is recommended for planning and evaluating brain biopsies.
Laboratory examinations are used to supplement physical examinations by confirming or ruling out possible diagnoses. The selection of laboratory tests should be based on the clinical information they can provide. Biopsies are commonly used to establish diagnoses in cases of suspected neoplastic disease by removing tissue samples for microscopic examination. Proper handling and preparation of biopsy specimens is important for accurate microscopic analysis and diagnosis.
This document provides an overview of biopsy procedures. It defines a biopsy as the removal of tissue from a living organism for microscopic examination and diagnosis. The history of biopsies is discussed, noting their introduction in the late 19th century as an essential diagnostic tool. Different types of biopsies are described, including incisional, excisional, punch and fine needle aspiration biopsies. Indications for biopsies and contraindications are outlined. The document provides details on performing biopsies, including selecting the biopsy area, preparing the surgical field, using local anesthesia, handling specimens, and suturing wounds. Potential artifacts and complications of biopsies are also reviewed.
- A biopsy is the removal of tissue for diagnostic examination and includes oral cytology, aspiration biopsy, incisional biopsy, and excisional biopsy.
- It is important to properly prepare for and handle biopsy specimens to avoid altering the tissue and properly orient the pathologist.
- If biopsy results do not match the clinical impression, the biopsy should be repeated at an oral pathology expert to accurately diagnose the lesion.
This document provides an overview of biopsy procedures. It begins with definitions of biopsy and outlines its historical development. It then discusses various types of biopsies including incisional, excisional, punch, and frozen section biopsies. The document provides details on the indications, techniques, advantages and disadvantages of each biopsy type. It emphasizes that the goal of biopsy is to obtain a representative tissue sample for diagnosis while minimizing patient discomfort.
Oral biopsy is a surgical procedure to obtain tissue samples for microscopic examination to establish a diagnosis. There are several types of biopsies depending on the procedure, including incisional and excisional biopsies. Biopsies are indicated for suspected malignant, precancerous, or chronic lesions of unknown cause, while normal tissues, inflammatory lesions responding to treatment, and angiomatous lesions do not require biopsy. The biopsy procedure involves selecting the area, administering local anesthesia, making an elliptical incision to obtain a representative sample, handling the sample gently and placing it in fixative, and suturing the wound. Common errors to avoid include applying too much pressure, infiltrating anesthesia in the lesion, using insufficient
BIOPSY AND HEALING OF THE BIOPSY WOUND / dental crown & bridge coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
- Biopsy is recommended for lesions persisting over 2 weeks to evaluate through histopathological examination. It involves removing a tissue sample.
- The key steps of a biopsy are obtaining a health history, clinical exam, potential radiographs or labs, and surgically removing a sample for pathological analysis.
- The goals are obtaining a representative sample for diagnosis while minimizing patient discomfort. Proper technique and sample handling are important for accurate results.
This document provides information on biopsy and exfoliative cytology procedures. It defines biopsy as the removal of living tissue for examination to establish a diagnosis. Biopsies are categorized as excisional, incisional, or needle biopsies. Exfoliative cytology examines cells that exfoliate or abrade from body surfaces through microscopic analysis. It was pioneered by Dr. Papanicolaou in 1941 and provides a non-invasive method for examining superficial cells through smears. Both procedures provide important diagnostic information but biopsy is needed to confirm cytology findings.
This document discusses the management of cervical intraepithelial neoplasia (CIN). It covers who and when to treat CIN, treatment options including cryotherapy, laser vaporization, loop electrosurgical excision procedure, and conization. It provides guidance on treatment based on CIN grade, patient characteristics like pregnancy, and risk factors. The main treatment goals are prompt treatment of CIN 2-3 while allowing regression of many CIN 1 cases. Complications, reproductive outcomes, and prognosis after treatment are also reviewed.
