Cytology. Since the publication of the consensus guidelines, new cervical cancer screening guidelines have been published and new information has. ASCCP Guideline. HPV Unknown. HPV Positive*. Repeat Cytology. -. @ 12 mos. Cytology. @ 6 & 12 mos OR. HPV DNA Testing. @ 12 mos. ASC or HPV (+) —. Manage per. ASCCP Guideline. HPV Unknown. HPV Positive*. Repeat cytology. >> ASC or HPV (+) > Repeat Colposcopy. @ 12 mos cytology. @6& 12 mos OR.
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Guidelines – ASCCP
See related handout on HPV and Pap testingwritten by the authors of this aasccp. New data have algorthm since publication of the American Society for Colposcopy and Cervical Pathology’s consensus guidelines for management of abnormal cervical cytology and histology.
The guidelines include recommendations for algorithhm populations i. Human papillomavirus testing is now included for management of atypical glandular cytology, for follow-up after treatment for cervical intraepithelial neoplasia, and in combination with cytologic screening in women 30 years and older. The preferred management of atypical squamous cells of undetermined significance in adult women is reflex human papillomavirus DNA testing.
Colposcopy is recommended for adult women with low-grade squamous intraepithelial lesion, atypical glandular cells, high-grade intraepithelial neoplasia, and atypical squamous cells—cannot exclude high-grade intraepithelial neoplasia.
Cervical intraepithelial neoplasia, grade 1 can be managed conservatively in adult women, but treatment for cervical intraepithelial neoplasia, grades 2 and 3 is recommended. Immediate treatment is an option for adult women but not for adolescents with high-grade squamous intraepithelial lesion. Conservative management of adolescents with any cytologic or histologic diagnosis except specified cervical intraepithelial neoplasia, grade 3 akgorithm adenocarcinoma in situ is recommended.
Colposcopy is preferred for pregnant women with low-grade squamous intraepithelial lesion and high-grade squamous intraepithelial lesion, but evaluation of the former may be deferred until no earlier than six weeks postpartum. Treatment during pregnancy is unacceptable unless invasive carcinoma is identified. Since publication of the American Society for Colposcopy and Cervical Pathology Axccp consensus guidelines for management of abnormal cervical cytology 12 and histology, 34 new data have emerged.
Updated guidelines published in October place greater emphasis on testing for high-risk human papillomavirus HPV. The management of abnormal cytologic and histologic findings has been updated. Management algorithms and information on strength of recommendations and quality of evidence can be found at http: Colposcopic biopsy of lesions suspicious for cancer or CIN 2,3 is preferred in pregnant women, but biopsy of other lesions is acceptable.
Endocervical curettage is unacceptable.
Updated Consensus Guidelines FAQs
qlgorithm References 5 through 8 are American Society for Colposcopy and Cervical Pathology consensus guidelines, expert review. For information about the SORT evidence rating system, go to https: Information from references 5 through 8. One of multiple options when data indicate another approach is superior or when no data favor any single option.
Obtaining a histologic specimen of the transformation zone and endocervical canal by alvorithm or cold-knife conization or loop electrosurgical excision or conization. Evaluating the endocervical canal for neoplasia by colposcopy or endocervical sampling. Obtaining a cytologic sample with a cytobrush or histologic specimen by a cytobrush or endocervical curette.
Obtaining a specimen for histologic evaluation by endometrial biopsy, dilatation and curettage, or hysteroscopy. The relationship of cervical intraepithelial neoplasia, grades 2 and 3 CIN 2,3 and cervical cancer to HPV infection is well established. HPV infection is most prevalent among women 20 to 24 years of age, with a gradual decline in prevalence through 59 years of age. However, even with negative cytology, older women who are HPV positive have a greater risk of developing CIN 3 within 10 years, compared with younger women Women with a positive HPV test and negative cytology can have conservative follow-up with repeat combination testing at 12 months.
Cytology alone is an acceptable screening method accp women 30 years and older. Use of human papillomavirus DNA testing as an adjunct to cytology for cervical cancer screening in women 30 years and older. Ascvp of women with atypical squamous cells of undetermined significance. In women with atypical squamous cells—cannot exclude high-grade squamous intraepithelial lesion ASC-Hthe prevalence of CIN 2,3 is as high as 50 percent. Colposcopy is recommended for adult women with low-grade squamous intraepithelial lesion LSILbecause 28 percent will harbor CIN 2,3 over a two-year period 5623 Figure 3 6.
If satisfactory colposcopy does not identify CIN 2,3 and endocervical sampling is negative, management may include a diagnostic excisional procedure or cytology and colposcopy every six months until both are negative twice. HPV positivity has a high positive predictive value for significant cervical disease, with 20 percent of women having CIN 3 or cancer on biopsy.
