Question

A 34-year-old G2P2 who recently underwent colposcopy with biopsy following a Pap smear which showed low-grade squamous intraepithelial lesion, comes in to discuss her results. The biopsy results showed HSIL (CIN III). Endocervical curettage showed benign endocervical cells. What is the most appropriate next step in the management of this patient?

A. Radical hysterectomy
B. Simple hysterectomy
C. Repeat Pap smear in four months
D. Human Papilloma Virus (HPV) testing
E. Loop Electrosurgical Excision Procedure (LEEP)

Answer 1

The most appropriate next step in the management of this patient is Loop Electrosurgical Excision Procedure (LEEP) (Choice E).

Step-by-step explanation:

The most appropriate next step in the management of this patient is Loop Electrosurgical Excision Procedure (LEEP) (Choice E).

In this case, the patient's biopsy results showed HSIL (CIN III), which indicates a high-grade precancerous lesion. Since the endocervical curettage showed benign endocervical cells, the lesion is localized to the cervix. LEEP is a surgical procedure that removes the abnormal tissue and can be performed in an outpatient setting under local anesthesia. This procedure is effective in the treatment of high-grade precancerous cervical lesions.

Repeat Pap smear (Choice C) may be an option for monitoring the patient's progression or regression, but given the high-grade lesion, it is not the most appropriate next step. Radical hysterectomy (Choice A) and simple hysterectomy (Choice B) are more invasive procedures and are reserved for cases where there is evidence of invasive cancer or when conservative treatment options have failed.