This document discusses the management of cervical intraepithelial neoplasia (CIN). It defines CIN and describes its grading from CIN1 to CIN3 based on the level of involvement of the cervical epithelium. For CIN1, observation or treatment are accepted depending on factors like age and lesion characteristics. CIN2/3 should be treated as regression is only 30-40% and progression risk is higher. Accepted treatment modalities include ablation methods like cryotherapy or laser vaporization and excisional methods like LEEP. Follow up is important after treatment to monitor for regression or recurrence.
This document discusses screening and treatment strategies for cervical intraepithelial neoplasia (CIN). It recommends a see-and-treat single visit approach using cryotherapy, cold coagulation, or LEEP for lesions suggestive of significant CIN. Ablative treatments like cryotherapy are preferred for lesions entirely in the ectocervix while excisional treatments like LEEP are used for endocervical lesions or when histology is needed. Cold coagulation and LEEP have high success rates of over 95% for treating CIN while maintaining low risks. The document provides details on techniques, eligibility criteria, advantages, and disadvantages of different screening, diagnostic and treatment approaches for CIN.
This document provides guidance on managing and treating women with histologically confirmed cervical intraepithelial neoplasia (CIN). It describes excisional and ablative treatment methods, including their characteristics, indications, and potential complications. It recommends local excision is the preferred treatment method to allow full histological assessment. The document also discusses options for monitoring outcomes after treatment and provides specific recommendations for managing CIN in special clinical situations.
Endoscopy involves examining the interior of hollow organs using an endoscope. It has become an important tool for both diagnostic and therapeutic purposes in GI surgery. Key developments include the first endoscopes in the early 1800s, and the modern fiberoptic endoscope in the 1950s. Common endoscopic procedures today include upper and lower GI endoscopy, ERCP, EUS, and PEG/PEG-J placement. Endoscopy is used to diagnose and treat conditions like GI bleeding, varices, strictures, cancers, and stones. Procedures include biopsy, polypectomy, dilation, ablation, ligation, and stent/drain placement.
This document discusses different types of biopsy techniques used in surgery. It defines a biopsy as the removal of tissue for examination. The main techniques discussed are incisional biopsy, excisional biopsy, punch biopsy, fine needle aspiration biopsy, exfoliative cytology, shave biopsy, and frozen section biopsy. For each technique, the document outlines the indications, contraindications, and procedural details. The goal of biopsy is to confirm a diagnosis, determine the nature and extent of a lesion, and help guide further treatment. Proper biopsy technique depends on factors like the size and location of the lesion.
Advancements in modern imaging techniques such as ultrasound, magnetic resonance imaging, computer tomography and other radiological procedures have improved the diagnosis of gynecological conditions to a great extent. However, the establishment of a final diagnosis and the initiation of appropriate treatment requires direct viewing of the uterine cavity as in hysteroscopy. In many cases, the patient can be treated during the initial hysteroscopy.
The document discusses cervical histology and screening for cervical cancer. It describes the squamocolumnar junction (SCJ) and transformation zone of the cervix. The location of the SCJ changes with age due to regenerative changes. Screening guidelines from ACOG and WHO are provided regarding what ages to screen and what tests to use. Screening methods like Pap smear, HPV testing, visual inspection with acetic acid are outlined. Management of abnormal screening results including follow up testing and treatment options like cryotherapy, LEEP, and hysterectomy are summarized.
This document discusses different types of biopsies used to aid in definitive diagnosis of lesions. It describes excisional biopsy, incisional biopsy, punch biopsy, fine needle aspiration cytology, core needle biopsy, and exfoliative cytology. Excisional biopsy implies complete removal of the lesion while incisional biopsy implies removal of only a piece. Fine needle aspiration cytology uses a needle to draw a small tissue sample into the syringe. Core needle biopsy removes a small amount of suspicious tissue with a larger hollow needle. Exfoliative cytology examines shed surface cells without removing tissue. Potential dangers of biopsy include spreading infection, hemorrhage, infection, and operative trauma.