Endometrial cells are found on 0. CIN 3 is considered a cancer precursor. AIS is a high-grade glandular lesion that is relatively rare 0. Colposcopy is ascco unremarkable when AIS is present, because it can extend deep into the endocervical canal with noncontiguous lesions. Therefore, if the initial cytology is AGC—favor neoplasia or AIS and no invasion is identified, an excisional procedure is still recommended.
Most HPV infections occur in adolescents shortly after first intercourse, 38 with acscp prevalence up to 54 percent. Because up to 90 percent of HPV infections algorihhm adolescents are asxcp or cleared spontaneously within two years, 4243 the guidelines have been modified to avoid unnecessary testing and treatment.
Cytologic screening should be initiated three years after first intercourse, or at 21 years of age, whichever comes first. Repeat cytology in 12 months is recommended to allow these changes to resolve. Adolescents with Alogrithm 1 are managed with repeat cytology at 12 and 24 months. Management of adolescent women 20 years and younger with a histologic diagnosis of cervical intraepithelial neoplasia, grade 1.
The incidence of HSIL in adolescents is 0.
If CIN 2,3 is not found, cytology and colposcopy are preferred every six months for one year with biopsy if high-grade lesions are identified or if HSIL persists on subsequent cytology. Some pathologists are beginning to separate CIN 2 and 3 by histologic criteria.
If histology indicates CIN 2,3—not otherwise specified, adolescents may undergo colposcopy and cytology every six months up to 24 months, or treatment with excision or ablation. Pregnancy does not accelerate cervical lesions, and cervical cancer occurs in only five ofpregnancies. Already a member or subscriber? Address correspondence to Barbara S.
Reprints are not available from the authors. Apgar is a member of the American Society for Colposcopy and Cervical Pathology Board of Directors and author of two colposcopy publications. J Low Genit Tract Dis. Am J Obstet Gynecol. The carcinogenicity of human papillomavirus types reflects viral evolution. Screening for cervical cancer Rockville, Md: Agency for Healthcare Research and Quality January Accessed March 30, International trends in incidence of cervical cancer: Accuracy of the Papanicolaou test in screening for and follow-up of cervical cytologic abnormalities: Screening for high-grade cervical intraepithelial neoplasia and cancer by testing for high-risk HPV, routine cytology or colposcopy.
Randomized controlled trial of human papillomavirus testing versus Pap cytology in the primary screening for cervical cancer precursors: Baseline cytology, human papillomavirus testing, and risk for cervical neoplasia: J Natl Cancer Inst.
The absolute risk of cervical abnormalities in high-risk human papillomavirus-positive, cytologically normal women over a year period. Bigras G, de Marval F. The probability for a Pap test to be abnormal is directly proportional to HPV viral load: Bethesda implementation and reporting rates: Arch Pathol Lab Med.
Clinical applications of HPV testing: Cervical cytology of atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion ASC-H: Should women with atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion, receive reflex human papillomavirus-DNA testing?
Prospective follow-up suggests similar risk of subsequent cervical intraepithelial neoplasia grade 2 or 3 among women with cervical intraepithelial neoplasia grade 1 or negative colposcopy and directed biopsy. A randomized trial on the management of low-grade squamous intraepithelial lesion cytology interpretations. Biopsy correlates of abnormal cervical cytology classified using the Bethesda system. Rate of pathology from atypical glandular cell Pap tests classified by the Bethesda nomenclature.
Dysplasia associated with atypical glandular cells on cervical cytology [published correction appears in Obstet Gynecol. Human papillomavirus DNA detection and histological findings in women referred for atypical glandular cells or adenocarcinoma in situ aeccp their Pap smears. Endometrial cells in cervical cytology: Reporting endometrial cells in women 40 years and older: Am J Clin Pathol. Natural history of cervical intraepithelial neoplasia: Int J Gynecol Pathol.
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Prediction of recurrence after treatment for high-grade cervical intraepithelial neoplasia: Cervical adenocarcinoma and squamous cell carcinoma incidence trends among white women and black women in the United States for — Is conservative treatment for adenocarcinoma in situ of the cervix safe?
Adenocarcinoma in situ of the cervix: Genital human papillomavirus infection: Alggorithm of and risks for cervical human papillomavirus infection and squamous intraepithelial lesions in adolescent girls: Arch Pediatr Adolesc Med. National Cancer Institute; Risk factors for adenocarcinoma and squamous cell carcinoma of the cervix in women aged 20—44 years: Natural history of cervicovaginal papillomavirus infection in young women.
N Engl J Med. Human papillomavirus infection is transient in young women: