Читать книгу Assisted Reproduction Techniques - Группа авторов - Страница 194

Glandular abnormalities (as in Case History 3) warrant a prompt direct referral to colposcopy and should be seen within 2 weeks [2]. There is a high prevalence of invasive adenocarcinoma, cervical glandular intraepithelial neoplasia (CGIN) and CIN in this population of patients [2]. Cervical biopsy alone in this setting lacks adequate sensitivity and excisional treatment such as a LLETZ is preferable to establish a reliable diagnosis of high‐grade CGIN. Distinction from invasive adenocarcinoma can only be achieved by histopathology, and an excisional biopsy including the endocervical canal is required for this purpose [2]. The excisional treatment needs to include the entire transformation zone and extend at least 1cm above the squamocolumnar junction [2], although this may increase the risk of preterm birth. All glandular cytology and histology samples should be discussed at the local colposcopy MDT meeting.

Those with complete excision should be offered HPV test of cure sampling 6‐ and 18‐months posttreatment and return to normal recall if both samples are normal [2]. In health systems without HPV test of cure, cytological follow up at 6 months and then annually for 10 years should be followed.

Those that are incomplete should consider a repeat LLETZ, accepting a further increased risk of preterm birth, or colposcopy and screening 6 months after treatment, and then annually for 10 years [2], whilst accepting that incomplete removal further increases the risk of recurrence of cervical disease which could lead to cancer in the future.