Surgical Excision Of Limbal Squamous Cell Carcinoma With Cryotherapy And Mito...Dr. Jagannath Boramani
This case report describes the surgical excision of a squamous cell carcinoma located at the limbus of a patient's right eye, along with cryotherapy and topical Mitomycin-C to prevent recurrence. A 40-year old male presented with a reddish, irregular limbal mass in his right eye. The mass was excised locally under anesthesia along with cryotherapy. Topical Mitomycin-C drops were administered post-operatively to prevent recurrence, which was successful. Wide excision along with cryotherapy and Mitomycin-C is an effective treatment for limbal squamous cell carcinoma to cure the cancer and prevent recurrence.
This document provides information on diabetic foot. It begins by defining diabetic foot as infection, ulceration or destruction of deep tissues of the lower limb associated with neurological abnormalities and peripheral vascular disease in diabetic patients.
Some key points made include:
- The prevalence of foot ulcers in diabetic patients ranges from 4% to 27% and they account for a large burden on healthcare systems.
- Risk factors for diabetic foot ulcers include neuropathy, foot deformities, and poor blood sugar control.
- Treatment requires a multidisciplinary approach including wound care, offloading, infection management, and improving blood sugar and blood flow.
Tonsillectomy is the surgical removal of the tonsils. It is usually done to treat chronic tonsil infections, sleep apnea, or other conditions. The document discusses various indications for tonsillectomy including recurrent infections or enlarged tonsils causing obstruction. It describes contraindications and provides details on techniques, equipment, positioning, anesthesia, steps of the procedure, post-operative care, complications, and other methods for tonsillectomy.
Therapeutic endoscopy is used in GI surgery to directly examine and treat problems in the digestive tract. It allows diagnosis and treatment without invasive surgery. Common therapeutic endoscopic procedures described include hemostasis for bleeding ulcers or varices, polypectomy, stricture dilation, stent placement, and debridement for conditions like achalasia. New techniques under development include natural orifice transluminal endoscopic surgery (NOTES) to perform surgical procedures without external incisions by entering through natural openings. Therapeutic endoscopy provides minimally invasive options for many GI conditions.
The document describes a new endoscopic spine surgery system called "Easy GO" for performing lumbar discectomies. Some key points:
- The Easy GO system uses a 1.5cm diameter working sheath and 30 degree endoscope for visualization, allowing standard microsurgical techniques to be used through a smaller incision compared to open surgery.
- A study of the first patients treated with Easy GO found no complications and postoperative pain relief in 89% of patients at 10 months follow up on average, comparable to results from other techniques.
- While the skin incision size is smaller than open surgery, the extent of decompression and neural tissue trauma is similar to standard microdiscectomy. The
Oral Biopsy Methods Used In Surgical practicesuhaskamble151
This document provides information about oral biopsy procedures. It defines what a biopsy is, discusses different types of biopsies including incisional, excisional, needle and brush biopsies. It outlines indications and contraindications for biopsies. Key steps in performing a biopsy are described, including selecting the biopsy site, using local anesthesia, making the incision, handling the tissue sample, and suturing. Important considerations for different types of lesions are highlighted. Equipment and materials needed for biopsies are also listed.
This document discusses sclerotherapy as a treatment for varicose and spider veins. It provides details on:
1) The technique of sclerotherapy, which involves injecting a caustic solution into veins to destroy the intima and obliterate the vessel.
2) Evaluation of patients prior to treatment, including physical exam and duplex ultrasound to identify refluxing veins.
3) Materials used, including sclerosing agents like sodium tetradecyl sulfate (STS) and polidocanol.
4) The procedure steps, including patient preparation, positioning, skin preparation, choice of sclerosant concentration, and injection.
This document provides information on general histopathology techniques. It defines histology and histopathology, and describes the process of collecting biopsy specimens including fixation, storage, and labeling. It discusses different types of biopsies like core needle, fine needle, excisional, and incisional biopsies. Common histological techniques are also outlined, such as frozen section, fine needle aspiration, and exfoliative cytology. Immunohistochemistry is also briefly described.
Necrotizing pancreatitis is a rapidly progressing soft tissue infection associated with significant morbidity and mortality. It is usually polymicrobial but can be monomicrobial with Group A streptococcus. Diagnosis is clinical but the finger test can help by probing for lack of resistance in the deep fascia. Treatment requires aggressive IV antibiotics and urgent surgical debridement, with repeat debridements as needed. Hyperbaric oxygen therapy may help reduce mortality.
The Sepsis Six bundle for treating sepsis includes giving IV fluids, antibiotics and oxygen to patients and obtaining blood cultures, full blood count and lactate from patients.
Cutting current in monopolar diathermy has low voltage and a continuous waveform for cutting tissue
The document discusses wound infection, providing details on normal wound healing, classification of wounds and surgical site infections, complications of wounds like seroma and hematoma, prevention of surgical site infections through various patient, surgical, and post-operative measures, and general management of wound infections including debridement, irrigation, antibiotic therapy, and wound management techniques. Risk factors, signs, diagnosis, and treatment of surgical site infections are covered.
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Dr Ayman Ewies - Topical Vaginal Oestrogen in the management of postmenopausa...AymanEwies
This document provides an overview of topical vaginal estrogen in managing postmenopausal vaginal atrophy. It discusses that vaginal atrophy is a common problem affecting over 60% of postmenopausal women, causing symptoms like dryness and pain. While systemic hormone therapy can help, it may have risks and up to 45% of users still experience dryness. Topical vaginal estrogen is effective at treating symptoms by restoring the vaginal lining, has minimal systemic absorption, and long-term studies show no increased endometrial risk without needing additional progestogen in non-hysterectomized women. The document reviews treatment options and safety of topical vaginal estrogen.
Dr Ayman Ewies - Principles of HysteroscopyAymanEwies
This document provides an overview of hysteroscopy procedures. It discusses the history and development of hysteroscopy, describes hysteroscope equipment and how it is used, outlines the steps for performing diagnostic and operative hysteroscopies, reviews indications and contraindications, and discusses techniques for performing hysteroscopy in an outpatient setting. The risks and complications of hysteroscopy are also reviewed. In summary, the document is a comprehensive guide to hysteroscopy procedures, equipment, techniques, and considerations for patient safety.
Dr Ayman Ewies - Prevalence of hyperplasia and cancer in endometrial polyps i...AymanEwies
This document summarizes a study that aimed to quantify the prevalence of hyperplasia and cancer in endometrial polyps among women with postmenopausal bleeding (PMB). The study conducted a systematic review and meta-analysis of 10 studies and found an overall prevalence of hyperplasia and cancer of 8.9%. However, there remains uncertainty around the exact prevalence due to heterogeneity in prior studies. There is also no consensus on whether polyps should be routinely removed or if expectant management could be adopted in some cases. Future research with large prospective studies is needed to help guide clinical practice.
Dr Ayman Ewies - Operative Hysteroscoy Practical TipsAymanEwies
This document discusses submucous fibroids (SMF) and their treatment. It provides background on the prevalence of SMF and their effects on infertility and recurrent pregnancy loss. It describes the classification of SMF and techniques for hysteroscopic myomectomy including using bipolar versus monopolar energy. Key steps in the procedure include differentiating type 1 and 2 fibroids, extracting tissue chips, and ensuring hemostasis. Long-term outcomes of hysteroscopic resection are generally good with high satisfaction rates. The document also briefly discusses techniques for endometrial ablation and hysteroscopic septum resection.
Dr Ayman Ewies - Mirena: why 50% of women dislike it?AymanEwies
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Dr Mona Elshafie and Dr Ayman Ewies - The Effect Of Leptin On Maturation Of T...AymanEwies
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Dr Ayman Ewies - Endometrial Polyps in Postmenopausal WomenAymanEwies
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2. It found that 17% of women had endometrial polyps, and of these polyps, 7.8% showed hyperplasia or cancer.
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Dr Ayman Ewies - What makes an effective e-tutorial?AymanEwies
This document discusses what makes an effective e-tutorial. It notes that e-learning is great because it is comprehensive, accessible, responsive, up-to-date, and greener than traditional learning. Effective e-tutorials should be engaging and interesting through the use of case studies, interactive tasks, assessment questions, videos, animations and graphics. They should also be comprehensive, highlight advanced content, include key points and user feedback. Support is provided to authors through guidelines, templates and incentives. Challenges include ensuring quality through updating, copyright issues, and plagiarism.
