Screening Tools for Gynecology

1. Screening Tools for Gynecology

2. Screening • It is a strategy used to detect disease in a population • Patients may choose to undergo these screening tests with or without symptoms.

3. Papsmear • Conventional • Fluid based • Visual inspection with ascetic acid • Colposcopy • Ultrasound • Pelvic • Transvaginal • Transrectal • Doppler • Sonohysterosalpingography • CT • MRI CERVIX UTERUS & OVARIES

4. Papanicolau Test • It detects cancerous and precancerous changes in the cervix. • In addition, may also detect infections and abnormalities in the endocervix and endometrium

6. Start within 3 years after first vaginal intercourse or by age 21 or whichever comes first. Repeat every 2 years. • After age 30 with three consecutive normal tests, repeat every 3 years. • Until age 65

8. Types • Conventional Slide • SN 72% • SP 94% • Fluid Based Cytology • SN 66% • SP 91% Coste J, Cochand-Priollet B, de Cremoux P, et al. (2003). "Cross sectional study of conventional cervical smear, monolayer cytology, and human papillomavirus DNA testing for cervical cancer screening". BMJ 326 (7392): 733

12. Conventional vs Fluid Based

13. Bethesda System • Atypical squamous cells • Atypical squamous cells of undetermined significance (ASC-US) • Atypical squamous cells - cannot exclude HSIL (ASC-H) • Low grade squamous intraepithelial (LSIL) • High grade squamous intraepithelial lesion (HSIL) • Squamous cell carcinoma • Atypical Glandular Cells not otherwise specified (AGC-NOS) • Atypical Glandular Cells, suspicious for AIS or cancer (AGC-neoplastic) • Adenocarcinoma in situ (AIS)

15. HPV DNA testing • Is a screening method of detecting the presence of HPV DNA (16, 18). There are two methods: • Visual inspection with acetic acid (VIA) • Colposcopy

16. This is usually done in the clinical setting of Pap smears with atypical squamous cells of undetermined significance. • In financially challenged settings, VIA is an alternative to doing Pap smears. • HPV DNA testing starts at 30 years old or 8 years from coitarche.

18. Visual Inspection with Acetic Acid • Grossly, the normal cervix is pink, and smooth. • In VIA, 3-5% acetic acid is applied to the cervix using cotton swabs. • Areas of the cervix which turn white after the application of acetic acid or have an abnormal vascular pattern are often considered for biopsy. If no lesions are visible, an iodine solution may be applied to the cervix to help highlight areas of abnormality

19. These abnormal cells have increased nuclear protein – higher cytoplasmic nuclear ratio. • The acid coagulates the protein, causing the whitish colored reaction. • The test is considered positive when it turns white.

21. Colposcopy • Is a medical diagnostic procedure to examine an illuminated, magnified view of the cervix and the tissues of the vagina and vulva. • In cases where Pap smears and VIAs are positive and biopsy is to be done, colposcopy allows directed-biopsy sampling and close examination of normal and abnormal appearing tissue.

22. Low power (2× to 6×) may be used to obtain a general impression of the surface architecture. • Medium (8× to 15×) and high (15× to 25×) powers are utilized to evaluate the vagina and cervix.

23. The higher powers are often necessary to identify certain vascular patterns that may indicate the presence of more advanced precancerous or cancerous lesions. • Acetic acid solution and iodine solution (Lugol's or Schiller's) are applied to the surface to improve visualization of abnormal areas.

24. Pap Smear and HPV Testing • Normal Pap smear and (-) HPV • Risk for cervical CA 0.2% • Repeat after 3 years • Abnormal Pap smear and (+) HPV • Risk for cervical CA 6-7%

25. Ultrasonography

26. Ultrasonography • is an ultrasound-based diagnostic imaging technique used to visualize subcutaneous body structures. • It uses high frequency sound waves greater than the normal range of hearing of the human ear or 20 kilohertz. • Various types: Pelvic, Transvaginal, Transrectal, Doppler

27. Ultrasound is advantageous for it’s ability to visualize structures without being invasive, and still be economical and with no adverse effect. However, it is limited by its poor penetration on air and bone.

31. Uses • Screening and evaluation of pelvic masses • Benign or malignant – sassone scoring • Endometrial changes during the menstrual cycle • Infertility work-ups • Obstetric ultrasound

34. Doppler sonography detects the heartbeat of the fetus. It can also be used to evaluate the pulsations in the fetal heart and bloods vessels for signs of abnormalities.

36. Computed Tomography

37. Computed Tomography • is a medical imaging method employing tomography created by computer processing. • Digital geometry processing is used to generate a three-dimensional image of the inside of an object from a large series of two-dimensional X-ray images taken around a single axis of rotation.

38. CT is a sensitive method for diagnosis of abdominal diseases. • It is used frequently to determine stage of cancer and to follow progress. • However, it has limited application in the evaluation of the pelvis.

39. For the female pelvis in particular, ultrasound and MRI are the imaging modalities of choice. • Nevertheless, it may be part of abdominal scanning (e.g. for abdominal tumors).

41. MRI • is primarily a noninvasive medical imaging technique used in radiology to visualize detailed internal structure and limited function of the body. • useful in neurological (brain), musculoskeletal, cardiovascular, and oncological (cancer) imaging.

42. ~Fin~

46. Squamous cell abnormalities • LSIL • removal of the affected tissue, which can be accomplished by LEEP, cryosurgery, cone biopsy, or laser ablation • HSIL • emoval or destruction of the affected cells, usually by LEEP. Other methods include cryotherapy, cautery, or laser ablation, but none are performed on pregnant women for fear of disrupting the pregnancy

47. Glandular cell abnormalities • Adenocarcinoma • AGC • colposcopy with or without an endometrial biopsy