ls /home/daytona/workspace/ 2>/dev/null || echo "workspace empty"

mkdir -p /home/daytona/workspace/endometrial-pap-pptx

~/endometrial-pap-pptx/build.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_WIDE";
pres.title = "Interpretation of Endometrial Biopsy and Pap Smear Reports";
pres.author = "Orris Medical Education";

// ─── COLOR PALETTE ───────────────────────────────────────────────────────────
const C = {
  navy:    "0D1B3E",   // dominant dark
  teal:    "1A7A7A",   // accent 1
  coral:   "C84B31",   // accent 2 (warnings / abnormal)
  gold:    "D4A017",   // highlight
  white:   "FFFFFF",
  offwhite:"F4F6FA",
  ltgray:  "DDE3EC",
  midgray: "8898A8",
  green:   "1E6B3C",   // normal / benign
  amber:   "C87800",   // intermediate
  red:     "A01010",   // malignant
};

// ─── REUSABLE HELPERS ────────────────────────────────────────────────────────
function addDarkSlide(pres) {
  const s = pres.addSlide();
  s.background = { color: C.navy };
  return s;
}
function addLightSlide(pres) {
  const s = pres.addSlide();
  s.background = { color: C.offwhite };
  return s;
}
function sectionBanner(slide, text, y = 0) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y, w: 13.3, h: 0.55, fill: { color: C.teal } });
  slide.addText(text, { x: 0.2, y: y + 0.05, w: 13, h: 0.45, fontSize: 15, bold: true, color: C.white, valign: "middle" });
}
function bullet(text, level = 0, bold = false, color = C.navy) {
  return { text, options: { bullet: { type: "bullet" }, indentLevel: level, bold, color, fontSize: 14, breakLine: true } };
}
function subbullet(text, color = C.navy) {
  return bullet(text, 1, false, color);
}
function label(text, color = C.white) {
  return { text, options: { bold: true, color, fontSize: 13, breakLine: true } };
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = addDarkSlide(pres);
  // Decorative left bar
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.35, h: 7.5, fill: { color: C.teal } });
  s.addShape(pres.ShapeType.rect, { x: 0.35, y: 0, w: 0.12, h: 7.5, fill: { color: C.coral } });

  s.addText("Complete Interpretation of", {
    x: 0.7, y: 1.6, w: 12, h: 0.6, fontSize: 22, color: C.gold, bold: false, italic: true
  });
  s.addText("Endometrial Biopsy\n& Pap Smear Reports", {
    x: 0.7, y: 2.2, w: 12, h: 2.0, fontSize: 38, bold: true, color: C.white, valign: "top"
  });
  s.addShape(pres.ShapeType.rect, { x: 0.7, y: 4.35, w: 5.5, h: 0.05, fill: { color: C.coral } });
  s.addText("A Comprehensive Clinical Reference for Gynecologic Pathology Reporting", {
    x: 0.7, y: 4.5, w: 11, h: 0.5, fontSize: 13, color: C.ltgray, italic: true
  });
  s.addText("Sources: Pfenninger & Fowler's Procedures for Primary Care | Symptom to Diagnosis 4e | Bailey & Love's Surgery 28e\nCreasy & Resnik's Maternal-Fetal Medicine | Tietz Textbook of Laboratory Medicine 7e", {
    x: 0.7, y: 6.5, w: 11.5, h: 0.8, fontSize: 10, color: C.midgray, italic: true
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 2 — TABLE OF CONTENTS
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = addLightSlide(pres);
  sectionBanner(s, "OVERVIEW");
  s.addText("What This Presentation Covers", {
    x: 0.4, y: 0.65, w: 12, h: 0.5, fontSize: 20, bold: true, color: C.navy
  });

  const topics = [
    ["PART 1", "Endometrial Biopsy", "Indications, procedure, specimen adequacy, histologic findings, and management pathways"],
    ["PART 2", "Pap Smear / Cervical Cytology", "Bethesda 2001 classification, squamous & glandular abnormalities, HPV co-testing"],
    ["PART 3", "Management Algorithms", "Step-by-step clinical follow-up for each result category"],
    ["PART 4", "Special Populations", "Pregnancy, Lynch syndrome, postmenopausal women"],
    ["PART 5", "Screening Guidelines", "USPSTF 2018, ASCCP 2019 updated guidelines"],
  ];

  topics.forEach(([num, title, desc], i) => {
    const y = 1.3 + i * 1.1;
    s.addShape(pres.ShapeType.rect, { x: 0.4, y, w: 1.2, h: 0.9, fill: { color: C.teal }, line: { type: "none" } });
    s.addText(num, { x: 0.4, y: y + 0.1, w: 1.2, h: 0.7, fontSize: 11, bold: true, color: C.white, align: "center", valign: "middle" });
    s.addShape(pres.ShapeType.rect, { x: 1.65, y, w: 10.8, h: 0.9, fill: { color: C.ltgray }, line: { type: "none" } });
    s.addText(title, { x: 1.8, y: y + 0.05, w: 10.5, h: 0.35, fontSize: 14, bold: true, color: C.navy });
    s.addText(desc, { x: 1.8, y: y + 0.42, w: 10.5, h: 0.4, fontSize: 11, color: C.midgray, italic: true });
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 3 — ENDOMETRIAL BIOPSY: OVERVIEW & INDICATIONS
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = addLightSlide(pres);
  sectionBanner(s, "PART 1 — ENDOMETRIAL BIOPSY");
  s.addText("Indications for Endometrial Biopsy", {
    x: 0.4, y: 0.65, w: 12, h: 0.5, fontSize: 20, bold: true, color: C.navy
  });

  // Left column - indications
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.25, w: 6.1, h: 5.9, fill: { color: C.ltgray }, line: { type: "none" } });
  s.addText("Clinical Indications", { x: 0.5, y: 1.3, w: 5.7, h: 0.4, fontSize: 14, bold: true, color: C.teal });
  s.addText([
    bullet("Suspected endometrial pathology (abnormal uterine bleeding)"),
    bullet("Women >45 y with failed medical treatment"),
    bullet("Persistent intermenstrual bleeding"),
    bullet("Postmenopausal endometrial thickness >4 mm on ultrasound"),
    bullet("Premenopausal endometrial thickness >7 mm with PCOS"),
    bullet("Unscheduled bleeding on HRT (after first 3 months)"),
    bullet("Lynch syndrome — annual screening from age 35"),
    bullet("HNPCC family history screening"),
  ], { x: 0.5, y: 1.75, w: 5.8, h: 5.2, fontSize: 12, color: C.navy, valign: "top" });

  // Right column - risk factors
  s.addShape(pres.ShapeType.rect, { x: 6.7, y: 1.25, w: 6.2, h: 2.9, fill: { color: C.navy }, line: { type: "none" } });
  s.addText("Risk Factors for Hyperplasia/Cancer", { x: 6.9, y: 1.3, w: 5.8, h: 0.4, fontSize: 13, bold: true, color: C.gold });
  s.addText([
    bullet("Age >50 years", 0, false, C.white),
    bullet("Atypical endometrial hyperplasia", 0, false, C.white),
    bullet("Chronic anovulation / PCOS", 0, false, C.white),
    bullet("Obesity (>50 lbs overweight: 3x risk)", 0, false, C.white),
    bullet("Nulliparity, late menopause (>55 y)", 0, false, C.white),
    bullet("Unopposed estrogen therapy", 0, false, C.white),
    bullet("Tamoxifen therapy", 0, false, C.white),
    bullet("Diabetes mellitus", 0, false, C.white),
  ], { x: 6.9, y: 1.75, w: 5.8, h: 3.2, fontSize: 12, color: C.white, valign: "top" });

  // Contraindications
  s.addShape(pres.ShapeType.rect, { x: 6.7, y: 4.25, w: 6.2, h: 2.9, fill: { color: "#2A1010" }, line: { type: "none" } });
  s.addText("Contraindications", { x: 6.9, y: 4.3, w: 5.8, h: 0.4, fontSize: 13, bold: true, color: C.coral });
  s.addText([
    { text: "ABSOLUTE:", options: { bold: true, color: C.coral, fontSize: 12, breakLine: true } },
    subbullet("Pregnancy", C.white),
    subbullet("Bleeding diathesis / coagulopathy", C.white),
    { text: "RELATIVE:", options: { bold: true, color: C.amber, fontSize: 12, breakLine: true } },
    subbullet("Anticoagulant therapy", C.white),
    subbullet("Active vaginal/cervical/uterine infection", C.white),
    subbullet("Cervical stenosis, morbid obesity", C.white),
    subbullet("Significant uterine prolapse", C.white),
  ], { x: 6.9, y: 4.75, w: 5.8, h: 3.0, fontSize: 12, color: C.white, valign: "top" });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 4 — EMB PROCEDURE & INSTRUMENTS
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = addLightSlide(pres);
  sectionBanner(s, "PART 1 — ENDOMETRIAL BIOPSY");
  s.addText("Procedure & Equipment", {
    x: 0.4, y: 0.65, w: 12, h: 0.5, fontSize: 20, bold: true, color: C.navy
  });

  // Step-by-step boxes
  const steps = [
    { n: "1", title: "Patient Prep", body: "Perform bimanual exam to determine uterine position. Apply povidone-iodine. Consider NSAID premedication for pain." },
    { n: "2", title: "Speculum Insertion", body: "Large Graves speculum inserted. Cervix visualized and cleansed. Single-tooth tenaculum applied if needed." },
    { n: "3", title: "Sound the Uterus", body: "Uterine sound passed to assess cavity length and direction. Avoids perforation. Typical depth: 6-9 cm." },
    { n: "4", title: "Sampling Device", body: "Pipelle/Endocell (flexible plastic aspirator) most common. Creates suction as inner plunger is withdrawn while rotating." },
    { n: "5", title: "Specimen Handling", body: "Tissue placed in buffered formalin. Label containers. Send to pathology. Endocervical curette (Kevorkian) may be used concurrently." },
    { n: "6", title: "Post-Procedure", body: "Cramping expected. Spotting for 1-2 days normal. Advise to return if heavy bleeding, fever, or worsening pain." },
  ];

  steps.forEach((st, i) => {
    const col = i % 2 === 0 ? 0.3 : 6.7;
    const row = Math.floor(i / 2);
    const y = 1.25 + row * 2.0;
    s.addShape(pres.ShapeType.roundRect, { x: col, y, w: 6.2, h: 1.8, fill: { color: C.navy }, line: { type: "none" }, rectRadius: 0.1 });
    s.addShape(pres.ShapeType.rect, { x: col, y, w: 0.6, h: 1.8, fill: { color: C.teal }, line: { type: "none" } });
    s.addText(st.n, { x: col, y: y + 0.55, w: 0.6, h: 0.7, fontSize: 22, bold: true, color: C.white, align: "center" });
    s.addText(st.title, { x: col + 0.7, y: y + 0.1, w: 5.3, h: 0.4, fontSize: 13, bold: true, color: C.gold });
    s.addText(st.body, { x: col + 0.7, y: y + 0.5, w: 5.3, h: 1.1, fontSize: 11, color: C.ltgray, wrap: true });
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 5 — EMB REPORT INTERPRETATION: SPECIMEN ADEQUACY & NORMAL
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = addLightSlide(pres);
  sectionBanner(s, "PART 1 — INTERPRETING THE ENDOMETRIAL BIOPSY REPORT");
  s.addText("Specimen Adequacy, Normal & Pregnancy-Related Findings", {
    x: 0.4, y: 0.65, w: 12, h: 0.5, fontSize: 19, bold: true, color: C.navy
  });

  // Color-coded category boxes (4 boxes 2x2)
  const boxes = [
    {
      title: "INSUFFICIENT TISSUE", color: C.midgray, tcolor: C.white, y: 1.25, x: 0.3,
      items: [
        "Definition: Inadequate cellular material for diagnosis",
        "Causes: Cervical stenosis, atrophic endometrium, sampling error",
        "Management depends on clinical suspicion:",
        "  → Low suspicion: Observe or repeat EMB",
        "  → High suspicion: Saline-infusion sonography or hysteroscopy + D&C",
        "Note: Atrophic postmenopausal endometrium may not yield cells even when normal",
      ]
    },
    {
      title: "NORMAL FINDINGS", color: C.green, tcolor: C.white, y: 1.25, x: 6.7,
      items: [
        "Proliferative endometrium — estrogen-dominant phase; glands and stroma proliferating",
        "Secretory endometrium — progesterone effect; subnuclear vacuoles → luminal secretions",
        "Atrophic endometrium — postmenopausal; thin inactive glands, scant stroma",
        "Weakly proliferative / disordered proliferative — perimenopausal variant; no treatment unless symptomatic",
        "Clinical action: Reassure; treat underlying cause of bleeding if symptoms persist",
      ]
    },
    {
      title: "PREGNANCY-RELATED", color: C.amber, tcolor: C.white, y: 4.35, x: 0.3,
      items: [
        "Retained products of conception (RPOC) — villi ± trophoblast; manage with uterine evacuation",
        "Decidua only (no villi) — consider ectopic pregnancy or missed abortion; check serum hCG + ultrasound",
        "Arias-Stella reaction — hypersecretory glandular changes; benign, associated with intrauterine or ectopic pregnancy",
        "Gestational trophoblastic disease — molar villi; refer to oncology",
      ]
    },
    {
      title: "ENDOMETRITIS", color: C.coral, tcolor: C.white, y: 4.35, x: 6.7,
      items: [
        "Acute: Neutrophils in glands/stroma — usually associated with intrauterine device, abortion, or STI",
        "Chronic: Plasma cells in stroma (key finding) — associated with chlamydia, PID, TB",
        "Plasma cells = hallmark of chronic endometritis (not normally present in endometrium)",
        "Management: Treat the underlying infection (e.g., doxycycline ± metronidazole for PID)",
        "Granulomatous endometritis — consider TB; AFB stain + culture",
      ]
    },
  ];

  boxes.forEach(b => {
    s.addShape(pres.ShapeType.rect, { x: b.x, y: b.y, w: 6.2, h: 3.0, fill: { color: b.color }, line: { type: "none" } });
    s.addText(b.title, { x: b.x + 0.15, y: b.y + 0.08, w: 5.9, h: 0.4, fontSize: 13, bold: true, color: b.tcolor });
    b.items.forEach((item, idx) => {
      s.addText("• " + item, { x: b.x + 0.15, y: b.y + 0.5 + idx * 0.42, w: 5.9, h: 0.4, fontSize: 10.5, color: b.tcolor, wrap: true });
    });
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 6 — EMB REPORT: HYPERPLASIA CLASSIFICATION
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = addDarkSlide(pres);
  sectionBanner(s, "PART 1 — ENDOMETRIAL BIOPSY: HYPERPLASIA CLASSIFICATION");
  s.addText("WHO Classification of Endometrial Hyperplasia", {
    x: 0.4, y: 0.65, w: 12, h: 0.5, fontSize: 20, bold: true, color: C.white
  });

  // Header row
  const headers = ["Category", "Architecture", "Cytologic Atypia", "Cancer Risk", "Management"];
  const colW = [2.8, 2.0, 2.2, 1.8, 3.8];
  let xPos = 0.3;
  headers.forEach((h, i) => {
    s.addShape(pres.ShapeType.rect, { x: xPos, y: 1.25, w: colW[i], h: 0.45, fill: { color: C.teal }, line: { type: "none" } });
    s.addText(h, { x: xPos + 0.05, y: 1.25, w: colW[i] - 0.1, h: 0.45, fontSize: 11, bold: true, color: C.white, valign: "middle" });
    xPos += colW[i] + 0.05;
  });

  const rows = [
    ["Simple (Cystic)\nHyperplasia", "Cystic gland dilation;\nno complexity", "Absent", "<2%", "Reassure; progestin if persistent bleeding"],
    ["Complex (Adenomatous)\nHyperplasia", "Crowded glands;\nbranching; back-to-back", "Absent", "3-5%", "Progestational agents;\nrepeat biopsy in 3-6 months"],
    ["Simple Atypical\nHyperplasia", "Cystic dilation", "Present —\nnuclear rounding, prominent nucleoli", "8-15%", "Progestin therapy or consider hysterectomy;\nfrequent follow-up biopsies"],
    ["Complex Atypical\nHyperplasia", "Crowded / complex\nglands", "Present —\nnuclear atypia", "23-29%", "HYSTERECTOMY preferred; if fertility desired: high-dose progestin + close surveillance"],
    ["Endometrial\nIntraepithelial\nNeoplasia (EIN)", "Gland area > stroma;\nsite-specific architectural change", "Present", "40-60%\n(concurrent carcinoma\npossible)", "HYSTERECTOMY recommended;\noncology referral"],
  ];

  const rowColors = [C.green, "#1E4A6B", C.amber, "#8B3A00", C.red];

  rows.forEach((row, ri) => {
    let xp = 0.3;
    row.forEach((cell, ci) => {
      s.addShape(pres.ShapeType.rect, { x: xp, y: 1.75 + ri * 1.05, w: colW[ci], h: 1.0, fill: { color: rowColors[ri] }, line: { color: "000000", pt: 0.3 } });
      s.addText(cell, { x: xp + 0.05, y: 1.75 + ri * 1.05 + 0.05, w: colW[ci] - 0.1, h: 0.9, fontSize: 10, color: C.white, valign: "middle", wrap: true });
      xp += colW[ci] + 0.05;
    });
  });

  s.addText("Note: EIN (WHO 2014 / 2020) replaces 'complex atypical hyperplasia' in modern classification. Both terms may appear in pathology reports.", {
    x: 0.3, y: 7.0, w: 12.7, h: 0.35, fontSize: 9.5, italic: true, color: C.midgray
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 7 — EMB: ADENOCARCINOMA & OTHER MALIGNANCIES
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = addLightSlide(pres);
  sectionBanner(s, "PART 1 — ENDOMETRIAL BIOPSY: MALIGNANT FINDINGS");
  s.addText("Endometrial Carcinoma on Biopsy", {
    x: 0.4, y: 0.65, w: 12, h: 0.5, fontSize: 20, bold: true, color: C.navy
  });

