nhs cervical screening programme nhslearnnhs的宫颈癌筛查项目课件

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1、COLPOSCOPYCervicalScreeningQARCTrainingSchoolOctober2012TerminologyDyskaryosisCervicalIntraepithelialNeoplasia(CIN)NormalepitheliumDiseaseprogressionInvasivecervicalcancerTimeYearsMonthsHPVinfection;koilocytosisCINICINIICINIIICINI57%CINII43%CINIII32%Approx.likelihoodofregressionBorderlineMildModer

2、ateSevereDyskaryosisIndicationsforColposcopyABNORMALCYTOLOGYModerateorseverelydyskaryoticresultBorderline/mildsamplesthatarehighrisk(16&18)HPVpositiveAbnormalglandularcellsFINDINGSORSYMPTOMSSuspiciousappearancetocervixSymptomatology–postcoitalbleedingExaminationCuscoSpeculum??repeatLBCsampleAcetic

3、Acid+/-LugolsIodineColposcopePunchBiopsySilvernitrateTreatmentExcisional–LETZ,KnifeConeDestructive-ColdCoag,LaserAblationRarely-HysterectomyFollow-UppriortoHPVtestingAfterTreatmentforhighgradeCIN(orworse)–Cervicalsampling6,12thenannuallyfor10yearsAfterTreatmentforlowgradeCIN–6,12,24thennormalrecal

4、lAfterhysterectomy(ifnoCervix)–nolongerpartofre-call!GynaecologistsetsintervalsWhatisHPVtestofcure?Womenwhohaveanormal,borderlineormildcervicalscreeningresultsixmonthsaftertreatmentforCINandwhoalsotestnegativeforhigh-riskHPVhaveaverylowriskofresidualdisease.Samplestakensixmonthsposttreatmentthatar

5、ecytologynegativeareHPVtested.Womenwhosesamplesshownohigh-riskHPVwillproceedtothreeyearroutinerecall–avoidingtheneedforupto10yearsofannualcervicalscreening.Womenwhohaveanabnormalcervicalscreeningresultorwhosesamplesshowhigh-riskHPVsixmonthsaftertreatmentwillbereferredbacktocolposcopy.Question1Ques

6、tion2Question3Question4Question5Question6Question7Question8Question9LetzandpregnancyKnifeconeworsethanLetzLaserablationcarriesnoriskComplicationsPrematurelabour(<37/40)1.7RRPrematureruptureofmembranes2.7RRLowbirthweight1.8RRCervicalstenosis–emergencyLSCSColposcopyinPregnancyAimistoexcludeinvasived

7、iseaseNoevidenceofmorerapidprogressioninpregnancyAvoidtreatmentbutcanbiopsyWartsmorefloridSamplingandcolposcopyareeasilyinterpreteddespitepregnancychangesIfhasinvasivediseasewhenpregnantTreatCacxifunder24/40i.e.t