High-grade lesion at colposcopy — counselling and treatment station

Communication-and-management station for a high-grade squamous lesion at colposcopy: candidate counsels a young woman wanting fertility, presents the excision-vs-ablation decision with the obstetric outcomes of excision, and agrees a treatment and surveillance plan. Includes assessor key and marking domains.

Prompt

A 29-year-old woman who wants children is referred with an HPV-positive screening test and high-grade squamous intraepithelial lesion cytology. Colposcopy shows a dense acetowhite lesion with the squamocolumnar junction fully visible, and the directed biopsy confirms CIN 3. You are the registrar; the consultant is available by phone. The candidate must counsel the woman and agree the treatment plan, balancing oncologic safety against the obstetric cost of excision.

Station brief

Format. Communication and management station, approximately 12 minutes. A simulated patient plays the woman; an examiner observes and feeds new information. The candidate leads the counselling and the treatment decision.^[5]

Candidate instruction. Counsel the woman on her diagnosis and the treatment options, present the excision-versus-ablation decision with its obstetric consequences, agree a plan, and outline the follow-up. Verbalise your reasoning and check her understanding.^[5]

References5Show

[1]Kyrgiou M, Koliopoulos G, Martin-Hirsch P, Arbyn M, Prendiville W, Paraskevaidis E Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and meta-analysis Lancet, 2006.PMID 16473126
[2]Athanasiou A, Veroniki AA, Efthimiou O, Kalliala I, Naci H, Bowden S, et al. Comparative effectiveness and risk of preterm birth of local treatments for cervical intraepithelial neoplasia and stage IA1 cervical cancer: a systematic review and network meta-analysis Lancet Oncol, 2022.PMID 35835138
[3]Effah K, Tekpor E, Wormenor CM, Essel NOM Transformation zone types: a call for review of the IFCPC terminology to embrace practice in low-resource settings Ecancermedicalscience, 2023.PMID 38414959
[4]Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, et al. 2019 ASCCP Risk-Based Management Consensus Guidelines: Updates Through 2023 J Low Genit Tract Dis, 2024.PMID 38117563
[5]Martin-Hirsch PP, Paraskevaidis E, Bryant A, Dickinson HO Surgery for cervical intraepithelial neoplasia Cochrane Database Syst Rev, 2013.PMID 24302546

High-grade lesion at colposcopy — counselling and treatment station

Station brief

References5Show

[1]Kyrgiou M, Koliopoulos G, Martin-Hirsch P, Arbyn M, Prendiville W, Paraskevaidis E Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and meta-analysis Lancet, 2006.PMID 16473126
[2]Athanasiou A, Veroniki AA, Efthimiou O, Kalliala I, Naci H, Bowden S, et al. Comparative effectiveness and risk of preterm birth of local treatments for cervical intraepithelial neoplasia and stage IA1 cervical cancer: a systematic review and network meta-analysis Lancet Oncol, 2022.PMID 35835138
[3]Effah K, Tekpor E, Wormenor CM, Essel NOM Transformation zone types: a call for review of the IFCPC terminology to embrace practice in low-resource settings Ecancermedicalscience, 2023.PMID 38414959
[4]Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, et al. 2019 ASCCP Risk-Based Management Consensus Guidelines: Updates Through 2023 J Low Genit Tract Dis, 2024.PMID 38117563
[5]Martin-Hirsch PP, Paraskevaidis E, Bryant A, Dickinson HO Surgery for cervical intraepithelial neoplasia Cochrane Database Syst Rev, 2013.PMID 24302546