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The document announces the 27th annual congress of the European Society of Gynaecological Endoscopy (ESGE) to be held from October 7-10, 2018 in Vienna, Austria. The congress will take a holistic approach to women's health, focusing on quality assurance and innovation. Seuvandhi Gunasekera of the United Kingdom, along with co-authors Ahmed Ghoubara and Ayman Ewies, will receive an award for their scientific work titled "Rate of hysterectomy following 419 Novasure procedures - real-life experience of a teaching hospital in the UK", which was selected for an oral presentation during the plenary sessions of the congress.
The Sandwell and West Birmingham Hospitals NHS Trust provides healthcare services to over 300,000 people living in the Sandwell and West Birmingham areas. It operates two main hospital sites, Sandwell General Hospital in West Bromwich and City Hospital in Birmingham. The Trust employs over 5,000 staff and provides a wide range of acute medical and surgical services including A&E, maternity, outpatients, and diagnostic imaging.
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This study evaluated an office hysteroscopy service with 700 annual cases. A retrospective review of 141 women undergoing NovaSure endometrial ablation from 2011-2015 found 79% did not require further treatment, while 21% received additional care including 10% who had a hysterectomy. A survey of 100 women in the office hysteroscopy service from 2015-2016 found high satisfaction, with 93 women scoring overall acceptability ≥8 and stating they would repeat the procedure. While 17 women reported severe pain during treatment, staff were found to be supportive and privacy was maintained.
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TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
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share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
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Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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3. 3
Is it important?
Biopsy is mandatory if the planned intervention is
destructive.
It may not be required if an excisional technique is to be
employed.
The type of biopsy depends on:
1. The clinical situation.
2. The degree of abnormality.
3. The need to exclude invasive or glandular disease.
5. 5
1- Punch Biopsy
It is indicated when there is discrepancy between cytology and colopsopy in
grading.
The lesion has to be fully visible i.e. satisfactory colposcopy.
Multiple biopsies give greater diagnostic accuracy than a single biopsy.
The most severe areas of the lesion should be included.
Biopsy should include the stroma.
Punch biopsy forceps is used to remove a piece of tissue (approximately 3.5
mm in diameter).
Usually no anesthetic is required.
Bleeding may require silver nitrate or Monsel’s solution.
6. 6
2- Cone Biopsy
It may be used for diagnostic and therapeutic purposes.
No further treatment may be needed in completely excised
early invasive disease, CIN, or CGIN.
It may be indicated for diagnostic purposes in the
following situations:
1. Suspected malignancy
2. Glandular abnormality
3. Positive cytology with unsatisfactory colposcopy.
4. Persistently positive cytology with negative colposcopy.
5. Upper limit of an apparent lesion is not visible.
7. 7
2- Cone Biopsy
It can be undertaken using different techniques:
1. Scalpel (needs GA).
2. Loop diathermy.
3. CO2 Laser.
9. 9
3- Endocervical Curettage (ECC)
Its use and indications remain controversial.
It may be useful in cases of unsatisfactory colposcopy
with:
1. Abnormal glandular cells on cytology.
2. Lesions extending into the canal.
The problems:
1. Blind procedure.
2. The scrapings are too superficial and may miss disease in the
crypts.
10. 10
3- Endocervical Curettage (ECC)
Studies showed that sampling with endocervical
brush to be equally or more informative.
12. 12
Rational for Treatment
Treatment is designed to prevent cervical cancer
development by eradicating the preinvasive process with
minimal morbidity.
Regardless of treatment modality used, the aim should be
to remove the TZ.
Depth of treatment should be to 7 mm since studies have
shown that gland crypts involved with CIN may extend up
to 5.2 mm into the cervical stroma.
Depth of treatment should be to 10 mm for CGIN.