  // Left — types
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.25, w: 6.1, h: 6.1, fill: { color: C.navy }, line: { type: "none" } });
  s.addText("Histologic Types", { x: 0.5, y: 1.35, w: 5.7, h: 0.4, fontSize: 14, bold: true, color: C.gold });

  const types = [
    ["Type I — Endometrioid Adenocarcinoma", "Most common (80%). Estrogen-related. Well-differentiated (G1/G2) better prognosis. Glandular pattern resembling normal endometrium."],
    ["Type II — Serous Carcinoma", "High grade, TP53 mutation, non-estrogen related. Papillary architecture. Psammoma bodies may be seen. Aggressive behaviour."],
    ["Type II — Clear Cell Carcinoma", "High grade. Hobnail cells, clear cytoplasm. Poor prognosis. Associated with Lynch syndrome."],
    ["Carcinosarcoma (MMMT)", "Mixed malignant mullerian tumor. Biphasic. Carcinoma + sarcoma. Highly aggressive; often Stage III/IV at diagnosis."],
    ["Grading (FIGO)", "G1: ≤5% solid non-squamous growth\nG2: 6-50% solid growth\nG3: >50% solid growth — highest risk"],
  ];

  types.forEach(([title, desc], i) => {
    s.addText(title, { x: 0.5, y: 1.85 + i * 1.05, w: 5.7, h: 0.35, fontSize: 12, bold: true, color: C.coral });
    s.addText(desc, { x: 0.5, y: 2.2 + i * 1.05, w: 5.7, h: 0.62, fontSize: 10.5, color: C.ltgray, wrap: true });
  });

  // Right — management
  s.addShape(pres.ShapeType.rect, { x: 6.7, y: 1.25, w: 6.2, h: 6.1, fill: { color: "#FEF0E0" }, line: { type: "none" } });
  s.addText("Clinical Action When Carcinoma Found on EMB", { x: 6.9, y: 1.35, w: 5.8, h: 0.5, fontSize: 13, bold: true, color: C.red });

  const mgmt = [
    ["Immediate Steps", "Refer to gynecologic oncologist.\nComplete staging workup."],
    ["Imaging", "MRI pelvis for myometrial invasion depth & cervical extension.\nCT chest/abdomen/pelvis for nodal & distant spread."],
    ["Surgical Staging", "Total hysterectomy + bilateral salpingo-oophorectomy + pelvic washings ± lymph node dissection ± omentectomy."],
    ["Adjuvant Therapy", "Based on FIGO stage, grade, histotype:\n• Stage IA G1/G2: Observation\n• Stage IB / G3: Vaginal brachytherapy\n• Stage III/IV: External beam RT ± chemotherapy"],
    ["Fertility-Sparing", "Only for G1 endometrioid confined to endometrium:\nHigh-dose progestin (medroxyprogesterone 160-320 mg/d or megestrol)\nStrict surveillance every 3-6 months"],
  ];

  mgmt.forEach(([title, body], i) => {
    s.addShape(pres.ShapeType.rect, { x: 6.8, y: 1.85 + i * 1.05, w: 5.9, h: 1.0, fill: { color: C.ltgray }, line: { type: "none" } });
    s.addShape(pres.ShapeType.rect, { x: 6.8, y: 1.85 + i * 1.05, w: 0.08, h: 1.0, fill: { color: C.coral }, line: { type: "none" } });
    s.addText(title, { x: 7.0, y: 1.9 + i * 1.05, w: 5.5, h: 0.3, fontSize: 11, bold: true, color: C.red });
    s.addText(body, { x: 7.0, y: 2.2 + i * 1.05, w: 5.5, h: 0.62, fontSize: 10, color: C.navy, wrap: true });
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 8 — EMB MANAGEMENT ALGORITHM (PREMENOPAUSAL)
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = addLightSlide(pres);
  sectionBanner(s, "PART 1 — MANAGEMENT ALGORITHM AFTER ENDOMETRIAL BIOPSY");
  s.addText("Post-EMB Management Pathways", {
    x: 0.4, y: 0.65, w: 12, h: 0.5, fontSize: 20, bold: true, color: C.navy
  });

  // Decision tree visual
  const branches = [
    { label: "Insufficient Tissue", col: C.midgray, x: 0.2, y: 1.25, action: "Repeat EMB or proceed to hysteroscopy + D&C if clinically indicated" },
    { label: "Normal Histology", col: C.green, x: 0.2, y: 2.35, action: "Treat underlying cause. Repeat EMB if symptoms persist after 3-6 months" },
    { label: "Endometritis", col: C.teal, x: 0.2, y: 3.45, action: "Targeted antibiotic therapy. Confirm eradication with follow-up biopsy if chronic" },
    { label: "Simple Hyperplasia (no atypia)", col: "#2B6E44", x: 0.2, y: 4.55, action: "Progestin therapy (medroxyprogesterone 10 mg × 12-14 d/month). Repeat EMB in 3-6 months" },
    { label: "Complex Hyperplasia (no atypia)", col: C.amber, x: 0.2, y: 5.65, action: "Progestin therapy. Repeat biopsy in 3-6 months. Follow-up mandatory" },
    { label: "Atypical Hyperplasia / EIN", col: "#A04000", x: 0.2, y: 6.75, action: "Hysterectomy recommended. Fertility-desired: high-dose progestin + frequent biopsies every 3 months + oncology consult" },
  ];

  branches.forEach(b => {
    s.addShape(pres.ShapeType.rect, { x: b.x, y: b.y, w: 3.8, h: 0.9, fill: { color: b.col }, line: { type: "none" } });
    s.addText(b.label, { x: b.x + 0.1, y: b.y + 0.15, w: 3.6, h: 0.6, fontSize: 11, bold: true, color: C.white, wrap: true, valign: "middle" });
    s.addShape(pres.ShapeType.line, { x: 4.05, y: b.y + 0.4, w: 0.5, h: 0, line: { color: b.col, pt: 2 } });
    s.addShape(pres.ShapeType.rect, { x: 4.6, y: b.y + 0.05, w: 8.4, h: 0.8, fill: { color: C.ltgray }, line: { type: "none" } });
    s.addShape(pres.ShapeType.rect, { x: 4.6, y: b.y + 0.05, w: 0.06, h: 0.8, fill: { color: b.col }, line: { type: "none" } });
    s.addText(b.action, { x: 4.75, y: b.y + 0.1, w: 8.1, h: 0.7, fontSize: 11, color: C.navy, wrap: true, valign: "middle" });
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 9 — PAP SMEAR: OVERVIEW & TECHNIQUE
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = addDarkSlide(pres);
  sectionBanner(s, "PART 2 — PAP SMEAR / CERVICAL CYTOLOGY");
  s.addText("Overview, Technique & Specimen Adequacy", {
    x: 0.4, y: 0.65, w: 12, h: 0.5, fontSize: 20, bold: true, color: C.white
  });

  // Three columns
  const cols = [
    {
      title: "What Is a Pap Smear?",
      color: C.teal,
      x: 0.3,
      items: [
        "Cytologic examination of cervical exfoliated cells",
        "Introduced by Papanicolaou in 1941",
        "Targets the transformation zone (squamocolumnar junction)",
        "Screens for cervical precancers (CIN) and cancer",
        "Reduced cervical cancer incidence by 60-90% in screened populations",
        "Sensitivity for HSIL ~56%; Specificity ~97%",
        "Sensitivity for LSIL ~77%; Specificity ~80%",
      ]
    },
    {
      title: "Collection Techniques",
      color: "#1E4A8A",
      x: 4.55,
      items: [
        "CONVENTIONAL PAP: Cells spread directly on glass slide, fixed immediately by examiner",
        "LIQUID-BASED CYTOLOGY (LBC): Cells rinsed into liquid preservative vial (ThinPrep / SurePath). Lab processes the slide",
        "Same sensitivity & specificity as conventional",
        "LBC allows reflex HPV co-testing from same sample",
        "Brush (endocervical + ectocervical) improves adequacy",
        "Avoid during menses; no douching/intercourse 48h prior",
      ]
    },
    {
      title: "Specimen Adequacy",
      color: "#5A2080",
      x: 8.8,
      items: [
        "SATISFACTORY: ≥8,000-12,000 well-visualized squamous cells (LBC: ≥5,000)",
        "Transformation zone component: Endocervical cells or squamous metaplastic cells",
        "UNSATISFACTORY: Excessive blood/inflammation obscuring >75% cells, or too few cells",
        "Action for unsatisfactory: Repeat in 2-4 months",
        "Note TZ component absence: Acceptable if patient >40 y, but increases false-negative rate",
      ]
    },
  ];

  cols.forEach(col => {
    s.addShape(pres.ShapeType.rect, { x: col.x, y: 1.25, w: 4.15, h: 6.1, fill: { color: col.color }, line: { type: "none" } });
    s.addText(col.title, { x: col.x + 0.15, y: 1.3, w: 3.85, h: 0.45, fontSize: 13, bold: true, color: C.gold });
    col.items.forEach((item, idx) => {
      s.addText("• " + item, { x: col.x + 0.15, y: 1.85 + idx * 0.78, w: 3.85, h: 0.7, fontSize: 11, color: C.white, wrap: true });
    });
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 10 — THE BETHESDA SYSTEM (2001) — OVERVIEW
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = addLightSlide(pres);
  sectionBanner(s, "PART 2 — THE BETHESDA CLASSIFICATION SYSTEM (2001)");
  s.addText("Bethesda 2001: Complete Terminology for Cervical Cytology Reporting", {
    x: 0.4, y: 0.65, w: 12, h: 0.5, fontSize: 18, bold: true, color: C.navy
  });

  // Left panel — complete hierarchy
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.25, w: 5.9, h: 6.1, fill: { color: C.navy }, line: { type: "none" } });
  s.addText("Bethesda Classification Categories", { x: 0.5, y: 1.3, w: 5.5, h: 0.4, fontSize: 13, bold: true, color: C.gold });

  const categories = [
    { text: "1. Negative for Intraepithelial Lesion or Malignancy (NILM)", bold: true, color: C.green },
    { text: "   • Non-neoplastic findings (atrophy, reactive changes, organisms)", bold: false, color: C.ltgray },
    { text: "2. Epithelial Cell Abnormalities — SQUAMOUS", bold: true, color: C.amber },
    { text: "   • ASC-US — Atypical squamous cells of undetermined significance", bold: false, color: C.ltgray },
    { text: "   • ASC-H — Cannot exclude HSIL", bold: false, color: C.ltgray },
    { text: "   • LSIL — Low-grade squamous intraepithelial lesion (CIN 1 / HPV effect)", bold: false, color: C.ltgray },
    { text: "   • HSIL — High-grade squamous intraepithelial lesion (CIN 2 / CIN 3 / CIS)", bold: false, color: C.coral },
    { text: "   • Squamous cell carcinoma", bold: false, color: C.red },
    { text: "3. Epithelial Cell Abnormalities — GLANDULAR", bold: true, color: C.amber },
    { text: "   • AGC — Atypical glandular cells (endocervical / endometrial / NOS)", bold: false, color: C.ltgray },
    { text: "   • AGC-FN — Atypical glandular cells, favor neoplastic", bold: false, color: C.coral },
    { text: "   • AIS — Endocervical adenocarcinoma in situ", bold: false, color: C.coral },
    { text: "   • Adenocarcinoma (endocervical / endometrial / extrauterine / NOS)", bold: false, color: C.red },
    { text: "4. Other Malignancies", bold: true, color: C.red },
  ];

  categories.forEach((cat, i) => {
    s.addText(cat.text, { x: 0.45, y: 1.78 + i * 0.37, w: 5.65, h: 0.35, fontSize: 10.5, bold: cat.bold, color: cat.color, wrap: true });
  });

  // Right panel — CIN vs Bethesda table
  s.addShape(pres.ShapeType.rect, { x: 6.4, y: 1.25, w: 6.6, h: 3.1, fill: { color: C.offwhite }, line: { color: C.ltgray, pt: 1 } });
  s.addText("Bethesda ↔ Histologic (CIN) Correlation", { x: 6.55, y: 1.3, w: 6.2, h: 0.4, fontSize: 13, bold: true, color: C.teal });

  const corr = [
    ["Bethesda Cytology", "CIN Grade", "Dysplasia (Old)"],
    ["NILM", "—", "Normal"],
    ["ASC-US", "CIN 1 (if confirmed)", "Minimal dysplasia"],
    ["LSIL", "CIN 1", "Mild dysplasia"],
    ["HSIL", "CIN 2", "Moderate dysplasia"],
    ["HSIL", "CIN 3", "Severe dysplasia / CIS"],
    ["Squamous cell carcinoma", "Invasive", "Invasive carcinoma"],
  ];

  corr.forEach((row, ri) => {
    const bg = ri === 0 ? C.teal : (ri % 2 === 0 ? C.ltgray : C.white);
    const fc = ri === 0 ? C.white : C.navy;
    row.forEach((cell, ci) => {
      s.addShape(pres.ShapeType.rect, { x: 6.4 + ci * 2.2, y: 1.75 + ri * 0.38, w: 2.2, h: 0.38, fill: { color: bg }, line: { type: "none" } });
      s.addText(cell, { x: 6.45 + ci * 2.2, y: 1.78 + ri * 0.38, w: 2.1, h: 0.32, fontSize: 10.5, bold: ri === 0, color: fc, valign: "middle" });
    });
  });

  // CIN pathology box
  s.addShape(pres.ShapeType.rect, { x: 6.4, y: 4.45, w: 6.6, h: 2.9, fill: { color: C.navy }, line: { type: "none" } });
  s.addText("CIN Histologic Features", { x: 6.6, y: 4.52, w: 6.1, h: 0.4, fontSize: 13, bold: true, color: C.gold });
  const cinFeatures = [
    "CIN 1: HPV cytopathic effect (koilocytes), nuclear atypia in lower 1/3 of epithelium, maturation maintained",
    "CIN 2: Dysplastic cells in lower 2/3 of epithelium; mitoses in lower half",
    "CIN 3 / CIS: Full-thickness dysplasia; loss of maturation; abnormal mitoses throughout all layers",
    "Koilocyte: Hallmark of HPV — perinuclear cytoplasmic clearing + irregular hyperchromatic nucleus",
  ];
  cinFeatures.forEach((f, i) => {
    s.addText("• " + f, { x: 6.6, y: 5.02 + i * 0.55, w: 6.1, h: 0.5, fontSize: 11, color: C.ltgray, wrap: true });
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 11 — SQUAMOUS CELL ABNORMALITIES IN DETAIL
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = addLightSlide(pres);
  sectionBanner(s, "PART 2 — PAP SMEAR: SQUAMOUS CELL ABNORMALITIES");
  s.addText("Detailed Interpretation of Squamous Categories", {
    x: 0.4, y: 0.65, w: 12, h: 0.5, fontSize: 20, bold: true, color: C.navy
  });

  const categories2 = [
    {
      title: "ASC-US", fullname: "Atypical Squamous Cells of Undetermined Significance", color: "#2B6E44", x: 0.3, y: 1.25,
      features: ["Cells with nuclear enlargement 2.5-3x normal; slight hyperchromasia", "Insufficient atypia to qualify as LSIL", "Most common abnormal Pap result (~5% of Paps)"],
      management: ["Age <25: Repeat Pap in 1 year", "Age ≥25: Reflex HPV testing (preferred) or Pap in 1 year", "If HPV+: Colposcopy", "If HPV-: Pap at 3 years"]
    },
    {
      title: "ASC-H", fullname: "Atypical Squamous Cells — Cannot Exclude HSIL", color: "#8B3A00", x: 6.7, y: 1.25,
      features: ["Small cells with high N:C ratio resembling HSIL but insufficient for diagnosis", "May represent immature squamous metaplasia, repair, or true HSIL", "~5-10% harbor CIN 2-3"],
      management: ["Colposcopy for ALL patients regardless of age or HPV status", "No option for repeat cytology — must proceed to colposcopy", "If no lesion at colposcopy: 6-month co-testing"]
    },
    {
      title: "LSIL", fullname: "Low-Grade Squamous Intraepithelial Lesion", color: "#1A5080", x: 0.3, y: 4.35,
      features: ["Koilocytes: clear perinuclear halo + irregular hyperchromatic nucleus (HPV effect)", "Nuclear enlargement >3x normal superficial cell nucleus", "Correlates with CIN 1 and productive HPV infection"],
      management: ["Age 21-24: Repeat Pap in 1 year", "Age ≥25: Colposcopy preferred", "HPV co-test if done: regardless of result — colposcopy", "Pregnancy: Colposcopy (defer treatment until postpartum)"]
    },
    {
      title: "HSIL", fullname: "High-Grade Squamous Intraepithelial Lesion", color: C.red, x: 6.7, y: 4.35,
      features: ["High N:C ratio, irregular nuclear membranes, hyperchromasia", "Scant cytoplasm; cells may be single or in syncytia", "Correlates with CIN 2 (moderate dysplasia) or CIN 3 / carcinoma in situ"],
      management: ["Immediate colposcopy mandatory", "If no lesion found: diagnostic excisional procedure (LEEP/cold knife cone)", "NEVER acceptable to just repeat Pap for HSIL", "If invasion suspected: immediate excision/biopsy"]
    },
  ];

  categories2.forEach(cat => {
    s.addShape(pres.ShapeType.rect, { x: cat.x, y: cat.y, w: 6.2, h: 2.9, fill: { color: cat.color }, line: { type: "none" } });
    s.addText(cat.title, { x: cat.x + 0.15, y: cat.y + 0.08, w: 2.5, h: 0.45, fontSize: 18, bold: true, color: C.white });
    s.addText(cat.fullname, { x: cat.x + 0.15, y: cat.y + 0.52, w: 5.8, h: 0.3, fontSize: 9.5, italic: true, color: C.ltgray });

    s.addShape(pres.ShapeType.rect, { x: cat.x + 0.1, y: cat.y + 0.88, w: 2.85, h: 1.9, fill: { color: "FFFFFF20" }, line: { type: "none" } });
    s.addText("Cytologic Features", { x: cat.x + 0.15, y: cat.y + 0.93, w: 2.75, h: 0.3, fontSize: 10, bold: true, color: C.gold });
    cat.features.forEach((f, i) => {
      s.addText("• " + f, { x: cat.x + 0.15, y: cat.y + 1.25 + i * 0.48, w: 2.75, h: 0.45, fontSize: 9.5, color: C.white, wrap: true });
    });

    s.addShape(pres.ShapeType.rect, { x: cat.x + 3.1, y: cat.y + 0.88, w: 2.9, h: 1.9, fill: { color: "FFFFFF20" }, line: { type: "none" } });
    s.addText("Management", { x: cat.x + 3.15, y: cat.y + 0.93, w: 2.8, h: 0.3, fontSize: 10, bold: true, color: C.gold });
    cat.management.forEach((m, i) => {
      s.addText("• " + m, { x: cat.x + 3.15, y: cat.y + 1.25 + i * 0.48, w: 2.8, h: 0.45, fontSize: 9.5, color: C.white, wrap: true });
    });
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 12 — GLANDULAR CELL ABNORMALITIES
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = addDarkSlide(pres);
  sectionBanner(s, "PART 2 — PAP SMEAR: GLANDULAR CELL ABNORMALITIES (AGC)");
  s.addText("Atypical Glandular Cells — The Most Important Pap Finding", {
    x: 0.4, y: 0.65, w: 12, h: 0.5, fontSize: 19, bold: true, color: C.white
  });

  // Why AGC matters
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.25, w: 12.7, h: 0.7, fill: { color: C.coral }, line: { type: "none" } });
  s.addText("⚠  AGC is associated with significant pathology in up to 25% of nonpregnant patients — including endometrial and endocervical carcinoma. Always warrants full evaluation.", {
    x: 0.5, y: 1.3, w: 12.3, h: 0.6, fontSize: 12, bold: true, color: C.white, valign: "middle"
  });

  // AGC subtypes table
  const agcData = [
    ["Category", "Description", "Associated Pathology", "Initial Work-up"],
    ["AGC-NOS\n(endocervical)", "Cells exceeding reactive changes but lacking definitive features of adenocarcinoma in situ", "Endocervical polyp, CIN, AIS, adenocarcinoma", "Colposcopy + endocervical curettage (ECC)"],
    ["AGC-NOS\n(endometrial)", "Cells with slight nuclear enlargement, mild chromatin abnormality", "Endometrial hyperplasia, polyp, carcinoma", "Colposcopy + ECC + endometrial sampling"],
    ["AGC-NOS\n(not otherwise specified)", "Origin uncertain", "Cervical, endometrial, ovarian, or tubal malignancy", "Colposcopy + ECC + endometrial sampling"],
    ["AGC Favor Neoplastic (AGC-FN)", "Qualitative or quantitative changes approaching AIS", "AIS, adenocarcinoma — higher risk than NOS", "Colposcopy + ECC + endometrial sampling; consider cone if no lesion"],
    ["AIS\n(Adenocarcinoma In Situ)", "Full cytologic criteria for AIS; mucin-depleted tall columnar cells with nuclear pseudostratification", "AIS with 48% harbor concurrent invasive disease", "Diagnostic excisional procedure (LEEP/cold knife cone) mandatory"],
    ["Adenocarcinoma", "Malignant glandular cells — endocervical, endometrial, or extrauterine pattern", "Invasive carcinoma", "Immediate referral to gynecologic oncologist"],
  ];

  const colWA = [2.2, 3.2, 2.8, 4.3];
  agcData.forEach((row, ri) => {
    const bg = ri === 0 ? C.teal : (ri % 2 === 0 ? "#1C2840" : "#243050");
    const tc = ri === 0 ? C.white : C.ltgray;
    let xp = 0.3;
    row.forEach((cell, ci) => {
      s.addShape(pres.ShapeType.rect, { x: xp, y: 2.05 + ri * 0.78, w: colWA[ci], h: 0.76, fill: { color: bg }, line: { color: "000000", pt: 0.2 } });
      s.addText(cell, { x: xp + 0.08, y: 2.1 + ri * 0.78, w: colWA[ci] - 0.16, h: 0.66, fontSize: ri === 0 ? 11 : 10, bold: ri === 0, color: tc, valign: "middle", wrap: true });
      xp += colWA[ci];
    });
  });

  s.addText("Key: ECC = Endocervical Curettage; AIS = Adenocarcinoma In Situ; NOS = Not Otherwise Specified", {
    x: 0.3, y: 7.1, w: 12.7, h: 0.3, fontSize: 9.5, italic: true, color: C.midgray
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 13 — NILM: NON-NEOPLASTIC FINDINGS
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = addLightSlide(pres);
  sectionBanner(s, "PART 2 — PAP SMEAR: NILM — NON-NEOPLASTIC FINDINGS");
  s.addText("Negative for Intraepithelial Lesion or Malignancy (NILM)", {
    x: 0.4, y: 0.65, w: 12, h: 0.5, fontSize: 19, bold: true, color: C.navy
  });

  // Green box for NILM
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.2, w: 12.7, h: 0.5, fill: { color: C.green }, line: { type: "none" } });
  s.addText("NILM = Normal result. No evidence of malignancy or precancerous change. May still include clinically significant incidental findings noted below.", {
    x: 0.5, y: 1.25, w: 12.3, h: 0.4, fontSize: 11, bold: true, color: C.white, valign: "middle"
  });

  const nilmCols = [
    {
      title: "Reactive / Reparative Changes",
      color: "#1E4A8A", x: 0.3, y: 1.8,
      items: [
        "Reactive cellular changes associated with inflammation (neutrophils, lymphocytes)",
        "Reparative changes — monolayer sheets, enlarged nuclei, prominent nucleoli; do NOT overinterpret as malignancy",
        "IUD-related changes — vacuolated cells, small glandular clusters; benign",
        "Radiation changes — cytomegaly, multinucleation, cytoplasmic vacuolation",
        "Post-radiation dysplasia: report separately if persists >6 months",
      ]
    },
    {
      title: "Hormonal Patterns",
      color: C.teal, x: 4.55, y: 1.8,
      items: [
        "Atrophy (postmenopausal) — parabasal cells predominate; may show nuclear enlargement mimicking HSIL; consider hormonal context",
        "Atrophy with inflammation — not to be confused with HSIL; clinical correlation needed",
        "Pregnancy effect — decidual cells, Arias-Stella reaction; benign",
        "Contraceptive effect — progestin effect on glandular cells",
      ]
    },
    {
      title: "Organisms Identified on Pap",
      color: "#5A2080", x: 8.8, y: 1.8,
      items: [
        "Trichomonas vaginalis — pear-shaped organisms with granular cytoplasm and eccentric nucleus",
        "Bacterial vaginosis (BV) — clue cells; shift in flora (Gardnerella/Mobiluncus)",
        "Candida sp. — pseudohyphae and budding yeast; often incidental",
        "Actinomyces — sulfur granule-like cotton-ball colonies (IUD users)",
        "HSV — multinucleation, nuclear molding, Cowdry A inclusions",
        "CMV — 'owl eye' intranuclear inclusions",
      ]
    },
  ];

  nilmCols.forEach(col => {
    s.addShape(pres.ShapeType.rect, { x: col.x, y: col.y, w: 4.15, h: 5.5, fill: { color: col.color }, line: { type: "none" } });
    s.addText(col.title, { x: col.x + 0.15, y: col.y + 0.1, w: 3.85, h: 0.45, fontSize: 13, bold: true, color: C.gold });
    col.items.forEach((item, idx) => {
      s.addText("• " + item, { x: col.x + 0.15, y: col.y + 0.65 + idx * 0.88, w: 3.85, h: 0.82, fontSize: 11, color: C.white, wrap: true });
    });
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 14 — HPV TESTING & CO-TESTING
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = addLightSlide(pres);
  sectionBanner(s, "PART 2 — HPV TESTING AND CO-TESTING STRATEGY");
  s.addText("HPV Co-Testing: Integration with Pap Smear Results", {
    x: 0.4, y: 0.65, w: 12, h: 0.5, fontSize: 20, bold: true, color: C.navy
  });

  // HPV types box
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.25, w: 4.2, h: 6.1, fill: { color: C.navy }, line: { type: "none" } });
  s.addText("HPV Genotypes", { x: 0.5, y: 1.3, w: 3.9, h: 0.4, fontSize: 14, bold: true, color: C.gold });
  const hpvTypes = [
    ["High-Risk (Oncogenic)", "16, 18, 31, 33, 45, 52, 58\n(14 total oncogenic types)", C.coral],
    ["HPV 16 & 18", "Responsible for ~70% of cervical cancers. HPV 16 — squamous carcinoma; HPV 18 — adenocarcinoma", C.amber],
    ["Low-Risk", "6, 11 — cause condylomata; not associated with cancer", C.green],
    ["Testing Methods", "HC2 (Hybrid Capture 2); Cobas 4800; Aptima HPV (E6/E7 mRNA); Cervista", C.teal],
    ["Primary HPV Test", "FDA approved for primary screening alone (age 25+). Reflex cytology if HPV+.", C.midgray],
  ];
  hpvTypes.forEach(([title, body, color], i) => {
    s.addShape(pres.ShapeType.rect, { x: 0.4, y: 1.8 + i * 1.05, w: 4.0, h: 1.0, fill: { color }, line: { type: "none" } });
    s.addText(title, { x: 0.5, y: 1.85 + i * 1.05, w: 3.8, h: 0.3, fontSize: 11, bold: true, color: C.white });
    s.addText(body, { x: 0.5, y: 2.15 + i * 1.05, w: 3.8, h: 0.58, fontSize: 10.5, color: C.white, wrap: true });
  });

  // Co-testing results matrix
  s.addShape(pres.ShapeType.rect, { x: 4.7, y: 1.25, w: 8.3, h: 6.1, fill: { color: C.offwhite }, line: { type: "none" } });
  s.addText("Co-Testing Result Combinations & Management (Age ≥30)", { x: 4.9, y: 1.3, w: 8.0, h: 0.4, fontSize: 13, bold: true, color: C.teal });

  const coTestData = [
    ["Pap Result", "HPV Result", "Interpretation", "Action"],
    ["NILM", "Negative", "Low risk", "Repeat co-testing in 5 years"],
    ["NILM", "Positive (16/18)", "High-risk HPV despite normal cytology", "Colposcopy"],
    ["NILM", "Positive (other HR)", "Intermediate risk", "Repeat co-testing in 1 year"],
    ["ASC-US", "Negative", "Low risk", "Repeat co-testing in 3 years"],
    ["ASC-US", "Positive", "Moderate risk", "Colposcopy"],
    ["LSIL", "Any", "CIN 1 possible", "Colposcopy (age ≥25)"],
    ["HSIL", "Any", "CIN 2-3 / CIS likely", "Immediate colposcopy; LEEP if no lesion"],
    ["AGC", "Any", "Significant pathology possible", "Colposcopy + ECC + endometrial sampling"],
  ];

  const ctColW = [2.1, 1.8, 2.8, 2.5];
  coTestData.forEach((row, ri) => {
    const bg = ri === 0 ? C.teal : (ri % 2 === 0 ? C.ltgray : C.white);
    const tc = ri === 0 ? C.white : C.navy;
    let xp = 4.7;
    row.forEach((cell, ci) => {
      s.addShape(pres.ShapeType.rect, { x: xp, y: 1.75 + ri * 0.6, w: ctColW[ci], h: 0.58, fill: { color: bg }, line: { color: C.ltgray, pt: 0.3 } });
      s.addText(cell, { x: xp + 0.05, y: 1.78 + ri * 0.6, w: ctColW[ci] - 0.1, h: 0.5, fontSize: ri === 0 ? 11 : 10, bold: ri === 0, color: tc, valign: "middle", wrap: true });
      xp += ctColW[ci];
    });
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 15 — SCREENING GUIDELINES
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = addDarkSlide(pres);
  sectionBanner(s, "PART 5 — CERVICAL CANCER SCREENING GUIDELINES");
  s.addText("USPSTF 2018 & ASCCP 2019 Recommendations", {
    x: 0.4, y: 0.65, w: 12, h: 0.5, fontSize: 20, bold: true, color: C.white
  });

  // Age-based timeline
  const ageGroups = [
    { age: "< 21 years", color: C.midgray, recommendation: "NO SCREENING — regardless of sexual activity onset" },
    { age: "21 – 24 years", color: "#1E6B3C", recommendation: "Cytology (Pap) alone every 3 years. No HPV testing (high false-positive rate). Abnormal results managed conservatively." },
    { age: "25 – 29 years", color: C.teal, recommendation: "Cytology every 3 years (preferred). OR\nHPV testing alone every 5 years. OR\nCo-testing (Pap + HPV) every 5 years." },
    { age: "30 – 65 years", color: "#1E4A8A", recommendation: "Any of three acceptable options:\n• Cytology alone every 3 years\n• HPV testing alone every 5 years (Grade A)\n• Co-testing every 5 years (Grade A)" },
    { age: "> 65 years", color: "#5A2080", recommendation: "STOP SCREENING if adequate prior screening (3 consecutive negative Pap OR 2 negative co-tests in past 10 years, most recent within 5 years). No history of CIN 2+." },
    { age: "Post-hysterectomy", color: "#3A1A1A", recommendation: "NO SCREENING for vaginal cuff cytology if hysterectomy for benign disease and no history of CIN 2 or higher." },
  ];

