Question

A 40 year old woman presents with abnormal cervical cytology on PAP smear suggestive of CIN III (HSIL). The next best step in management is:

• A. Hysterectomy
• B. Colposcopy and LEEP
• C. Colposcopy and cryotherapy
• D. Conization

Hint:

A screening smear needs colposcopic confirmation; for HSIL pick the option that also yields a specimen.

Answer 1

The Correct Option is B

Step 1: Understand the cytology finding. A PAP smear is only a screening test. CIN III on cytology means a high grade squamous intraepithelial lesion (HSIL) is suspected, but cytology cannot tell how deep the lesion goes or whether invasion has already occurred.

Step 2: Recall the rule that an abnormal screening smear must be confirmed by a diagnostic step before any treatment. For HSIL the standard next step is colposcopy, which lets you see the abnormal area and take a directed biopsy.

Step 3: Choose the procedure that both confirms and treats. In a see-and-treat approach for HSIL, colposcopy is combined with LEEP (loop electrosurgical excision procedure). LEEP removes the transformation zone, gives a tissue specimen for histology to rule out invasion, and treats the lesion in one sitting.

Step 4: Rule out the wrong options. Hysterectomy (A) is too aggressive for a pre-invasive lesion and removes the chance of histological assessment. Cryotherapy (C) is an ablative method, so no specimen is obtained and it is not preferred for high grade disease. Conization (D) is reserved when the lesion extends into the canal, colposcopy is unsatisfactory, or microinvasion is suspected, not as the routine first step.

Answer: Colposcopy and LEEP (Option B).