Tests/treatment for HPV/dysplasia

[ashbar]

I've had 2 abnormal pap smears this year (with normal paps in between).  The 2nd indicated high grade changes, but the resulting biopsy showed only mild dysplasia.  Because of this discrepancy, my dr wants to remove the lesion with a LEEP.  Would it be more prudent to do another colposcopy/biopsy instead of this invasive procedure?  Would you recommend getting the Amplicor test in order to know exactly which strain of HPV I have, since some strains are more agressive than others?  I've never had any HPV test, my dr said it is assumed that you have high risk HPV if you have dysplasia.  If I have a less aggressive type, I would think regular paps/colposcopies for the next few months would suffice?

Thanks,
Ashley

[ashbar]

Thanks, I think along the same lines as you that perhaps a wait & see approach would be better in my case, since I know what I'm dealing with.  I have an appointment with my family pracitioner this week, just to get his opinion as well, but I'm leaning toward postponing the LEEP for at least 3 months to see if the dysplasia clears on its own.  

[simplynat]

We do know that if you have cervical dysplasia then yes, you would have to had an active HPV infection at some point, however in my opinion, the important question is whether or not that HPV infection is still active. It is possible to have cleared the HPV infection since the dysplasia developed and if the active infection is cleared then the dysplasia would likely soon follow, therefore not requiring more invasive measures.
You are correct, the pap is only a screening tool and the colposcopy is used more for as diagnostic tool. I have heard of doctors deciding to perform a LEEP when the colposcopy and smear differ but whether or not that is proper management I can't say. In my opinion, that may be a fairly invasive technique in order to diagnose. Especially if there is no longer an active HPV infection, in which case your body will likely clear any possible dysplasia - especially mild dyplasia. If that is the case, this could be the reason your smear and colposcopy having different results. It is also possible that he/she may have missed an area with a higher degree of dysplasia during the colposcopy. The good news is, that cervical cancer tends to be very slow growing and not all dysplasias will necessarily advance which is why a watch and wait method (typically 6 months) for some women may be acceptable. However, no women wants to wait too long in case the dysplasia does progress, becoming invasive to the nearby tissue, resulting in cervical cancer. Hopefully with some research you will be able to decide what is best for you body and your health. Best wishes to you.

[ashbar]

I think that he did do an ecc.  I know he took a cell sample from the cervical canal, as well as doing a punch biopsy.  I asked him in my consultation if he found nothing in the canal & he said no.

I have had no HPV test since this process began.  He said that once they find dysplasia they know you have high-risk HPV & do not do the test until you start going for regular checkups again.

The reason he wants to do the LEEP is because the pap smear showed severe dysplasia, but the biopsy showed mild.  He wants to do the LEEP "just in case".  I would think that the biopsy would be more accurate than the pap??

[simplynat]

During the colposcopy did they also do an ecc? I would be interested to know if you currently have an active HPV infection. It may be that you did have an active HPV infection which caused some dysplasia but the virus has since been cleared - if so any remaining dysplasia would soon follow. It really is a matter of what you are comfortable with. As you likely know, if you only have mild dysplasia your body will likely be able to clear this on it's own, even severe dysplasia can sometimes clear on it's own. The problem is it is impossible to know who will progress and who won't so the higher the level of dysplasia the higher the necessity for treatment. A LEEP does come with it's own risks and it's own healing time  - my own personal opinion is that I would follow up with an HPV test and a colposcopy in either 3 or 6 months, following the results of that I would make my decision. But it is your body, your health and your peace of mind so you need to do what feels right for you. Best wishes to you!