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}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 16 — SPECIAL POPULATIONS
// ═══════════════════════════════════════════════════════════════════════════
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  sectionBanner(s, "PART 4 — SPECIAL POPULATIONS");
  s.addText("Special Considerations in Specific Patient Groups", {
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      title: "Pregnancy",
      color: C.teal,
      x: 0.3, y: 1.25, w: 6.1, h: 2.8,
      items: [
        "Pap / cervical cytology screening continues as per non-pregnant schedule",
        "Endocervical curettage (ECC) — AVOID in pregnancy (risk of membrane rupture)",
        "Colposcopy safe, but biopsy deferred unless invasion suspected",
        "AGC in pregnancy: decidual cells / Arias-Stella can mimic AGC — interpret cautiously",
        "Cervical dysplasia rarely progresses in pregnancy; regression common postpartum",
        "Goal: Rule out invasive cancer; defer definitive treatment until after delivery",
        "Endometrial sampling also avoided in pregnancy",
      ]
    },
    {
      title: "Lynch Syndrome / HNPCC",
      color: "#8B3A00",
      x: 6.7, y: 1.25, w: 6.2, h: 2.8,
      items: [
        "Lifetime endometrial cancer risk up to 60% (vs 3% general population)",
        "Annual TVU + endometrial biopsy from age 35 (or 5 years before youngest affected relative)",
        "Mean age at diagnosis ~50 years (earlier than sporadic cases)",
        "Prophylactic hysterectomy + BSO discussed after childbearing complete",
        "DNA mismatch repair (MMR) gene testing: MLH1, MSH2, MSH6, PMS2",
        "5-year survival similar to sporadic cases despite younger age",
      ]
    },
    {
      title: "Postmenopausal Women",
      color: "#1A5080",
      x: 0.3, y: 4.15, w: 6.1, h: 2.8,
      items: [
        "Atrophic endometrium may not yield adequate EMB sample — not a failure",
        "TVU: endometrial stripe >4 mm warrants biopsy even if asymptomatic",
        "Postmenopausal bleeding (PMB): ALWAYS warrants investigation — 10% harbor carcinoma",
        "Pap smear: atrophic pattern with parabasal cells common; distinguish from HSIL by clinical context",
        "Hormonal priming (topical estrogen 2 weeks) may improve Pap adequacy in atrophic vaginitis",
        "Co-testing recommended until age 65 if no prior adequate screening",
      ]
    },
    {
      title: "Immunocompromised / HIV",
      color: "#4A0060",
      x: 6.7, y: 4.15, w: 6.2, h: 2.8,
      items: [
        "HIV-positive women: higher prevalence and persistence of HPV",
        "Higher risk of CIN progression and multifocal disease",
        "Screening: Pap every 12 months regardless of CD4 count (after 2 normal initial annual Paps, consider every 3 years if CD4 >200)",
        "HSIL more likely to progress in immunocompromised — treatment threshold lower",
        "Annual Pap recommended by most guidelines for HIV+",
        "Immunosuppression post-transplant: similar approach to HIV",
      ]
    },
  ];

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// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 17 — COLPOSCOPY & FOLLOW-UP PROCEDURES
// ═══════════════════════════════════════════════════════════════════════════
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  const s = addLightSlide(pres);
  sectionBanner(s, "PART 3 — MANAGEMENT PROCEDURES");
  s.addText("Colposcopy, LEEP, and Cone Biopsy — When and How", {
    x: 0.4, y: 0.65, w: 12, h: 0.5, fontSize: 20, bold: true, color: C.navy
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  const procedures = [
    {
      proc: "COLPOSCOPY",
      icon: "🔬",
      color: C.teal,
      x: 0.3, y: 1.25,
      when: "ASC-US + HPV+, ASC-H (all), LSIL (age ≥25), HSIL, AGC (all), AIS",
      how: "Magnified visualization of cervix after 3-5% acetic acid application. Identify acetowhite areas, punctation, mosaic patterns, atypical vessels. Map transformation zone. Directed biopsy of most abnormal-appearing areas + ECC.",
      findings: "Acetowhite epithelium, coarse punctation/mosaic, abnormal vessels → highly suspicious for high-grade CIN or carcinoma."
    },
    {
      proc: "LEEP / LLETZ",
      icon: "⚡",
      color: "#8B3A00",
      x: 0.3, y: 3.55,
      when: "CIN 2-3 confirmed on colposcopy, HSIL with no visible lesion (diagnostic), AIS (therapeutic)",
      how: "Loop Electrosurgical Excision Procedure. Excises transformation zone with 5-8mm margin. Provides tissue for histologic diagnosis AND is therapeutic for CIN 2-3. Can be done in office under local anesthesia.",
      findings: "Pathology specimen graded for CIN severity and margin status. Clear margins reduce recurrence. Endocervical margin involvement → consider repeat excision or cone."
    },
    {
      proc: "COLD KNIFE CONE (CKC)",
      icon: "🔪",
      color: "#1A5080",
      x: 6.7, y: 1.25,
      when: "AIS (preferred over LEEP for glandular lesions), recurrent HSIL, HSIL with unsatisfactory colposcopy, suspected microinvasion",
      how: "Scalpel excision of cervical cone under general/regional anesthesia. Larger specimen, cleaner margins than LEEP (no thermal artifact). ECC always performed after cone.",
      findings: "Margin status critical — positive margins (especially endocervical) increase recurrence risk. Hysterectomy if margins positive in AIS."
    },
    {
      proc: "D&C / HYSTEROSCOPY",
      icon: "🏥",
      color: "#5A2080",
      x: 6.7, y: 3.55,
      when: "Inadequate EMB, abnormal uterine bleeding with inconclusive outpatient biopsy, atypical hyperplasia, suspected polyp/submucosal fibroid",
      how: "Hysteroscopy + directed biopsy (gold standard for intrauterine pathology) allows direct visualization and targeted sampling. D&C (dilation and curettage) is blind but useful when hysteroscopy unavailable.",
      findings: "Histology same as EMB. Hysteroscopy additionally visualizes polyps, fibroids, AVM, Asherman's. Essential if EMB yields 'insufficient' tissue in high-suspicion cases."
    },
  ];

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}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 18 — QUICK REFERENCE SUMMARY TABLE
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = addDarkSlide(pres);
  sectionBanner(s, "QUICK REFERENCE SUMMARY");
  s.addText("At-a-Glance: Pap Smear & EMB Report Interpretation", {
    x: 0.4, y: 0.65, w: 12, h: 0.5, fontSize: 20, bold: true, color: C.white
  });

  const summaryRows = [
    ["Finding", "Risk Level", "Next Step", "Timeframe"],
    // PAP
    ["PAP: NILM", "✓ Low", "Routine screening per age guidelines", "Per schedule"],
    ["PAP: NILM + HPV 16/18+", "▲ High-intermediate", "Colposcopy", "Prompt"],
    ["PAP: ASC-US + HPV-", "✓ Low", "Repeat co-testing in 3 years", "3 years"],
    ["PAP: ASC-US + HPV+", "▲ Moderate", "Colposcopy", "3-6 months"],
    ["PAP: ASC-H", "▲ Moderate-high", "Colposcopy", "Prompt"],
    ["PAP: LSIL", "▲ Moderate", "Colposcopy (age ≥25)", "3-6 months"],
    ["PAP: HSIL", "⚠ High", "Colposcopy ± LEEP", "Urgent"],
    ["PAP: AGC (any)", "⚠ High", "Colposcopy + ECC + EMB", "Urgent"],
    ["PAP: AIS", "⚠ Very High", "Diagnostic cone biopsy", "Urgent"],
    // EMB
    ["EMB: Insufficient", "? Unknown", "Repeat EMB / D&C / hysteroscopy", "1-3 months"],
    ["EMB: Normal", "✓ Low", "Reassure; treat AUB cause", "Routine"],
    ["EMB: Simple hyperplasia", "✓ Low-intermediate", "Progestin therapy + follow-up EMB", "3-6 months"],
    ["EMB: Complex hyperplasia", "▲ Intermediate", "Progestin therapy + biopsy in 3-6 months", "3-6 months"],
    ["EMB: Atypical hyperplasia / EIN", "⚠ High", "Hysterectomy or high-dose progestin if fertility desired", "Urgent"],
    ["EMB: Adenocarcinoma", "⚠ Malignant", "Gynecologic oncology referral + staging", "Immediate"],
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// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 19 — CLOSING / KEY TAKE-HOME POINTS
// ═══════════════════════════════════════════════════════════════════════════
{
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  s.addText("KEY TAKE-HOME POINTS", { x: 0.4, y: 0.1, w: 12.5, h: 0.6, fontSize: 18, bold: true, color: C.white });

  const points = [
    ["EMB Findings", "Normal histology is reassuring but does not exclude pathology if symptoms persist. Atypical hyperplasia / EIN carries significant malignant potential — hysterectomy is the standard of care."],
    ["PAP: NILM is Not Always Trivial", "Always check HPV co-test result alongside NILM. NILM + HPV 16/18 positive still requires colposcopy."],
    ["AGC = Most Dangerous Pap Result", "Don't under-manage AGC. Up to 25% of nonpregnant patients with AGC have a significant pathology including endometrial carcinoma. Full workup mandatory."],
    ["HSIL = Urgent, Not Elective", "HSIL must not be managed with 'repeat Pap.' Colposcopy is mandatory and immediate LEEP is acceptable (see-and-treat approach)."],
    ["Screening Stops at 65", "Only if adequate prior screening documented. Inadequately screened women >65 should continue screening."],
    ["Pregnancy Modifies Management", "Defer treatment of CIN (except invasive cancer) until postpartum. Colposcopy is safe. ECC and EMB must be avoided."],
    ["Lynch Syndrome = Lifetime Risk Up to 60%", "Annual TVU + EMB from age 35. Discuss prophylactic hysterectomy after childbearing is complete."],
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  s.addText("Pfenninger & Fowler's Procedures | Symptom to Diagnosis 4e | Bailey & Love's Surgery 28e | Creasy & Resnik's MFM | Tietz Lab Medicine 7e", {
    x: 0.3, y: 7.22, w: 12.7, h: 0.24, fontSize: 8.5, color: C.white, italic: true
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// ─── WRITE FILE ──────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/endometrial-pap-pptx/Endometrial_Biopsy_and_Pap_Smear_Interpretation.pptx" })
  .then(() => console.log("SUCCESS: Presentation saved."))
  .catch(err => console.error("ERROR:", err));

cd /home/daytona/workspace/endometrial-pap-pptx && node build.js 2>&1

~/endometrial-pap-pptx/build.js

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/endometrial-pap-pptx/build.js'

~/endometrial-pap-pptx/build.js

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/endometrial-pap-pptx/build.js'

cd /home/daytona/workspace/endometrial-pap-pptx && node build.js 2>&1

~/endometrial-pap-pptx/build_colposcopy.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_WIDE";
pres.title = "Colposcopy-Guided Biopsy Interpretation";
pres.author = "Orris Medical Education";

// ─── COLOR PALETTE ───────────────────────────────────────────────────────────
const C = {
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  plum:       "4A1060",  // accent dark
  violet:     "7B2FA8",  // main accent
  lavender:   "A855D9",  // highlight accent
  coral:      "C84B31",  // warnings / high-grade
  gold:       "D4A017",  // highlight labels
  white:      "FFFFFF",
  offwhite:   "F5F0FA",
  ltpurple:   "E8D5F5",
  midgray:    "8898A8",
  ltgray:     "DDE3EC",
  green:      "1E6B3C",  // normal/benign
  amber:      "B07800",  // intermediate
  red:        "A01010",  // malignant/high-grade
  teal:       "1A7A7A",  // info boxes
  navy:       "0D1B3E",
};

// ─── HELPERS ────────────────────────────────────────────────────────────────
function darkSlide() {
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}
function lightSlide() {
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function banner(slide, text) {
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}

// ═══════════════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE
// ═══════════════════════════════════════════════════════════════════════
{
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  s.addText("Complete Interpretation of", {
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  s.addText("Colposcopy-Guided\nCervical Biopsy Reports", {
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  s.addText("Colposcopic findings • Biopsy histology • LAST/Lower ANOGENITAL Standardized Terminology\nCIN grading • p16/Ki-67 biomarkers • ASCCP management algorithms", {
    x: 0.75, y: 4.55, w: 11.5, h: 0.7, fontSize: 12, color: C.ltgray, italic: true
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  s.addText("Sources: Berek & Novak's Gynecology | Robbins & Cotran Pathologic Basis of Disease\nPfenninger & Fowler's Procedures for Primary Care | Sabiston Textbook of Surgery 21e", {
    x: 0.75, y: 6.55, w: 11.5, h: 0.7, fontSize: 10, color: C.midgray, italic: true
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}

// ═══════════════════════════════════════════════════════════════════════
// SLIDE 2 — TABLE OF CONTENTS
// ═══════════════════════════════════════════════════════════════════════
{
  const s = lightSlide();
  banner(s, "OVERVIEW");
  s.addText("What This Presentation Covers", {
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  const parts = [
    ["PART 1", "Anatomy & The Transformation Zone", "SCJ, TZ types, ectropion — where disease begins"],
    ["PART 2", "The Colposcopy Procedure", "Technique, satisfactory vs unsatisfactory, acetic acid, Lugol's iodine"],
    ["PART 3", "Colposcopic Findings", "Acetowhite, punctation, mosaic, atypical vessels, leukoplakia — grading systems"],
    ["PART 4", "Biopsy Histology & LAST Terminology", "CIN 1/LSIL, CIN 2/HSIL, CIN 3, koilocytes, morphology, p16/Ki-67"],
    ["PART 5", "Natural History & Risk Stratification", "Regression/progression rates, HPV type, host factors"],
    ["PART 6", "Management Algorithms", "CIN 1, CIN 2, CIN 3, AIS, special populations, ASCCP 2019"],
    ["PART 7", "Treatment Modalities", "Cryotherapy, LEEP, cold knife cone, margins, surveillance"],
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// ═══════════════════════════════════════════════════════════════════════
// SLIDE 3 — ANATOMY: TRANSFORMATION ZONE & SCJ
// ═══════════════════════════════════════════════════════════════════════
{
  const s = lightSlide();
  banner(s, "PART 1 — ANATOMY OF THE TRANSFORMATION ZONE");
  s.addText("The Squamocolumnar Junction & Transformation Zone", {
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  // Left anatomy text
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  s.addText("Key Anatomical Concepts", { x: 0.5, y: 1.32, w: 5.7, h: 0.4, fontSize: 14, bold: true, color: C.gold });

  const concepts = [
    ["Original SCJ", "Junction between original squamous (ectocervix) and columnar (endocervix) epithelium. Static — position determines TZ size."],
    ["Physiologic Ectropion / Ectopy", "Columnar epithelium extending onto ectocervix. Appears red, granular, friable. Normal variant — prominent in adolescence, pregnancy, OCP use."],
    ["New (Functional) SCJ", "Current junction between squamous and columnar epithelium. Located at the upper margin of the transformation zone. Must be fully visualized for a satisfactory colposcopy."],
    ["Transformation Zone (TZ)", "Area between original and functional SCJ. Site of squamous metaplasia — highest vulnerability to HPV-induced neoplasia. Nearly ALL CIN and cervical carcinomas arise here."],
    ["TZ Type (IFCPC 2011)", "Type 1: Fully ectocervical, completely visible\nType 2: Partly endocervical but fully visible\nType 3: Partly/fully endocervical, NOT fully visible → unsatisfactory colposcopy"],
    ["Metaplasia", "Replacement of columnar epithelium by squamous epithelium. Active zone of cell division → susceptibility to HPV. Immature metaplasia appears gray-white on acetic acid."],
  ];

  concepts.forEach(([title, body], i) => {
    s.addShape(pres.ShapeType.rect, { x: 0.38, y: 1.82 + i * 0.88, w: 0.07, h: 0.75, fill: { color: C.lavender }, line: { type: "none" } });
    s.addText(title, { x: 0.55, y: 1.85 + i * 0.88, w: 5.5, h: 0.28, fontSize: 11.5, bold: true, color: C.lavender });
    s.addText(body, { x: 0.55, y: 2.14 + i * 0.88, w: 5.5, h: 0.48, fontSize: 10.5, color: C.ltgray, wrap: true });
  });

