Mengenali Hasil Abnormal Pap Dan Iva (Teori) Dr.rizal s

MENGENALI HASIL ABNORMAL PAP SMEAR DAN IVA

Dr. H. RIZAL SANIF, SpOG(K)

DEVISI ONKOLOGI BAGIAN/ DEPARTEMEN

OBSGIN FK UNSRI / RSMH

PALEMBANG

PASIEN EKSTRIM RISIKO RENDAH TES PAP (-)

VIRGIN

HISTEREKTOMI PENYAKIT BENIGNA

USIA > 65 TAHUN DAN LEBIH 10 KALI PAP

NORMAL

PASIEN RISIKO RENDAH KRITERIA:

1. SEKSUAL AKTIF USIA > 20 TAHUN : MULAI PAP 3 TAHUN SETELAH INTERCOURE PERTAMA

2. USIA < 21 TAHUN : PAP 3 TAHUN SETELAH INTERCOURSE PERTAMA:

a. PASANGAN SEKSUAL <3

b. KONSISTEN MEMAKAI BARIER KONTRA

c. TIDAK MEROKOK

d. PAP SEBELUMNYA NORMAL

e. TIDAK ADA RIWAYAT STD

PROTOKOL RISIKO RENDAH

1. PENAPISAN AWAL : TES PAP SETIAP TAHUN NORMAL SAMPAI 3 TAHUN

2. SELANJUTNYA (BILA PENAPISAN NORMAL) : SETIAP 2 ATAU 3 TAHUN

PASIEN RISIKO TINGGI

1. AKTIFITAS SEKSUAL USIA < 20 TAHUN

2. TIGA ATAU LEBIH PASANGAN

3. RIWAYAT HVP ATAU PENYAKIT AKIBAT HUBUNGAN KELAMIN (STD)

4. TES PAP SEBELUMNYA ABNORMAL

5. PECANDU ROKOK

PROTOKOL RISIKO TINGGI

PENAPISAN AWAL : 2 KALI SETAHUN

SELANJUTNYA SETIAP TAHUN

SETELAH HISTEREKTOMI REKOMENDASI UMUM : SITOLOGI VAGINA• TIDAK ADA RIWAYAT PAP ABNORMAL :

a. TIDAK PERLU PENAPISAN ATAU

b. PENAPISAN SETIAP 10 TAHUN

2. ABNORMAL PAP SEBELUMNYA :

a. PENAPISAN AWAL 3 TAHUN SETELAH

HISTEREKTOMI

b. SELANJUTNYA SETIAP 5 TAHUN

Inspeksi Visual dengan Asam Asetat (IVA)

Melihat serviks untuk mendeteksi abnormalitas setelah pemakaian asam

asetat

TEHNIK IVA

BANTUAN SPEKULUM SERVIKS

DITAMPAKKAN

SERVIKS DIPULAS DENGAN ASAM ASETAT 3 – 5 %

DINILAI: BERCAK PUTIH ( ACETO WHITE EPITHELIUM) POSITIF : LESI PREKANKER

Inspeksi Visual dengan Asam Asetat (IVA)Inspeksi Visual dengan Asam Asetat (IVA)

Epitel putih dengan asam asetatEpitel putih dengan asam asetat

Asam asetat

3-5%

Visualisasi

NIS

P. Osmolar

HipertonikEkstra seluler

Membrankolaps

DNA

Epitel putihasetat

SERVIKS NORMALASAM ASETTA TERKUMPUL

PADA JAM 6

TIDAK PERLU INTERVENSI MEDIK

PERLU PENAPISAN ULANG

Normal cervix, negative Acetic Acid Test (AAT), small condyloma

acuminatum on left vaginal wall (9 o'clock)

No medical intervention required.Call for re-screening according to established policy.

Normal cervix, negative AAT. Some degree of ectopy is visible and

subsequently, the squamo-columnar junction line is clearly visible. White

endocervical mucous is present.

No medical intervention required.Call for re-screening according to established policy

Severe postmenopausal atrophy of the squamous

epithelium, negative AAT.

Refer the patient to Primary Health Clinic for treatment if patient symptomatic.

Cervical polyp, negative AAT.

No medical intervention required.Call for re-screening according to established policy.

Normal cervix, negative AAT. Ectopy is present with metaplastic

epitheliumgrowing medially at 12 o'clock (containing crypt openings).

Posteriorly several "bands" of metaplastic epithelium are visible.

Outside the squamo-columnar junction line the transformation zone is visible

as a slightly white circular area.

Marked ectopy, negative AAT.

No medical intervention required.Call for re-screening according to established policy.

Nabothian cyst at 5 o'clock. Atypical acetowhite lesion at 11 o'clock extending up into

the canal - colposcopy indicated.

Take swab for culture (if facilities available).Refer the patient to Primary Health Clinic.

Atypical lesion anteriorly, positive AAT - repeat screening

in 6 month's time.

Refer the patient to Primary Health Clinic.

Acetowhite metaplastic epithelium anterior and

posterior. Atypical lesion at 12 o'clock (at the periphery)

Refer the patient to Primary Health Clinic.

Condylomata acuminata at 10 o'clock.

Refer the patient to Primary Health Clinic.

Negative with acetowhite metaplasia. Crypt openings are present within

metaplastic epithelium. At 1 o'clock Nabothian cyst is present (yellow).

False negative AAT

Refer the patient to Primary Health Clinic.

Normal with acetowhite metaplasia in the

transformation zone. False positive AAT.

Refer the patient to Primary Health Clinic.

Condylomata acuminata at 6 o'clock, acetowhite metaplasia

anterior.

Refer the patient to Primary Health Clinic.

Atypical acetowhite lesion extending up into the canal -

colposcopy and biopsy indicated.

Refer the patient to Primary Health Clinic.

Positive AAT. Probably normal, but a biopsy is desired in order

to rule out cancer.

Refer the patient to Primary Health Clinic.

Positive AAT. Probably normal, but abnormal blood vessels

indicate biopsy.

Refer the patient to Primary Health Clinic.

Low grade SIL (CIN I) at 12 o'clock with acetowhite metaplastic epithelium

posterior

Refer the patient to Primary Health Clinic.

Positive AAT, low grade SIL (condylomata acuminata).

Refer the patient to Primary Health Clinic.

Positive AAT, high grade SIL anterior (CIN II).

Refer the patient to Primary Health Clinic.

Positive AAT, high grade SIL (CIN III) at 5 o'clock. Acetowhite metaplastic

epithelium anterior.

Refer the patient to Primary Health Clinic.

Leukoplakia before application of acetic acid;

probably high grade SIL (CIN III).

Refer the patient to Oncology Centre.

Infiltrating cancer.

Refer the patient to Oncology Centre.

Infiltrating cancer.

Refer the patient to Oncology Centre.