cone biopsy)Downloads

A 27-year-old G3P2002 presents to the clinic for follow up after her initial prenatal visit. Her last period was 8 weeks ago. Her medical history is notable for obesity, hypertension, type 2 diabetes, and eczema. Her current two children are healthy. Her current pregnancy is with a new partner after she separated from her previous partner. Her vaccinations are up to date since the delivery of her second child. Her temperature is 98°F (37°C), blood pressure is 110/60 mmHg, pulse is 85/min, and respirations are 18/min. Her physical exam is unremarkable. Laboratory results are shown below: Hemoglobin: 14 g/dL Hematocrit: 41% Leukocyte count: 9,000/mm^3 with normal differential Platelet count: 210,000/mm^3 Blood type: O Rh status: Negative Urine: Epithelial cells: Rare Glucose: Positive WBC: 5/hpf Bacterial: None Rapid plasma reagin: Negative Rubella titer: > 1:8 HIV-1/HIV-2 antibody screen: Negative Gonorrhea and Chlamydia NAAT: negative Pap smear: High-grade squamous intraepithelial lesion (HGSIL) What is the best next step in management?

A 38-year-old G2P2 presents to her gynecologist to discuss the results of her diagnostic tests. She has no current complaints or concurrent diseases. She underwent a tubal ligation after her last pregnancy. Her last Pap smear showed a high-grade squamous intraepithelial lesion and a reflex HPV test was positive. Colposcopic examination reveals areas of thin acetowhite epithelium with diffuse borders and fine punctation. The biopsy obtained from the suspicious areas shows CIN 1. Note the discordancy between the cytology (HSIL) and histology (CIN 1) results. Which of the following is an appropriate next step in the management of this patient?