  // Right boxes — TZ types + clinical significance
  const tzTypes = [
    { type: "TZ TYPE 1", color: C.green, x: 6.7, y: 1.25, desc: "Ectocervical only\nEntirely visible on colposcopy\nAblatve treatment (cryotherapy) acceptable\nNo endocervical assessment needed", note: "MOST FAVORABLE" },
    { type: "TZ TYPE 2", color: C.amber, x: 6.7, y: 3.05, desc: "Extends into endocervical canal\nNew SCJ fully visible with aid of endocervical speculum\nAblation may be acceptable if entire TZ visualized\nECC recommended", note: "INTERMEDIATE" },
    { type: "TZ TYPE 3", color: C.coral, x: 6.7, y: 4.85, desc: "Extends into canal\nNew SCJ NOT fully visible\nSatisfactory colposcopy NOT possible\nDiagnostic excisional procedure (cone) required\nECC mandatory", note: "UNSATISFACTORY" },
  ];

  tzTypes.forEach(t => {
    s.addShape(pres.ShapeType.rect, { x: t.x, y: t.y, w: 6.2, h: 1.7, fill: { color: t.color }, line: { type: "none" } });
    s.addText(t.type, { x: t.x + 0.15, y: t.y + 0.1, w: 4.0, h: 0.4, fontSize: 16, bold: true, color: C.white });
    s.addText(t.note, { x: t.x + 4.2, y: t.y + 0.15, w: 1.8, h: 0.35, fontSize: 10, bold: true, color: C.white, align: "right" });
    s.addText(t.desc, { x: t.x + 0.15, y: t.y + 0.55, w: 5.85, h: 1.1, fontSize: 11, color: C.white, wrap: true });
  });

  s.addShape(pres.ShapeType.rect, { x: 6.7, y: 6.6, w: 6.2, h: 0.65, fill: { color: C.teal }, line: { type: "none" } });
  s.addText("Clinical pearl: The SCJ migrates inward (into the canal) with age and menopause. In postmenopausal women TZ is almost always Type 3 — expect unsatisfactory colposcopy and plan for cone/ECC.", {
    x: 6.85, y: 6.65, w: 5.9, h: 0.55, fontSize: 10, color: C.white, wrap: true
  });
}

// ═══════════════════════════════════════════════════════════════════════
// SLIDE 4 — COLPOSCOPY PROCEDURE STEP-BY-STEP
// ═══════════════════════════════════════════════════════════════════════
{
  const s = lightSlide();
  banner(s, "PART 2 — THE COLPOSCOPY PROCEDURE");
  s.addText("Technique, Setup & Systematic Examination Protocol", {
    x: 0.4, y: 0.65, w: 12, h: 0.5, fontSize: 20, bold: true, color: C.darkpurple
  });

  const steps = [
    { n: "1", title: "Patient Prep & History", body: "Ideally mid-cycle (not menstruating). No intercourse / douching 24h prior. Review referral cytology, HPV result, prior biopsies. Informed consent. NSAID premedication." },
    { n: "2", title: "Initial Visualization (No Stain)", body: "Large Graves speculum. Survey cervix, vaginal walls. Identify any leukoplakia (white before acid — biopsy first). Assess discharge. Identify os & TZ type." },
    { n: "3", title: "3–5% Acetic Acid Application", body: "Saturate cotton ball / spray. Wait 60–90 seconds. Repeat ×2-3. Identify acetowhite areas, vascular patterns (punctation, mosaic, atypical vessels), cuffed gland openings." },
    { n: "4", title: "Systematic Quadrant Survey", body: "Examine 12→3→6→9 o'clock under colposcopic magnification. Use green filter to enhance vascular patterns. Map TZ type. Note whether entire SCJ is visible." },
    { n: "5", title: "Schiller / Lugol's Iodine Test", body: "Normal glycogenated squamous epithelium stains mahogany brown. Dysplastic / columnar / metaplastic cells = iodine-negative (mustard yellow). Define biopsy sites." },
    { n: "6", title: "Directed Biopsy", body: "Biopsy most acetowhite / most abnormal-appearing areas. At least 2 biopsies recommended (improves detection). Cervical biopsy forceps (Tischler, Burke). Mark 12 o'clock. Fix in formalin." },
    { n: "7", title: "Endocervical Curettage (ECC)", body: "Kevorkian curette or cytobrush. Essential if TZ not fully visible (Type 2/3), AGC on cytology, post-treatment surveillance, or discordant results. AVOID in pregnancy." },
    { n: "8", title: "Post-Procedure", body: "Monsel's solution (ferric subsulfate) or silver nitrate for hemostasis. Advise spotting ×1-3 days, pelvic rest ×7 days. Report: fever, heavy bleeding, purulent discharge." },
  ];

  steps.forEach((st, i) => {
    const col = i % 2 === 0 ? 0.3 : 6.75;
    const row = Math.floor(i / 2);
    const y = 1.25 + row * 1.55;
    s.addShape(pres.ShapeType.roundRect, { x: col, y, w: 6.25, h: 1.45, fill: { color: C.darkpurple }, line: { type: "none" }, rectRadius: 0.08 });
    s.addShape(pres.ShapeType.rect, { x: col, y, w: 0.55, h: 1.45, fill: { color: C.violet }, line: { type: "none" } });
    s.addText(st.n, { x: col, y: y + 0.43, w: 0.55, h: 0.6, fontSize: 22, bold: true, color: C.white, align: "center" });
    s.addText(st.title, { x: col + 0.65, y: y + 0.1, w: 5.4, h: 0.35, fontSize: 12, bold: true, color: C.gold });
    s.addText(st.body, { x: col + 0.65, y: y + 0.48, w: 5.4, h: 0.88, fontSize: 10.5, color: C.ltgray, wrap: true });
  });
}

// ═══════════════════════════════════════════════════════════════════════
// SLIDE 5 — SATISFACTORY vs UNSATISFACTORY COLPOSCOPY
// ═══════════════════════════════════════════════════════════════════════
{
  const s = darkSlide();
  banner(s, "PART 2 — SATISFACTORY vs UNSATISFACTORY COLPOSCOPY");
  s.addText("Adequacy Assessment — The First and Most Critical Decision", {
    x: 0.4, y: 0.65, w: 12, h: 0.5, fontSize: 19, bold: true, color: C.white
  });

  // Two large boxes
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.25, w: 6.1, h: 5.2, fill: { color: C.green }, line: { type: "none" } });
  s.addText("SATISFACTORY", { x: 0.5, y: 1.3, w: 5.7, h: 0.5, fontSize: 22, bold: true, color: C.white });
  s.addText("(Adequate Colposcopy)", { x: 0.5, y: 1.82, w: 5.7, h: 0.35, fontSize: 13, italic: true, color: C.white });

  const satItems = [
    "The entire squamocolumnar junction (new SCJ) is FULLY VISIBLE",
    "The entire transformation zone is visualized",
    "All acetowhite or iodine-negative lesions are completely identified and their borders seen",
    "TZ Type 1 or 2 confirmed",
    "Management: Directed biopsy ± ECC based on findings. Ablation (cryotherapy) acceptable for CIN 1-2 if all criteria met",
    "If cytology and colposcopy are discordant (e.g., HSIL cytology but no lesion seen), repeat colposcopy + multiple biopsies or proceed to diagnostic excision",
  ];
  satItems.forEach((item, i) => {
    s.addText("✓  " + item, { x: 0.5, y: 2.28 + i * 0.63, w: 5.7, h: 0.58, fontSize: 11.5, color: C.white, wrap: true });
  });

  s.addShape(pres.ShapeType.rect, { x: 6.7, y: 1.25, w: 6.2, h: 5.2, fill: { color: C.coral }, line: { type: "none" } });
  s.addText("UNSATISFACTORY", { x: 6.9, y: 1.3, w: 5.8, h: 0.5, fontSize: 22, bold: true, color: C.white });
  s.addText("(Inadequate Colposcopy)", { x: 6.9, y: 1.82, w: 5.8, h: 0.35, fontSize: 13, italic: true, color: C.white });

  const unsatItems = [
    "Entire SCJ NOT visible (endocervical extension — TZ Type 3)",
    "Lesion extends into canal and upper border is not seen",
    "Severe inflammation / atrophy obscuring visualization",
    "Reason for unsatisfactory MUST be stated in the report",
    "Management: Diagnostic excisional procedure (LEEP / cold knife cone) is MANDATORY — ablation is NEVER acceptable",
    "ECC must accompany or precede excision",
    "Postmenopausal women: topical estrogen 2-4 weeks may improve visualization (maturation of atrophic epithelium)",
  ];
  unsatItems.forEach((item, i) => {
    s.addText("✗  " + item, { x: 6.9, y: 2.28 + i * 0.63, w: 5.8, h: 0.58, fontSize: 11.5, color: C.white, wrap: true });
  });

  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 6.55, w: 12.7, h: 0.75, fill: { color: C.violet }, line: { type: "none" } });
  s.addText("ASCCP Principle: Adequacy of colposcopy is the gatekeeper for ALL management decisions. When in doubt, perform diagnostic excision rather than observation.", {
    x: 0.5, y: 6.6, w: 12.3, h: 0.65, fontSize: 11, bold: true, color: C.white, valign: "middle"
  });
}

// ═══════════════════════════════════════════════════════════════════════
// SLIDE 6 — COLPOSCOPIC FINDINGS: ACETIC ACID & VASCULAR PATTERNS
// ═══════════════════════════════════════════════════════════════════════
{
  const s = lightSlide();
  banner(s, "PART 3 — COLPOSCOPIC FINDINGS: ACETOWHITE & VASCULAR PATTERNS");
  s.addText("Interpreting What You See — Systematic Finding Analysis", {
    x: 0.4, y: 0.65, w: 12, h: 0.5, fontSize: 19, bold: true, color: C.darkpurple
  });

  const findings = [
    {
      name: "ACETOWHITE EPITHELIUM",
      color: C.navy, x: 0.3, y: 1.25, w: 6.1, h: 2.15,
      mechanism: "Acetic acid coagulates nuclear protein → opaque white appearance. Degree inversely proportional to cytoplasmic glycogen.",
      significance: "Thin, faint, translucent AW: immature metaplasia or HPV effect (low grade)\nDense, thick, opaque AW with sharp borders: high-grade CIN\nCuffed gland openings within AW: deep CIN extending into crypts (high grade)",
      risk: "Grade"
    },
    {
      name: "LEUKOPLAKIA",
      color: "#2A5A3A", x: 6.7, y: 1.25, w: 6.2, h: 2.15,
      mechanism: "White plaque VISIBLE BEFORE acetic acid application. Represents surface keratinization (hyperkeratosis).",
      significance: "Biopsy mandatory — leukoplakia can overlie high-grade CIN or invasive cancer. Cannot reliably assess subepithelial changes until keratotic layer is removed on biopsy section.",
      risk: "Biopsy first"
    },
    {
      name: "PUNCTATION",
      color: "#5A2080", x: 0.3, y: 3.48, w: 6.1, h: 2.15,
      mechanism: "End-on view of capillary loops from columnar villi preserved within acetowhite area. Look like red dots on white background.",
      significance: "Fine punctation: CIN 1 or metaplasia (low-grade)\nCoarse punctation (irregular, widely spaced, caliber variation): CIN 2-3 or microinvasion\nAlways in association with acetowhite epithelium — punctation alone (outside AW) is insignificant",
      risk: "Coarse = high risk"
    },
    {
      name: "MOSAIC PATTERN",
      color: "#7B3010", x: 6.7, y: 3.48, w: 6.2, h: 2.15,
      mechanism: "Capillaries surrounding polygonal blocks of acetowhite epithelium — looks like tiles. Arises from coalescence of punctate vessels or gland-surrounding vessels.",
      significance: "Fine mosaic: CIN 1-2 (low to intermediate grade)\nCoarse mosaic (irregular tile size, wide intercapillary distance): CIN 2-3 or invasion\nCombination of coarse mosaic + coarse punctation = HIGH risk for CIN 3",
      risk: "Coarse = high risk"
    },
    {
      name: "ATYPICAL VESSELS",
      color: C.red, x: 0.3, y: 5.71, w: 6.1, h: 1.5,
      mechanism: "Irregular caliber vessels running parallel to surface: looped, branching, reticular, corkscrew patterns.",
      significance: "Highly predictive of INVASIVE cervical carcinoma. If atypical vessels identified: biopsy immediately, refer to gynecologic oncology.",
      risk: "⚠ INVASION"
    },
    {
      name: "IODINE / LUGOL'S TEST",
      color: C.teal, x: 6.7, y: 5.71, w: 6.2, h: 1.5,
      mechanism: "Iodine binds to glycogen in normal squamous epithelium → mahogany-brown stain. Dysplastic or columnar cells lack glycogen → yellow/mustard (iodine-negative).",
      significance: "Iodine-negative (yellow): dysplastic, columnar, or poorly glycogenated → biopsy\nIodine-positive (brown): normal squamous epithelium — no biopsy needed\nUsed to delineate biopsy/excision margins (remove all yellow areas)",
      risk: "Defines margins"
    },
  ];

  findings.forEach(f => {
    s.addShape(pres.ShapeType.rect, { x: f.x, y: f.y, w: f.w, h: f.h, fill: { color: f.color }, line: { type: "none" } });
    s.addText(f.name, { x: f.x + 0.15, y: f.y + 0.08, w: f.w - 0.3, h: 0.32, fontSize: 12, bold: true, color: C.gold });
    s.addText("Mechanism: " + f.mechanism, { x: f.x + 0.15, y: f.y + 0.43, w: f.w - 0.3, h: 0.58, fontSize: 10, color: C.ltgray, wrap: true, italic: true });
    s.addText("Significance: " + f.significance, { x: f.x + 0.15, y: f.y + 1.03, w: f.w - 0.3, h: 0.85, fontSize: 10, color: C.white, wrap: true });
  });
}

// ═══════════════════════════════════════════════════════════════════════
// SLIDE 7 — COLPOSCOPIC GRADING SYSTEMS (REID / SWEDE / IFCPC)
// ═══════════════════════════════════════════════════════════════════════
{
  const s = darkSlide();
  banner(s, "PART 3 — COLPOSCOPIC GRADING SYSTEMS");
  s.addText("Reid Colposcopic Index & IFCPC 2011 Grading Terminology", {
    x: 0.4, y: 0.65, w: 12, h: 0.5, fontSize: 19, bold: true, color: C.white
  });

  // Reid Index table
  s.addText("Reid Colposcopic Index (RCI) — Score 0-8", { x: 0.3, y: 1.25, w: 8, h: 0.4, fontSize: 14, bold: true, color: C.gold });

  const reidHeaders = ["Feature", "0 Points", "1 Point", "2 Points"];
  const reidRows = [
    ["Acetowhite Color", "Shiny white; snow-white; indistinguishable from immature metaplasia", "Intermediate shade (dull, opaque)", "Dull, oyster white; dense, thick opacity"],
    ["Lesion Margin & Surface", "Feathered, jagged; satellite lesion; angular or flocculated; microcondylomatous or micropapillary surface", "Regular, smooth margins with uniform contour", "Straight-edged, distinct margins with dense AW; rolled, peeling edges"],
    ["Vessels", "Fine caliber; poorly formed; ill-defined patterns; fine punctation / fine mosaic / absence of vessels", "Absent vessels", "Coarse punctation; coarse mosaic; atypical vessels"],
    ["Iodine Staining", "Positive iodine uptake (mahogany brown)", "Partial iodine staining (variegated)", "Negative iodine uptake (mustard yellow)"],
  ];
  const rColW = [2.8, 3.0, 2.8, 3.5];
  reidHeaders.forEach((h, ci) => {
    let xp = 0.3 + rColW.slice(0, ci).reduce((a, b) => a + b, 0);
    s.addShape(pres.ShapeType.rect, { x: xp, y: 1.72, w: rColW[ci], h: 0.4, fill: { color: C.violet }, line: { type: "none" } });
    s.addText(h, { x: xp + 0.05, y: 1.74, w: rColW[ci] - 0.1, h: 0.36, fontSize: 11, bold: true, color: C.white, valign: "middle" });
  });
  reidRows.forEach((row, ri) => {
    const bg = ri % 2 === 0 ? "#1C1040" : "#261450";
    row.forEach((cell, ci) => {
      let xp = 0.3 + rColW.slice(0, ci).reduce((a, b) => a + b, 0);
      s.addShape(pres.ShapeType.rect, { x: xp, y: 2.15 + ri * 0.72, w: rColW[ci], h: 0.7, fill: { color: bg }, line: { color: "333366", pt: 0.3 } });
      s.addText(cell, { x: xp + 0.05, y: 2.18 + ri * 0.72, w: rColW[ci] - 0.1, h: 0.64, fontSize: 9.5, color: C.ltgray, valign: "middle", wrap: true });
    });
  });

