Meena 45-years-old female presents with postcoital bleeding. On per speculum examination a friable mass is found in cervix. Next step in management is:
**Core Concept**
Colposcopy and biopsy are essential diagnostic tools for evaluating abnormal cervical lesions, which can be precancerous or cancerous. In cases of postcoital bleeding and a friable cervical mass, a definitive histopathological diagnosis is crucial for guiding further management.
**Why the Correct Answer is Right**
A friable cervical mass is highly suggestive of cervical cancer or a high-grade squamous intraepithelial lesion (HSIL). In such cases, a colposcopy-guided biopsy is the most appropriate next step to obtain a definitive histopathological diagnosis. This allows for accurate staging and planning of further treatment, which may include surgery, radiation, or chemotherapy. The biopsy sample will be examined for the presence of cancer cells, and the extent of invasion will be assessed to determine the stage of the disease.
**Why Each Wrong Option is Incorrect**
**Option A:** Immediate hysterectomy is not the next step in management as it is a major surgical procedure that should be reserved for patients who have undergone a thorough evaluation and have been staged appropriately.
**Option B:** Colposcopy is essential, but it is not the next step in management as a friable cervical mass is already suspected to be cancerous, and further evaluation is needed to confirm the diagnosis.
**Option C:** FISH (Fluorescence In Situ Hybridization) is a diagnostic tool used to detect genetic abnormalities, but it is not the next step in management as a biopsy is needed to obtain a definitive histopathological diagnosis.
**Clinical Pearl / High-Yield Fact**
A friable cervical mass is a red flag symptom for cervical cancer, and a colposcopy-guided biopsy should be performed as soon as possible to obtain a definitive diagnosis.
**Correct Answer:** C. Colposcopy-guided biopsy