Colposcopy and treatment of CIN/CGIN — structured oral station (12 minutes)

Opening prompt — "Take me through your colposcopic assessment."

Model response: [3]

• "I perform a magnified assessment of the transformation zone after acetic acid, because most cervical cancers develop there. My first question is whether the squamocolumnar junction is fully visible — the IFCPC transformation zone type."
• "Here the junction is fully visible, so the colposcopy is satisfactory. I record the lesion site, size and worst feature — dense acetowhite change with abnormal vessels — and I take a directed biopsy before any destructive treatment, because histology is the standard."

Probe 1 — "The biopsy confirms CIN 3. Do you ablate or excise?"

• "Either is eligible here because the lesion is fully visible, the junction is seen, and invasion is excluded on cytology, colposcopy and biopsy. Because she wants children I would prefer excision with LLETZ to obtain histology and confirm complete excision, while being deliberate about depth."[2]
• State the ablation eligibility criteria out loud: whole lesion visible, SCJ fully seen (type 1 or 2), no suspicion of invasion, no glandular disease, concordant cytology and colposcopy with a biopsy excluding invasion.[3]
• "If the zone were type 3 — the junction not fully seen — I would not ablate, because lesions in the endocervical canal may be missed; I would sample the endocervix and excise."

Probe 2 — "She asks how this treatment might affect a future pregnancy."

Counsel with the specifics — this is a scored domain: [1]

• "Excision of the transformation zone is associated with adverse pregnancy outcomes. In the Kyrgiou meta-analysis, LLETZ raised the risk of preterm delivery — relative risk 1.70 — low birthweight 1.82, and premature rupture of the membranes 2.69; cold-knife conisation carried higher risks still."
• "The Athanasiou network meta-analysis confirmed that more radical excision carries more preterm-birth risk, while ablation probably does not increase preterm-birth risk."
• Acknowledge her concern, give the numbers plainly, and commit to minimising excision depth and to a clear follow-up plan.

Probe 3 — "Her cytology had shown possible glandular neoplasia of endocervical type instead, with a normal-looking colposcopy. What would change?"

• "Excision is essential. Among women referred with possible glandular neoplasia on cytology, 85.4% had significant pathology — AIS, invasive cancer or high-grade CIN — and AIS is a histological diagnosis, so colposcopy alone cannot rule it out and complete excision is required."[4]
• "I would never ablate suspected glandular disease; I would perform endocervical sampling and an excisional cone, and counsel that residual AIS is found even after clear margins — about 32% in one series — so surveillance continues and hysterectomy is recommended once fertility is no longer desired."[5]

Probe 4 — "She is frightened by the word 'precancer'. How do you respond?"

Demonstrate rapport, respect and communication out loud: [6]

• Move to her eye level, use her name, explain plainly: the abnormal cells are at a stage before cancer, the treatment removes them, and the outlook is excellent.
• Avoid jargon, acknowledge her fear, confirm she has understood, and arrange a clear follow-up plan and a point of contact.

Probe 5 — "What about HPV vaccination in all this?"

• "Vaccination prevents disease but does not treat it — she can still develop disease from non-vaccine HPV types or from infection acquired before vaccination, so she still needs screening."[6]