  // Score interpretation
  const scores = [
    { range: "RCI 0–2", interp: "CIN 1 / HPV", action: "Observation or ablation if persistent 12 months", color: C.green },
    { range: "RCI 3–4", interp: "CIN 1–2", action: "Biopsy; manage per histology", color: C.amber },
    { range: "RCI 5–8", interp: "CIN 2–3 likely", action: "Biopsy; excisional procedure", color: C.red },
  ];
  s.addText("Score Interpretation:", { x: 0.3, y: 5.08, w: 4, h: 0.35, fontSize: 13, bold: true, color: C.gold });
  scores.forEach((sc, i) => {
    s.addShape(pres.ShapeType.rect, { x: 0.3 + i * 4.3, y: 5.5, w: 4.1, h: 1.2, fill: { color: sc.color }, line: { type: "none" } });
    s.addText(sc.range, { x: 0.5 + i * 4.3, y: 5.55, w: 3.7, h: 0.38, fontSize: 16, bold: true, color: C.white });
    s.addText(sc.interp, { x: 0.5 + i * 4.3, y: 5.95, w: 3.7, h: 0.3, fontSize: 12, color: C.white, bold: true });
    s.addText(sc.action, { x: 0.5 + i * 4.3, y: 6.3, w: 3.7, h: 0.35, fontSize: 10.5, color: C.white, italic: true });
  });

  s.addText("IFCPC 2011: Grade 1 (minor) = thin AW, irregular margins, fine vessels. Grade 2 (major) = dense AW, coarse vessels, sharp demarcation, cuffed glands. Both grades require biopsy; Grade 2 highly predictive of CIN 2+.", {
    x: 0.3, y: 6.85, w: 12.7, h: 0.55, fontSize: 10, italic: true, color: C.midgray, wrap: true
  });
}

// ═══════════════════════════════════════════════════════════════════════
// SLIDE 8 — BIOPSY REPORT: LAST TERMINOLOGY & HISTOLOGY
// ═══════════════════════════════════════════════════════════════════════
{
  const s = lightSlide();
  banner(s, "PART 4 — BIOPSY REPORT INTERPRETATION: LAST TERMINOLOGY");
  s.addText("Lower Anogenital Squamous Terminology (LAST / CAP-ASCCP 2012)", {
    x: 0.4, y: 0.65, w: 12, h: 0.5, fontSize: 18, bold: true, color: C.darkpurple
  });

  // Terminology evolution box
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.25, w: 12.7, h: 0.9, fill: { color: C.darkpurple }, line: { type: "none" } });
  s.addText("Terminology Evolution: Old Dysplasia → CIN → LAST Two-Tier System", { x: 0.5, y: 1.3, w: 12.0, h: 0.35, fontSize: 13, bold: true, color: C.gold });

  const termRow = ["Old Dysplasia", "CIN Grading", "LAST (2012) / WHO 5th Ed", "Bethesda Cytology"];
  const termData = [
    ["Mild dysplasia", "CIN 1", "LSIL (Low-Grade SIL)", "LSIL"],
    ["Moderate dysplasia", "CIN 2", "HSIL (may add 'CIN 2' in parentheses)", "HSIL"],
    ["Severe dysplasia", "CIN 3", "HSIL (may add 'CIN 3' in parentheses)", "HSIL"],
    ["Carcinoma in situ", "CIN 3", "HSIL (add 'CIN 3' or 'CIS')", "HSIL"],
  ];
  const tColW = [2.8, 2.5, 4.2, 3.0];
  termRow.forEach((h, ci) => {
    let xp = 0.3 + tColW.slice(0, ci).reduce((a, b) => a + b, 0);
    s.addShape(pres.ShapeType.rect, { x: xp, y: 2.2, w: tColW[ci], h: 0.4, fill: { color: C.violet }, line: { type: "none" } });
    s.addText(h, { x: xp + 0.05, y: 2.22, w: tColW[ci] - 0.1, h: 0.36, fontSize: 10.5, bold: true, color: C.white, valign: "middle" });
  });
  termData.forEach((row, ri) => {
    const bg = ri % 2 === 0 ? C.ltpurple : C.white;
    row.forEach((cell, ci) => {
      let xp = 0.3 + tColW.slice(0, ci).reduce((a, b) => a + b, 0);
      s.addShape(pres.ShapeType.rect, { x: xp, y: 2.63 + ri * 0.42, w: tColW[ci], h: 0.4, fill: { color: bg }, line: { color: C.ltgray, pt: 0.3 } });
      s.addText(cell, { x: xp + 0.05, y: 2.66 + ri * 0.42, w: tColW[ci] - 0.1, h: 0.34, fontSize: 10.5, color: C.darkpurple, valign: "middle" });
    });
  });

  // Histologic features panels
  const histoPanels = [
    {
      grade: "LSIL (CIN 1)", color: C.green, x: 0.3, y: 4.45,
      features: [
        "Koilocytic atypia — HALLMARK of HPV infection",
        "Koilocyte: perinuclear cytoplasmic clearing (halo) + irregular, raisinoid hyperchromatic nucleus",
        "Dysplastic cells confined to LOWER 1/3 of epithelium (basal layer)",
        "Upper 2/3: retained maturation toward surface",
        "Binucleation and multinucleation common",
        "Mitoses present but confined to lower epithelium",
        "p16: negative or non-block (focal/patchy)",
        "Ki-67: elevated cells in upper 1/3 (should be negative normally)",
        "Represents PRODUCTIVE HPV infection — high viral replication, low oncogenic risk",
      ]
    },
    {
      grade: "HSIL (CIN 2)", color: C.amber, x: 6.7, y: 4.45,
      features: [
        "Dysplastic cells extend into UPPER 2/3 of epithelium (but not full thickness)",
        "Reduced maturation in upper half",
        "Increased N:C ratio, irregular nuclear membranes, hyperchromasia",
        "Mitoses in upper half of epithelium",
        "Loss of cell polarity in mid/upper layers",
        "p16: BLOCK-POSITIVE (strong, diffuse cytoplasmic and nuclear) — confirms HSIL",
        "Ki-67: elevated cells throughout all layers",
        "EQUIVOCAL CIN 2: If p16 negative → reclassify as LSIL (conserve, observe)\nIf p16 positive → HSIL (treat)",
        "CIN 2 is the management threshold — treatment generally indicated",
      ]
    },
  ];

  histoPanels.forEach(p => {
    s.addShape(pres.ShapeType.rect, { x: p.x, y: p.y, w: 6.2, h: 2.8, fill: { color: p.color }, line: { type: "none" } });
    s.addText(p.grade, { x: p.x + 0.15, y: p.y + 0.1, w: 5.7, h: 0.4, fontSize: 15, bold: true, color: C.white });
    p.features.forEach((feat, i) => {
      s.addText("• " + feat, { x: p.x + 0.15, y: p.y + 0.56 + i * 0.24, w: 5.7, h: 0.23, fontSize: 9.5, color: C.white, wrap: true });
    });
  });
}

// ═══════════════════════════════════════════════════════════════════════
// SLIDE 9 — CIN 3 / HSIL HISTOLOGY + CARCINOMA FEATURES
// ═══════════════════════════════════════════════════════════════════════
{
  const s = darkSlide();
  banner(s, "PART 4 — HSIL (CIN 3) AND MICROINVASIVE CARCINOMA");
  s.addText("Full-Thickness Dysplasia to Early Invasion — Histologic Spectrum", {
    x: 0.4, y: 0.65, w: 12, h: 0.5, fontSize: 19, bold: true, color: C.white
  });

  // CIN 3 box
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.25, w: 6.1, h: 5.5, fill: { color: "#3A0A00" }, line: { type: "none" } });
  s.addText("HSIL — CIN 3 / Carcinoma In Situ", { x: 0.5, y: 1.32, w: 5.7, h: 0.4, fontSize: 14, bold: true, color: C.coral });

  const cin3Features = [
    ["Full-Thickness Atypia", "Dysplastic cells involve the ENTIRE thickness of the epithelium (not just basal). No surface maturation whatsoever."],
    ["Nuclear Features", "Marked nuclear enlargement, pleomorphism, coarse irregularly distributed chromatin, prominent nucleoli. High N:C ratio throughout all layers."],
    ["Mitoses", "Abnormal mitotic figures (tripolar, quadripolar) throughout all layers including surface. This is key — abnormal mitoses in upper epithelium = CIN 3."],
    ["Koilocytes", "May be absent or sparse in CIN 3 (low HPV replication — integration into host genome predominates)."],
    ["p16 IHC", "STRONG block-positive staining throughout full epithelial thickness. Mandatory in any HSIL to confirm and in CIN 2 to triage."],
    ["Ki-67", "Diffusely positive (MIB-1) through all epithelial layers. Paired with p16 confirms HSIL."],
    ["Rag Sign", "Irregular, ragged colposcopic surface correlating to CIN 3. Cuffed gland openings indicate deep endocervical gland involvement."],
    ["Progression Risk", "30% persist, 60% progress to carcinoma without treatment. TREATMENT MANDATORY."],
  ];

  cin3Features.forEach(([title, body], i) => {
    s.addShape(pres.ShapeType.rect, { x: 0.4, y: 1.83 + i * 0.6, w: 0.06, h: 0.5, fill: { color: C.coral }, line: { type: "none" } });
    s.addText(title, { x: 0.55, y: 1.87 + i * 0.6, w: 5.6, h: 0.22, fontSize: 11, bold: true, color: C.coral });
    s.addText(body, { x: 0.55, y: 2.1 + i * 0.6, w: 5.6, h: 0.3, fontSize: 10, color: C.ltgray, wrap: true });
  });

  // Right — invasion + staging
  s.addShape(pres.ShapeType.rect, { x: 6.7, y: 1.25, w: 6.2, h: 2.5, fill: { color: "#1A0A3A" }, line: { type: "none" } });
  s.addText("Microinvasive Carcinoma (FIGO Stage IA)", { x: 6.9, y: 1.32, w: 5.8, h: 0.4, fontSize: 13, bold: true, color: C.lavender });

  const microinv = [
    "Histologic diagnosis only — cannot diagnose microinvasion at colposcopy",
    "Features: Irregular tongues of squamous cells breaking through basement membrane, surrounded by desmoplastic stroma. Angiolymphatic space invasion.",
    "FIGO IA1: Stromal invasion ≤3 mm depth, ≤7 mm horizontal spread",
    "FIGO IA2: Invasion 3-5 mm depth, ≤7 mm horizontal spread",
    "Requires cone biopsy with negative margins for definitive diagnosis",
    "Management IA1 (no LVSI): Simple trachelectomy or hysterectomy",
  ];
  microinv.forEach((item, i) => {
    s.addText("• " + item, { x: 6.9, y: 1.8 + i * 0.3, w: 5.8, h: 0.28, fontSize: 10.5, color: C.ltgray, wrap: true });
  });

  s.addShape(pres.ShapeType.rect, { x: 6.7, y: 3.85, w: 6.2, h: 2.9, fill: { color: "#2A0A4A" }, line: { type: "none" } });
  s.addText("Biopsy Report — What to Look For", { x: 6.9, y: 3.92, w: 5.8, h: 0.4, fontSize: 13, bold: true, color: C.gold });

  const biopsyReport = [
    ["Diagnosis", "LSIL / HSIL / CIN grade (LAST preferred). Koilocytes noted."],
    ["Biomarkers", "p16 (block-positive = HSIL). Ki-67 pattern. Both mandatory for CIN 2."],
    ["Orientation", "Specimen orientation (12 o'clock suture). Biopsy site number."],
    ["Depth of Lesion", "Superficial / involving gland crypts / full thickness. Basement membrane intact vs breached."],
    ["Margins (Cone/LEEP)", "Ectocervical margin: positive / negative / close (< 1 mm). Endocervical margin: positive / negative (most critical). Deep margin."],
    ["Ancillary Findings", "Endocervical involvement, angiolymphatic space invasion, concurrent AIS."],
  ];

  biopsyReport.forEach(([label, body], i) => {
    s.addShape(pres.ShapeType.rect, { x: 6.75, y: 4.42 + i * 0.36, w: 5.9, h: 0.33, fill: { color: i % 2 === 0 ? "#1A0A3A" : "#321060" }, line: { type: "none" } });
    s.addText(label + ":", { x: 6.85, y: 4.45 + i * 0.36, w: 1.8, h: 0.28, fontSize: 10, bold: true, color: C.lavender, valign: "middle" });
    s.addText(body, { x: 8.65, y: 4.45 + i * 0.36, w: 3.95, h: 0.28, fontSize: 10, color: C.ltgray, valign: "middle", wrap: true });
  });
}

// ═══════════════════════════════════════════════════════════════════════
// SLIDE 10 — P16 / KI-67 BIOMARKERS
// ═══════════════════════════════════════════════════════════════════════
{
  const s = lightSlide();
  banner(s, "PART 4 — p16 AND Ki-67 IMMUNOHISTOCHEMISTRY IN BIOPSY INTERPRETATION");
  s.addText("Biomarker-Guided Triage of Equivocal Cervical Biopsies", {
    x: 0.4, y: 0.65, w: 12, h: 0.5, fontSize: 19, bold: true, color: C.darkpurple
  });

  // p16 section
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.25, w: 6.1, h: 5.5, fill: { color: C.darkpurple }, line: { type: "none" } });
  s.addText("p16 (CDKN2A) Immunohistochemistry", { x: 0.5, y: 1.32, w: 5.7, h: 0.4, fontSize: 14, bold: true, color: C.lavender });

  const p16data = [
    ["Mechanism", "p16 is a cyclin-dependent kinase inhibitor. Normally, pRb suppresses p16. HPV E7 protein inactivates pRb → p16 overexpressed. Block-positive p16 = HPV E7 is active = oncogenic transformation."],
    ["Block-Positive Pattern", "Strong, diffuse cytoplasmic AND nuclear staining throughout full thickness of epithelium (or at least 2/3). This is significant."],
    ["Non-Block Positive", "Focal, patchy, or basal-only staining. NOT considered block-positive. Seen in reactive/inflammatory changes, atrophy, immature metaplasia."],
    ["LSIL + Block p16", "Suggests HSIL risk. Consider upgrading to CIN 2-3. Consult pathologist. Excision rather than ablation."],
    ["CIN 2 + Block p16", "Confirms HSIL → treatment indicated (excision or ablation if TZ type 1-2 and satisfactory colposcopy)."],
    ["CIN 2 + Non-Block p16", "Reclassify as LSIL. Can manage conservatively (observe with co-testing at 1-3 years). Avoids overtreatment."],
    ["Indications", "Mandatory: Any CIN 2 diagnosis (to triage). Equivocal HSIL. Immature squamous metaplasia vs CIN. Atrophy vs HSIL (postmenopausal)."],
    ["Pitfall", "p16 positive in other cancers (oropharyngeal, endocervical, some vulvar). Interpret in context of HPV-driven pathology only."],
  ];

  p16data.forEach(([title, body], i) => {
    s.addShape(pres.ShapeType.rect, { x: 0.4, y: 1.83 + i * 0.6, w: 0.07, h: 0.52, fill: { color: C.lavender }, line: { type: "none" } });
    s.addText(title, { x: 0.57, y: 1.87 + i * 0.6, w: 5.6, h: 0.22, fontSize: 11, bold: true, color: C.lavender });
    s.addText(body, { x: 0.57, y: 2.1 + i * 0.6, w: 5.6, h: 0.3, fontSize: 10, color: C.ltgray, wrap: true });
  });

  // Ki-67 section
  s.addShape(pres.ShapeType.rect, { x: 6.7, y: 1.25, w: 6.2, h: 3.5, fill: { color: "#1A2A3A" }, line: { type: "none" } });
  s.addText("Ki-67 (MIB-1) Proliferation Marker", { x: 6.9, y: 1.32, w: 5.8, h: 0.4, fontSize: 14, bold: true, color: C.gold });

  const ki67data = [
    ["Normal Pattern", "Ki-67 positive cells confined to basal/parabasal layers only. Upper 2/3 of epithelium: Ki-67 negative."],
    ["LSIL (CIN 1)", "Ki-67 positive cells present in upper 1/3 (abnormal). Reflects HPV's ability to maintain proliferation in cells that should be differentiating."],
    ["HSIL (CIN 2-3)", "Ki-67 diffusely positive throughout all layers. Full-thickness proliferative activity. Correlates with degree of dysplasia."],
    ["CINtec PLUS", "Dual stain (p16 + Ki-67 on same cell). If both positive in same cell → highly predictive of CIN 2+ (99% specificity). Used in cervical cytology samples."],
    ["Interpretation", "Use Ki-67 alongside p16. Pattern must be interpreted in architectural context. Ki-67 alone insufficient — always combine with H&E morphology."],
  ];

  ki67data.forEach(([title, body], i) => {
    s.addText("▸ " + title + ":", { x: 6.9, y: 1.83 + i * 0.6, w: 5.8, h: 0.22, fontSize: 11, bold: true, color: C.gold });
    s.addText(body, { x: 6.9, y: 2.06 + i * 0.6, w: 5.8, h: 0.34, fontSize: 10.5, color: C.ltgray, wrap: true });
  });

