Clinical scenario... patient presents with HGSIL on PAP smear... what are your options?
... the short answer in the patient of any age is to perform a colposcopy.
However, in the non-adolescent (i.e., ≥ age 20)...
... an accepted management step is to bypass the colposcopy... and perform a colposcopically-directed LEEP (loop electrosurgical excisional procedure), as this may be the most cost-effective approach and achieve more compliance.
"An immediate colposcopically-guided LEEP conisation after HSIL Pap smear may be a safe and time saving strategy."
"The use of a see and treat protocol for patients with HSIL (CIN 2) Pap smear results may be an acceptable treatment option because of a high incidence of CIN 2 and CIN 3."
"Women undergoing LEEP for discrepancy >5 months from their HGSIL Pap demonstrated a trend toward less CIN 2,3 on LEEP pathology."