13. 13
Criteria for ideal techniques
1. Office based.
2. Cheap.
3. Quick.
4. With minimal or no discomfort.
5. Curative.
6. With little or no adverse effects.
7. Followed by good healing.
8. Allow for adequate cytology follow up.
14. 14
Techniques
Ablation (destruction) Excision*
Cryotherapy Diathermy Loop Excision
Thermal Ablation Laser Cone Biopsy
Cold coagulation Cold knife Cone Biopsy
CO2 laser ablation Hysterectomy
*Much more commonly used in the current practice.
15. 15
Advantages of excisional techniques
1. Allow using of “see & treat” policy.
2. Allow histological analysis of the excised specimens
(Punch biopsy may miss pathology).
3. Help recognizing incomplete treatment.
4. Excisional histology can be used in quality assurance of
the colposcopist.
16. 16
1- Diathermy Loop Excision
The leading mode of treatment in most countries
because of :
1. Ease of performance
2. Very low associated morbidity
In Europe LLETZ = Large Loop Excision of
Transformation Zone.
In North America LEEP = Loop
Electrosurgical Excision Procedure.
17. 17
1- Diathermy Loop Excision
Fulguration: occurs when the electrode is placed a millimeter or so
from the tissue to be treated.
– Using a blend of cutting and coagulation for the excision, the loop
should be transversed across slowly so that a fulgurative cutting
and coagulative effect ensues.
– If the loop is pushed or a hurried procedure is conducted, then
desiccation occurs and thermal damage occurs to the excised
specimen.
Desiccation (literally means dehydration): occurs when the electrode
(loop ore ball) physically is touching the tissue and causes more
thermal damage.
18. 18
CIN extending to margins at excision results in higher
incidence of recurrence but does not justify routine repeat
excision as long as:
– No glandular abnormality.
– No invasive disease.
– <50 years of age.
Women >50 years who have CIN 2/3 at the endocervical
margin and in whom satisfactory cytology and colposcopy
cannot be guaranteed repeat excision to obtain clear
margins.
Women with CGIN with incomplete excision at
endocervical margin repeat excision to obtain clear
margins and exclude occult invasive disease.
1- Diathermy Loop Excision
19. 19
Information given to patients following loop excision
Not to use tampons.
To abstain from intercourse for 4 weeks.
A single loop excision is associated with small but significant increase
incidence of preterm labour (7% V 11%).
There may be a change in the menstrual pattern.
Not to swim for 2 weeks.
Normal activities including light exercise can continue as normal.
1- Diathermy Loop Excision
23. Video Clip 4 - 10:34 min
LLETZ
..VideosClip 4 - LLETZ -
10.34.flv
24. 24
2- Laser
The CO2 laser is most widely used.
It can be used for either ablative or excisional techniques.
It is a precise tool that can be focused to a specific spot
0.2-2mm diameter.
1. It allows good control of depth of destruction & good
haemostasis.
2. It allows excellent healing because there is minimal
thermal damage to the adjacent tissues.
25. 25
2- Laser
The biologic effect is thermal.
– The tissue is vaporized at the speed of light.
It requires local anesthetic and speculum with a smoke
extractor.
Disadvantage: the initial cost and maintenance of the
machines.
26. 26
3- Cold Knife Cone Biopsy
It is still used in cases where:
1. The TZ is not fully visualized.
2. There is suspected invasive disease or glandular
abnormality which requires histopathological
guarantee of the excision margins.
27. 27
4- Hysterectomy
It may be indicated when:
1. CIN is present with other gynaecological condition e.g.
fibroids.
2. CIN is suspected or confirmed with no much cervix
left after multiple treatments.
28. 28
Requirements for ablative treatment
1. Satisfactory colposcopy i.e.
– TZ is fully visible.
– The lesion is completely visible.
2. Invasive disease ruled out by biopsy.
3. Concordance between cytology, colposcopy and
histology.
4. No evidence of a glandular lesion.
5. No evidence of endocervical involvement (Colposcopy ±
ECC).