  // Decision flowchart
  s.addShape(pres.ShapeType.rect, { x: 6.7, y: 4.85, w: 6.2, h: 1.9, fill: { color: C.violet }, line: { type: "none" } });
  s.addText("p16 Triage Algorithm for CIN 2", { x: 6.9, y: 4.92, w: 5.8, h: 0.35, fontSize: 13, bold: true, color: C.white });
  s.addText("Biopsy shows CIN 2", { x: 6.9, y: 5.35, w: 5.8, h: 0.28, fontSize: 11, bold: true, color: C.gold });
  s.addText("↓", { x: 8.8, y: 5.63, w: 1.0, h: 0.25, fontSize: 14, bold: true, color: C.white, align: "center" });
  s.addText("p16 Block-Positive                          p16 Non-Block (Negative/Focal)", {
    x: 6.9, y: 5.9, w: 5.8, h: 0.25, fontSize: 10, color: C.white
  });
  s.addText("        ↓ HSIL confirmed → Treat                           ↓ Reclassify LSIL → Observe", {
    x: 6.9, y: 6.18, w: 5.8, h: 0.25, fontSize: 10, color: C.white
  });
  s.addText("Excision or ablation (if TZ1/2 + satisfactory colposcopy)     Co-testing at 1-3 years", {
    x: 6.9, y: 6.46, w: 5.8, h: 0.25, fontSize: 9.5, color: C.ltgray, italic: true
  });
}

// ═══════════════════════════════════════════════════════════════════════
// SLIDE 11 — NATURAL HISTORY & RISK STRATIFICATION
// ═══════════════════════════════════════════════════════════════════════
{
  const s = lightSlide();
  banner(s, "PART 5 — NATURAL HISTORY & RISK STRATIFICATION");
  s.addText("Regression, Persistence & Progression of CIN Lesions", {
    x: 0.4, y: 0.65, w: 12, h: 0.5, fontSize: 20, bold: true, color: C.darkpurple
  });

  // Natural history table
  s.addText("2-Year Natural History (Robbins & Cotran / Berek & Novak)", { x: 0.4, y: 1.28, w: 12, h: 0.35, fontSize: 13, bold: true, color: C.violet });

  const nhHeaders = ["Lesion", "Regress", "Persist", "Progress to Next Grade", "Progress to Carcinoma"];
  const nhData = [
    ["LSIL (CIN 1)", "60%", "30%", "10% → HSIL", "<1%"],
    ["HSIL (CIN 2)", "40-60%", "20-30%", "20% → CIN 3", "~5%"],
    ["HSIL (CIN 3 / CIS)", "30%", "~60%", "—", "10-12% (2-10 years)"],
  ];
  const nhColW = [2.5, 1.8, 1.8, 3.0, 2.5];
  nhHeaders.forEach((h, ci) => {
    let xp = 0.3 + nhColW.slice(0, ci).reduce((a, b) => a + b, 0);
    s.addShape(pres.ShapeType.rect, { x: xp, y: 1.68, w: nhColW[ci], h: 0.42, fill: { color: C.violet }, line: { type: "none" } });
    s.addText(h, { x: xp + 0.05, y: 1.7, w: nhColW[ci] - 0.1, h: 0.38, fontSize: 11, bold: true, color: C.white, valign: "middle" });
  });
  nhData.forEach((row, ri) => {
    const rowBg = ri === 0 ? "#1E6B3C" : ri === 1 ? "#B07800" : "#A01010";
    row.forEach((cell, ci) => {
      let xp = 0.3 + nhColW.slice(0, ci).reduce((a, b) => a + b, 0);
      s.addShape(pres.ShapeType.rect, { x: xp, y: 2.13 + ri * 0.5, w: nhColW[ci], h: 0.48, fill: { color: rowBg }, line: { color: "000000", pt: 0.2 } });
      s.addText(cell, { x: xp + 0.05, y: 2.16 + ri * 0.5, w: nhColW[ci] - 0.1, h: 0.42, fontSize: 11, bold: ci === 0, color: C.white, valign: "middle" });
    });
  });

  // Risk factors for progression
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 3.4, w: 6.1, h: 3.9, fill: { color: C.darkpurple }, line: { type: "none" } });
  s.addText("Factors Favoring PROGRESSION", { x: 0.5, y: 3.47, w: 5.7, h: 0.4, fontSize: 13, bold: true, color: C.coral });
  const progFactors = [
    "HPV 16 or 18 infection (high-risk types)",
    "Older age (>35 years) with persistent HPV",
    "Immunosuppression (HIV, transplant, steroids)",
    "High lesion grade at initial biopsy",
    "Persistent HPV positivity >12 months",
    "Smoking (2-4× increased risk)",
    "Multiple HPV type co-infection",
    "Positive ECC (endocervical extension)",
    "CIN 2 with block-positive p16 staining",
    "Large lesion (>2 quadrants of TZ)",
  ];
  progFactors.forEach((f, i) => {
    s.addText("↑  " + f, { x: 0.5, y: 3.97 + i * 0.32, w: 5.7, h: 0.3, fontSize: 11, color: C.ltgray, wrap: true });
  });

  // Factors favoring regression
  s.addShape(pres.ShapeType.rect, { x: 6.7, y: 3.4, w: 6.2, h: 3.9, fill: { color: "#1A3A1A" }, line: { type: "none" } });
  s.addText("Factors Favoring REGRESSION", { x: 6.9, y: 3.47, w: 5.8, h: 0.4, fontSize: 13, bold: true, color: C.green });
  const regFactors = [
    "Age <25 years (high spontaneous clearance rate)",
    "CIN 1 — 60-85% regress within 2 years",
    "Low-risk HPV types (HPV 6, 11, 31, 33)",
    "Short duration of HPV infection (<12 months)",
    "Intact immunity (no immunosuppression)",
    "HPV clearance on follow-up testing",
    "Single HPV type infection",
    "CIN 2 with non-block p16 staining",
    "Small lesion (<1 quadrant)",
    "Postpartum regression — CIN often regresses after delivery",
  ];
  regFactors.forEach((f, i) => {
    s.addText("↓  " + f, { x: 6.9, y: 3.97 + i * 0.32, w: 5.8, h: 0.3, fontSize: 11, color: C.ltgray, wrap: true });
  });
}

// ═══════════════════════════════════════════════════════════════════════
// SLIDE 12 — MANAGEMENT ALGORITHMS BY CIN GRADE
// ═══════════════════════════════════════════════════════════════════════
{
  const s = darkSlide();
  banner(s, "PART 6 — MANAGEMENT ALGORITHMS BY HISTOLOGIC GRADE (ASCCP 2019)");
  s.addText("Management After Colposcopy-Directed Biopsy Results", {
    x: 0.4, y: 0.65, w: 12, h: 0.5, fontSize: 19, bold: true, color: C.white
  });

  const mgmtBlocks = [
    {
      grade: "LSIL (CIN 1)", color: C.green, x: 0.3, y: 1.25,
      principle: "Not a cancer precursor. 60-85% regress spontaneously within 2 years. Treatment NOT recommended for CIN 1 alone.",
      options: [
        "Observation with co-testing (Pap + HPV) at 12 and 24 months (preferred)",
        "If co-tests negative ×2: return to 3-year screening",
        "If any abnormal co-test: repeat colposcopy",
        "CIN 1 for 24 months with HSIL on cytology: excision acceptable",
        "CIN 1 for 24 months without HSIL cytology: continue surveillance OR ablation",
        "Ablation acceptable if TZ fully visible, no gland involvement on biopsy, negative ECC",
      ]
    },
    {
      grade: "HSIL (CIN 2)", color: C.amber, x: 0.3, y: 3.85,
      principle: "Treatment threshold. Significant progression risk. TREAT unless patient is pregnant or strongly desires fertility preservation.",
      options: [
        "Satisfactory colposcopy + TZ type 1-2: Ablation (cryotherapy) OR excision (LEEP) both acceptable",
        "Unsatisfactory colposcopy (TZ type 3): Diagnostic excision (LEEP or CKC) — MANDATORY",
        "CIN 2 with negative p16: May observe with co-testing every 6 months ×2 (shared decision-making)",
        "Young women (<25) seeking fertility: Observation with colposcopy q6 months acceptable for CIN 2 (not CIN 3)",
        "After treatment: co-test at 6 months. If negative: annual co-test ×3, then 3-year screening ×20 years.",
      ]
    },
    {
      grade: "HSIL (CIN 3 / CIS)", color: C.coral, x: 6.7, y: 1.25,
      principle: "Definitive treatment MANDATORY. Do not observe. 10-12% progress to carcinoma over 2-10 years.",
      options: [
        "Excisional procedure (LEEP preferred) — preserves fertility vs CKC",
        "Cold knife cone: preferred for AIS, positive ECC, recurrent CIN 3, or suspicion of microinvasion",
        "Hysterectomy: reserved for recurrent/persistent CIN 3 post-excision, positive margins on cone, or when childbearing complete",
        "Endocervical margin positive after excision: repeat excision or hysterectomy",
        "Post-treatment surveillance: Co-test at 6 months. HPV clearance is endpoint. Annual co-test ×3, then 3-year for 20 years.",
        "NEVER ablate without biopsy-confirmed diagnosis first",
      ]
    },
    {
      grade: "AIS (Adenocarcinoma In Situ)", color: C.red, x: 6.7, y: 3.85,
      principle: "High risk. 48% have concurrent invasive disease. Diagnostic excision (cone) mandatory for all. Hysterectomy is standard of care.",
      options: [
        "Diagnostic cold knife cone biopsy — 12 o'clock suture. ECC from residual canal.",
        "NEGATIVE margins on cone: hysterectomy strongly recommended (preferred). Skip lesions common → residual disease despite negative margins.",
        "If fertility desired + negative cone margins: Surveillance q6 months with co-test + ECC for 3 years, then consider hysterectomy",
        "POSITIVE margins: Re-excision or hysterectomy. Never observe positive-margin AIS.",
        "Post-conization surveillance: cytology + colposcopy + HPV + ECC at 6 months if NOT hysterectomy",
      ]
    },
  ];

  mgmtBlocks.forEach(b => {
    const h = b.x === 0.3 ? 2.5 : 2.5;
    s.addShape(pres.ShapeType.rect, { x: b.x, y: b.y, w: 6.2, h: 2.5, fill: { color: b.color }, line: { type: "none" } });
    s.addText(b.grade, { x: b.x + 0.15, y: b.y + 0.08, w: 5.7, h: 0.38, fontSize: 15, bold: true, color: C.white });
    s.addText(b.principle, { x: b.x + 0.15, y: b.y + 0.5, w: 5.7, h: 0.48, fontSize: 10, color: C.white, italic: true, wrap: true });
    b.options.forEach((opt, i) => {
      s.addText("• " + opt, { x: b.x + 0.15, y: b.y + 1.02 + i * 0.25, w: 5.7, h: 0.24, fontSize: 9.5, color: C.white, wrap: true });
    });
  });
}

// ═══════════════════════════════════════════════════════════════════════
// SLIDE 13 — TREATMENT: CRYOTHERAPY VS LEEP VS CONE
// ═══════════════════════════════════════════════════════════════════════
{
  const s = lightSlide();
  banner(s, "PART 7 — TREATMENT MODALITIES COMPARED");
  s.addText("Cryotherapy vs LEEP vs Cold Knife Cone — Indications, Technique & Outcomes", {
    x: 0.4, y: 0.65, w: 12, h: 0.5, fontSize: 18, bold: true, color: C.darkpurple
  });

  const treatments = [
    {
      name: "CRYOTHERAPY", subtitle: "Ablative — No Tissue for Histology",
      color: C.teal, x: 0.3, y: 1.25, w: 4.2,
      indication: "CIN 1 persisting >24 months, or CIN 2 with ALL criteria:",
      criteria: ["Small lesion (<75% ectocervix)", "Ectocervical only (entire lesion visible)", "Negative ECC", "No gland crypt involvement on biopsy", "TZ Type 1 only", "No suspicion of glandular lesion"],
      mechanism: "Freeze-thaw-freeze. Ice ball −20 to −30°C. Nitrous oxide (−89°C) or CO₂ (−65°C). Probe 5mm beyond lesion edge.",
      results: "CIN 1: 94% cure. CIN 2: 91% cure. CIN 3: 82% cure. Large lesions / gland involvement: failure up to 42%.",
      complications: "Watery discharge 2-3 weeks. Rare: bleeding, infection, cervical stenosis.",
      advantage: "Office-based, no anesthesia, inexpensive, no specimens."
    },
    {
      name: "LEEP / LLETZ", subtitle: "Excisional — Tissue for Histology",
      color: C.violet, x: 4.65, y: 1.25, w: 4.2,
      indication: "CIN 2-3 with satisfactory OR unsatisfactory colposcopy; CIN 1 failing 24 months observation; HSIL cytology after negative colposcopy; diagnostic ('see-and-treat')",
      criteria: ["Loop electrode 15-20mm width", "Width chosen to exceed lesion by 5-8mm", "Depth 7-8mm ectocervical", "Endocervical pass (top hat) for canal extension", "Must include SCJ in specimen"],
      mechanism: "High-frequency AC current. Cutting and coagulation simultaneously. Local anesthesia (cervical block). Specimens in formalin.",
      results: "CIN 2/3 clearance rate 90-95%. Recurrence 5-10% over 2 years. Positive margin → 3-6× increased recurrence risk.",
      complications: "Bleeding (primary + secondary), infection, cervical stenosis, preterm birth risk (2× increase for future pregnancies).",
      advantage: "Office-based under local, provides histology, therapeutic and diagnostic in one step."
    },
    {
      name: "COLD KNIFE CONE", subtitle: "Excisional — Gold Standard Margins",
      color: C.plum, x: 9.0, y: 1.25, w: 4.0,
      indication: "AIS (preferred), unsatisfactory LEEP margins, recurrent CIN 3, suspicion of microinvasion, large endocervical lesion, TZ Type 3 with HSIL",
      criteria: ["Scalpel (no thermal artifact)", "Shape: broad base (premenopausal) vs narrow apex (postmenopausal)", "12 o'clock suture orientation", "ECC from residual canal always after cone"],
      mechanism: "OR / GA or spinal. Lugol's to map lesion. Circumferential scalpel incision. Angle inward centrally. Measure specimen.",
      results: "Margin positive = 70% residual AIS in hysterectomy. Negative margin: residual disease still possible (skip lesions).",
      complications: "Cervical stenosis, incompetent cervix, preterm labor (higher risk than LEEP), hemorrhage.",
      advantage: "Best margin quality, best for glandular lesions, no thermal artifact affecting margin assessment."
    },
  ];

  treatments.forEach(t => {
    s.addShape(pres.ShapeType.rect, { x: t.x, y: t.y, w: t.w, h: 6.0, fill: { color: t.color }, line: { type: "none" } });
    s.addText(t.name, { x: t.x + 0.15, y: t.y + 0.1, w: t.w - 0.3, h: 0.38, fontSize: 14, bold: true, color: C.white });
    s.addText(t.subtitle, { x: t.x + 0.15, y: t.y + 0.5, w: t.w - 0.3, h: 0.28, fontSize: 10, italic: true, color: C.gold });

    const labels = ["Indication", "Criteria", "Technique", "Outcomes", "Complications", "Advantage"];
    const bodies = [t.indication, t.criteria.map(c => "• " + c).join("\n"), t.mechanism, t.results, t.complications, t.advantage];
    let yOff = 0.88;
    labels.forEach((lbl, i) => {
      s.addText(lbl + ":", { x: t.x + 0.15, y: t.y + yOff, w: t.w - 0.3, h: 0.22, fontSize: 10, bold: true, color: C.gold });
      yOff += 0.22;
      const lines = bodies[i].split("\n").length;
      const lineH = Math.min(0.78, lines * 0.2 + 0.1);
      s.addText(bodies[i], { x: t.x + 0.15, y: t.y + yOff, w: t.w - 0.3, h: lineH + 0.1, fontSize: 9.5, color: C.white, wrap: true });
      yOff += lineH + 0.18;
    });
  });
}

