Page 1 of 1: Ix of choice for a cervix nodule.

dr_saurabh · Credits: 7265 My Scrapbook

Hiiii folks,

There's a question in the "question buster section" of ths website whc i
cut n pasted . There's something tht doesn't seem right about the given
answer .

Kindly Go thru it ----->

A 55 year old lady presenting to out patent department (OPD) with postmenopausal bleeding for 3 months has a 1x1 cm nodule on the anterior lip of cervix. The most appropriate investigation to be done subsequently is:
1. Pap smear.
2. Punch biopsy.
3. Endocervical curettage.
4. Colposcopy.

Answer
2. Punch biopsy.

Reference
Test book of Gynaecology 2nd Edition D.C.Dutta 316 , 519
Shaw

Quality
Spotter

Status
Repeat

QTDF
Shaw

Discussion
Cytological Examination is now obligatory for establishing a diagnosis

Explanation
1. Pap smear can be used, and will be an
Answer if Punch biopsy is not given.
2. Punch biopsy is the most appropriate
Answer in this setting.
3. Endocervical curettage can be done after Punch Biopsy.
4. Coloposcopy is inferior to Punch biopsy.

Comments
An often and most repeated Question

The answer they have given is "Punch Biopsy"
But Shaw's Gyn. textbook says specifically :-
1) Punch biopsy tends to crush .
2) Doesn't include the matrix.
3) Gives too many false negetive results.
4) Hence, Punch Biopsy is NOT advocated .
So , should Pap smear have been the answer in the 1st case itself ??

friendy · Credits: 736 My Scrapbook

y not to go step by step dr,saurrab.!so better start with pap smear.wat do u say??

akanksha · Credits: 41247 My Scrapbook My Reading List 14 Books

well,Pap smear is jus a screening procedure.

& its purpose is to catch the cervical carcinoma at such an early stage,when the patient is neither complaining of any symptoms nor any growth/mass is visible.

its purpose is to prompt the physician to carry out further investigations in a patient,who is showing any abnormality in the pap smear.

here,the patient is having a small nodule on the ant. lip of cervix.

& to know the nature of this growth the best procedure will be to take a biopsy(as is required for any growth at any other site).

& considering the small size of the nodule,wont a punch biopsy will be the best thing to do,as it will serve a therapeutic benefit also?

will it be appropriate to concentrate more on taking a pap & leaving the nodule as such?

drpsg · Credits: 6178 My Scrapbook

ALSO JEFFCOTES MENTIONS THE SAME THING
I AGREE WITH AKANKSHA

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