6. No previous treatment to the cervix.
29. 29
1- Cryotherapy
Principle: It refers to the application of a super-cooled
probe using refrigerant gases (nitrous oxide or carbon
dioxide) directly to the cervical lesion.
– The freezing point of nitrous oxide is -90oC and that of CO2 is
-60oC.
– Cell death occurs at -20oC.
The biological effect: cryonecrosis (which occurs as a
result of formation of an iceball).
– Crystallization of intracellular water destroys the cells.
The margin of the iceball should be at least 3-5 mm in
excess of the area to be destroyed.
31. 31
1- Cryotherapy
Indication: small low grade lesions.
Duration of treatment: 2 minutes.
– if the lesion is large multiple applications should be
employed.
– A freeze-thaw-freeze (double freeze) technique is
associated with improved efficacy and must be used.
– No anesthesia is required.
Disadvantages:
1. Copious vaginal discharge for several weeks.
2. Cervical stenosis is commoner than other
modalities.
33. Video Clip 5 - 4:26 min
Cryotherapy
..VideosClip 5 - Cryotherapy -
4.26.flv
34. 34
2- Cold Coagulation
It employs heat applied to tissue using a Teflon-coated
thermosound.
Treatment is conducted usually at 100-120oC for 30
seconds.
The biological effect: desiccation.
These temperatures are much lower as compared with
earlier electrocautery, hence the term cold.
Advantages:
1. No anesthesia is required.
2. Following treatment, there is no need to place any restriction on
sexual intercourse or the use of tampons.
35. 35
3- Electro-diathermy = Thermal Ablation
It destroys tissue by burning with high frequency
alternating current using ball diathermy.
The biological effect: fulguration.
It requires local anesthetic and speculum with a smoke
extractor.
Fibrosis is commoner than other modalities of ablation,
but it does not appear to affect subsequent fertility or
obstetric outcome.
37. 37
Complications - rare
Morbidity is very low with all forms of treatment.
Early:
– Bleeding
– Secondary infection
– Discharge (mainly with cryotherapy)
Late: stenosis
– Commoner after cryotherapy and cold knife cone biopsy.
– Depends on the depth of treatment.
1. Difficulty in gaining adequate sample for cytology
2. Fertility problems
3. Menstrual dysfunction: amenorrhoea or dysmenorrhoea
43. 43
Follow-up
Objectives: To detect disease either:
1. Residual (within 12 months of treatment), or
2. Recurrent (after 12 months of treatment).
It is believed that most second lesions are due to
progressive enlargement of small foci of residual disease
which has been missed on treatment.
The risk of cervical cancer in women who underwent
treatment for CIN is 3-5 times the background rate for at
least 10 years.
The risk of cervical cancer in women who develop
abnormal cytology following treatment for CIN is 25-30
times the background rate.
44. 44
How?
The role of colposcopy is debatable in F/U of CIN:
– TZ may not be visible to its entirety.
– The regenerating epithelium is often misjudged as CIN.
Colposcopy has no role in F/U of CGIN.
Nonetheless, cytology can give false negative result:
– The residual disease may be very small.
– The residual disease may be covered by regenerated normal
epithelium.
45. 45
Risk factors for treatment failure
1. Large lesions (> 1cm2).
2. High grade lesions.
3. Older women > 50, since TZ is not always fully visualized.
4. Incompletely excised margins, particularly endocervical.
5. Smokers have 3-fold higher failure rate than non-smokers.
6. Technical reasons:
1. Inexperienced colposcopist.
2. Inappropriate choice of treatment method.
3. Operative difficulties e.g. poor access.
46. 46
Duration
No CIN (previous abnormal cytology) smear 6, 12 months.
CIN 1 smear at 6, 12, 24 months.
CIN 2 & 3 or CGIN* smear at 6 (± colposcopy), 12 months, then
annually for further 9 years.
CIN on hysterectomy:
– F/U as if cervix is in situ if concerned about excision margins.
– Vault smear 6, 12 months if margins are clear.
If all normal routine recall cytology
*ensure the sample contains endocervical cells.