// ═══════════════════════════════════════════════════════════════════════
// SLIDE 14 — MARGIN INTERPRETATION AND POST-TREATMENT SURVEILLANCE
// ═══════════════════════════════════════════════════════════════════════
{
  const s = darkSlide();
  banner(s, "PART 7 — MARGIN STATUS & POST-TREATMENT SURVEILLANCE");
  s.addText("Interpreting Excision Margins and Planning Follow-Up", {
    x: 0.4, y: 0.65, w: 12, h: 0.5, fontSize: 19, bold: true, color: C.white
  });

  // Margin types
  s.addText("Margin Interpretation (LEEP / Cone Specimen)", { x: 0.3, y: 1.25, w: 12.7, h: 0.4, fontSize: 14, bold: true, color: C.gold });

  const margins = [
    { type: "Clear (Negative) Margins", color: C.green, desc: "No dysplastic cells at any margin. Disease completely excised. Risk of residual disease: ~5-10% (depending on grade). Proceed to surveillance protocol." },
    { type: "Close Margins (<1 mm)", color: C.amber, desc: "Dysplastic cells present very close to but not at the inked margin. Risk of residual ~15-20%. Manage as positive margins in high-grade lesions. For CIN 1-2, surveillance acceptable." },
    { type: "Ectocervical Margin Positive", color: "#8B5A00", desc: "Dysplasia present at ectocervical margin. Risk of residual ~25-35%. For CIN 3: repeat co-test at 6 months. If positive: repeat excision or hysterectomy. For AIS: re-excision or hysterectomy." },
    { type: "Endocervical Margin Positive", color: C.coral, desc: "HIGHEST RISK margin. Disease extends into canal — lesion not fully excised. For CIN 3: repeat excision strongly recommended. For AIS: hysterectomy or re-excision mandatory." },
    { type: "Cannot Assess Margins (Fragmented)", color: C.midgray, desc: "Specimen fragmented — thermal artifact or multiple pieces prevent margin evaluation. Treat as positive margin. For CIN 3 or AIS: re-excision or hysterectomy." },
  ];

  margins.forEach((m, i) => {
    s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.73 + i * 0.85, w: 3.5, h: 0.78, fill: { color: m.color }, line: { type: "none" } });
    s.addText(m.type, { x: 0.45, y: 1.78 + i * 0.85, w: 3.2, h: 0.68, fontSize: 11, bold: true, color: C.white, valign: "middle", wrap: true });
    s.addShape(pres.ShapeType.rect, { x: 3.85, y: 1.73 + i * 0.85, w: 9.15, h: 0.78, fill: { color: "#1A1030" }, line: { type: "none" } });
    s.addShape(pres.ShapeType.rect, { x: 3.85, y: 1.73 + i * 0.85, w: 0.06, h: 0.78, fill: { color: m.color }, line: { type: "none" } });
    s.addText(m.desc, { x: 4.0, y: 1.78 + i * 0.85, w: 9.0, h: 0.68, fontSize: 11, color: C.ltgray, valign: "middle", wrap: true });
  });

  // Post-treatment surveillance
  s.addText("Post-Treatment Surveillance Protocol (ASCCP 2019)", { x: 0.3, y: 6.05, w: 12.7, h: 0.38, fontSize: 14, bold: true, color: C.gold });

  const surveillance = [
    { label: "6 months post-treatment", body: "Co-test (Pap + HPV). If BOTH negative → proceed to step 2." },
    { label: "12 months post-treatment", body: "Co-test again. If BOTH negative at 6 AND 12 months → annual co-testing." },
    { label: "Annual × 3 years", body: "Annual co-testing. If all negative → return to 3-year interval." },
    { label: "3-yearly × 20 years", body: "Co-test every 3 years for at least 20 years (even if >65 — treated CIN overrides standard stop-at-65 guideline)." },
  ];

  surveillance.forEach((sv, i) => {
    s.addShape(pres.ShapeType.rect, { x: 0.3 + i * 3.25, y: 6.5, w: 3.1, h: 0.85, fill: { color: C.violet }, line: { type: "none" } });
    s.addText(sv.label, { x: 0.45 + i * 3.25, y: 6.55, w: 2.85, h: 0.3, fontSize: 10, bold: true, color: C.gold });
    s.addText(sv.body, { x: 0.45 + i * 3.25, y: 6.87, w: 2.85, h: 0.42, fontSize: 9.5, color: C.white, wrap: true });
  });
}

// ═══════════════════════════════════════════════════════════════════════
// SLIDE 15 — DISCORDANT RESULTS (CYTOLOGY-HISTOLOGY MISMATCH)
// ═══════════════════════════════════════════════════════════════════════
{
  const s = lightSlide();
  banner(s, "CLINICAL PATHOLOGIC CORRELATION — DISCORDANT RESULTS");
  s.addText("When Cytology and Biopsy Don't Match — A Systematic Approach", {
    x: 0.4, y: 0.65, w: 12, h: 0.5, fontSize: 19, bold: true, color: C.darkpurple
  });

  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.25, w: 12.7, h: 0.75, fill: { color: C.violet }, line: { type: "none" } });
  s.addText("Principle (Berek & Novak's): Cytology, biopsy, and molecular testing results should be reviewed TOGETHER by pathologist and colposcopist. When cytology indicates a more significant lesion than histology, further evaluation is required.", {
    x: 0.5, y: 1.3, w: 12.3, h: 0.65, fontSize: 11, bold: true, color: C.white, valign: "middle", wrap: true
  });

  const scenarios = [
    {
      cytology: "HSIL", histology: "CIN 1 or Negative",
      color: C.coral, x: 0.3, y: 2.1,
      explanation: "Most common discordance. Causes: sampling error (biopsy missed the worst area), lesion located high in canal (not visible), regression, or false-positive cytology.",
      action: [
        "Review cytology and histology slides with pathologist",
        "Repeat colposcopy with multiple directed biopsies + ECC",
        "If second colposcopy also negative: diagnostic excisional procedure (LEEP / CKC) — mandatory",
        "Do NOT simply re-screen with Pap in 6 months for HSIL cytology",
        "NEVER accept 'no lesion' as final answer when HSIL cytology is present",
      ]
    },
    {
      cytology: "LSIL or ASC-US", histology: "CIN 3",
      color: "#7B2000", x: 0.3, y: 4.55,
      explanation: "Underestimated by cytology. Common if lesion is predominantly endocervical. Biopsy result takes precedence — manage per histology (CIN 3).",
      action: [
        "Biopsy result OVERRIDES cytology — manage as CIN 3",
        "Excision (LEEP or CKC) required",
        "Review cytology for missed features — quality audit",
      ]
    },
    {
      cytology: "AGC", histology: "Benign Endocervix",
      color: "#1A2A6A", x: 6.7, y: 2.1,
      explanation: "AGC may reflect endometrial pathology, not just cervical. Benign cervical biopsy does NOT exclude endometrial carcinoma, which is the major concern with AGC.",
      action: [
        "Add endometrial sampling (EMB or hysteroscopy) if not already done",
        "Review ECC findings carefully",
        "Consider repeat colposcopy if initial was unsatisfactory",
        "If all workup negative: co-test in 1 year",
        "Persistent AGC after negative workup: excision to exclude AIS",
      ]
    },
    {
      cytology: "ASC-H", histology: "Negative",
      color: "#2A4A1A", x: 6.7, y: 4.55,
      explanation: "ASC-H carries 5-10% risk of underlying CIN 2-3. Negative colposcopy does not exclude it. Lesion may be small, high-grade, and located in the canal.",
      action: [
        "Review cytology specimen for adequacy",
        "Repeat colposcopy with more thorough survey + ECC",
        "HPV 16/18 genotyping to risk-stratify",
        "If HPV 16/18 positive: proceed to excision",
        "If HPV negative: co-test at 1 year (ASCCP 2019)",
      ]
    },
  ];

  scenarios.forEach(sc => {
    s.addShape(pres.ShapeType.rect, { x: sc.x, y: sc.y, w: 6.2, h: 2.35, fill: { color: sc.color }, line: { type: "none" } });
    s.addText(`Cytology: ${sc.cytology}  ↔  Biopsy: ${sc.histology}`, { x: sc.x + 0.15, y: sc.y + 0.08, w: 5.7, h: 0.38, fontSize: 13, bold: true, color: C.gold });
    s.addText(sc.explanation, { x: sc.x + 0.15, y: sc.y + 0.5, w: 5.7, h: 0.42, fontSize: 10, italic: true, color: C.white, wrap: true });
    sc.action.forEach((a, i) => {
      s.addText("→ " + a, { x: sc.x + 0.15, y: sc.y + 0.98 + i * 0.27, w: 5.7, h: 0.25, fontSize: 10, color: C.white, wrap: true });
    });
  });
}

// ═══════════════════════════════════════════════════════════════════════
// SLIDE 16 — QUICK REFERENCE TABLE
// ═══════════════════════════════════════════════════════════════════════
{
  const s = darkSlide();
  banner(s, "QUICK REFERENCE — COLPOSCOPY BIOPSY RESULTS AT A GLANCE");
  s.addText("Complete Summary Table: Finding → Histology → Management", {
    x: 0.4, y: 0.65, w: 12, h: 0.5, fontSize: 19, bold: true, color: C.white
  });

  const qrHeaders = ["Colposcopic Finding", "Expected Histology", "p16 / Ki-67", "Management", "Surveillance"];
  const qrData = [
    ["Normal / No lesion", "Normal squamous / Metaplasia", "Negative", "Return to screening per age protocol", "Per guidelines"],
    ["Thin acetowhite, fine vessels", "LSIL (CIN 1) / HPV effect", "Negative or focal", "Observe with co-test q12-24m", "Co-test ×2, then 3-year"],
    ["Dense AW, fine punctation", "LSIL (CIN 1) to HSIL (CIN 2)", "p16 block = HSIL", "Biopsy; treat if CIN 2+ or p16+", "Per treatment"],
    ["Dense AW, coarse punctation", "HSIL (CIN 2-3)", "Block-positive p16", "Excision (LEEP) or ablation if TZ1", "Co-test q6m, then annual ×3, 3-yr ×20y"],
    ["Coarse mosaic + AW", "HSIL (CIN 2-3)", "Block-positive p16", "Excision mandatory", "Co-test q6m post-treatment"],
    ["Atypical vessels", "Microinvasion / Invasive Ca", "N/A (biopsy urgent)", "Immediate biopsy; oncology referral", "Per oncology"],
    ["Leukoplakia", "CIN any grade / Keratinizing Ca", "Per biopsy result", "Biopsy FIRST then manage per grade", "Per result"],
    ["Iodine-negative without AW", "Metaplasia / CIN 1", "Usually negative", "Biopsy if any concern; otherwise co-test", "Per result"],
    ["CIN 1 (histology)", "LSIL", "Negative", "Observe 24 months; ablation if persists", "Co-test q12m"],
    ["CIN 2 (histology)", "HSIL — equivocal", "Determines treatment", "p16 block: treat; p16 negative: observe", "Per decision"],
    ["CIN 3 (histology)", "HSIL — definitive", "Block-positive", "Excision mandatory (LEEP or CKC)", "Long-term 20 years"],
    ["AIS (histology)", "Glandular HSIL", "Block-positive", "Diagnostic cone → hysterectomy", "Strict long-term"],
    ["Microinvasion (histology)", "FIGO IA", "Block-positive", "Gynecology oncology referral", "Per stage"],
  ];

  const qrColW = [2.8, 2.5, 1.8, 3.5, 2.2];
  qrHeaders.forEach((h, ci) => {
    let xp = 0.3 + qrColW.slice(0, ci).reduce((a, b) => a + b, 0);
    s.addShape(pres.ShapeType.rect, { x: xp, y: 1.25, w: qrColW[ci], h: 0.4, fill: { color: C.violet }, line: { type: "none" } });
    s.addText(h, { x: xp + 0.04, y: 1.27, w: qrColW[ci] - 0.08, h: 0.36, fontSize: 10.5, bold: true, color: C.white, valign: "middle" });
  });

  qrData.forEach((row, ri) => {
    const riskLevel = ri <= 1 ? "#1A2A1A" : ri <= 3 ? "#2A1A00" : ri <= 7 ? "#2A0800" : ri <= 9 ? "#3A0800" : "#250040";
    row.forEach((cell, ci) => {
      let xp = 0.3 + qrColW.slice(0, ci).reduce((a, b) => a + b, 0);
      s.addShape(pres.ShapeType.rect, { x: xp, y: 1.68 + ri * 0.42, w: qrColW[ci], h: 0.4, fill: { color: riskLevel }, line: { color: "222244", pt: 0.2 } });
      s.addText(cell, { x: xp + 0.04, y: 1.71 + ri * 0.42, w: qrColW[ci] - 0.08, h: 0.36, fontSize: 9.5, color: C.ltgray, valign: "middle", wrap: true });
    });
  });
}

// ═══════════════════════════════════════════════════════════════════════
// SLIDE 17 — CLOSING / KEY TAKE-HOME POINTS
// ═══════════════════════════════════════════════════════════════════════
{
  const s = darkSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 0.8, fill: { color: C.violet } });
  s.addText("KEY TAKE-HOME POINTS", { x: 0.4, y: 0.1, w: 12.5, h: 0.6, fontSize: 18, bold: true, color: C.white });

  const points = [
    ["TZ Visibility = Gatekeeper", "Always establish TZ type (1/2/3) before management. Unsatisfactory colposcopy → diagnostic excision, not ablation, not observation."],
    ["Acetowhite Density Matters", "Thin/translucent AW = low-grade. Dense/opaque AW + coarse vascular patterns (punctation, mosaic) = CIN 2-3. Atypical vessels = invasive carcinoma until proven otherwise."],
    ["p16 Resolves CIN 2 Ambiguity", "For any CIN 2 diagnosis, p16 is mandatory. Block-positive → treat as HSIL. Non-block → reclassify as LSIL, observe. This avoids both overtreatment and undertreatment."],
    ["Never Ablate Without Histology", "Ablation (cryotherapy) is NEVER acceptable without biopsy-confirmed diagnosis. Always biopsy before any ablative treatment."],
    ["Discordant Results Demand Action", "HSIL cytology + negative biopsy is NOT reassuring. Repeat colposcopy + ECC. If still negative: diagnostic excision. Never accept discordance without resolution."],
    ["AIS Has Skip Lesions", "Even negative cone margins do not guarantee clearance of AIS. Hysterectomy is the recommended treatment. If fertility desired, strict surveillance with ECC every 6 months."],
    ["Surveillance is Long-Term", "Post-treatment surveillance for CIN 3 / AIS is 20 years (not 5, not 10). HPV clearance is the surveillance endpoint. Treated patients do NOT return to standard 3-year screening."],
  ];

  points.forEach(([title, body], i) => {
    s.addShape(pres.ShapeType.rect, { x: 0.3, y: 0.9 + i * 0.91, w: 0.5, h: 0.8, fill: { color: C.lavender }, line: { type: "none" } });
    s.addText(String(i + 1), { x: 0.3, y: 1.0 + i * 0.91, w: 0.5, h: 0.6, fontSize: 16, bold: true, color: C.white, align: "center" });
    s.addText(title + ": ", { x: 0.9, y: 0.97 + i * 0.91, w: 2.8, h: 0.75, fontSize: 11, bold: true, color: C.gold, wrap: true, valign: "top" });
    s.addText(body, { x: 3.55, y: 0.97 + i * 0.91, w: 9.5, h: 0.75, fontSize: 11, color: C.ltgray, wrap: true, valign: "top" });
  });

  s.addShape(pres.ShapeType.rect, { x: 0, y: 7.22, w: 13.3, h: 0.28, fill: { color: C.violet } });
  s.addText("Berek & Novak's Gynecology | Robbins & Cotran Pathologic Basis of Disease | Pfenninger & Fowler's Procedures for Primary Care | Sabiston Textbook of Surgery", {
    x: 0.3, y: 7.24, w: 12.7, h: 0.22, fontSize: 8.5, color: C.white, italic: true
  });
}

// ─── WRITE FILE ──────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/endometrial-pap-pptx/Colposcopy_Guided_Biopsy_Interpretation.pptx" })
  .then(() => console.log("SUCCESS: Colposcopy deck saved."))
  .catch(err => console.error("ERROR:", err));

cd /home/daytona/workspace/endometrial-pap-pptx && node build_colposcopy.js 2>&1