Levine_Handbook for Principles and Practice of Gynecologic O

90 Handbook for Principles and Practice of Gynecologic Oncology

Management of women with atypical squamous cells of undetermined significance (ASC-US) on cytology*

Repeat cytology @ 1 year Acceptable

HPV testing Preferred

≥ ASC

Negative

HPV positive (Managed the same as women with LSIL)

HPV negative

Routine screening (Cytology in 3 years)

Repeat cotesting @ 3 years

Colposcopy Endocervical sampling preferred in women with no lesions, and those with inadequate colposcopy; it is acceptable for others

Manage per ASCCP guideline

*Management options may vary if the woman is pregnant or ages 21–24.

ASC-US. Due to the high prevalence of HPV infection and high rates of spon taneous clearance among women aged 21 to 24 years, repeat cytology at 12 months is recommended over reflex HPV testing in this population. Management options for pregnant patients with ASC-US are identical to those for nonpregnant patients with the exception that endocervical curet tage (ECC) should be deferred and it is acceptable to postpone colposcopic examination until the patient is 6 to 8 weeks postpartum. Atypical Squamous Cells—Cannot Exclude HSIL The prevalence of biopsy-confirmed CIN 2,3 is considerably higher among women referred for the evaluation of ASC-H cervical cytology than it is for women referred for the evaluation of ASC-US. Therefore, colposcopy is recommended regardless of HPV status. If CIN is not identified follow ing an adequate colposcopy with negative ECC, follow-up utilizing repeat cytology with HPV testing at 6 and 12 months or an excisional procedure is recommended. For women aged 21 to 24 years, adequate colposcopy with cytology is recommended every 6 months for 2 years rather than an excisional procedure. Low-Grade Squamous Intraepithelial Lesions As with ASC-US, there is considerable variation between populations and laboratories in the rates at which LSIL is reported. A cytologic result of LSIL is a very specific indicator of the presence of high-risk types of HPV. In the Atypical Squamous Cells of Undetermined Significance/Low-Grade FIGURE 4.4 ASCCP guidelines for the management of women with atypical squa mous cells of undetermined significance (ACS-US) on cytology. Source: Reprinted with permission from Massad LS, Einstein MH, Huh WK, et al. 2012 updated con sensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis . 2013;17(5 suppl 1):S1–S27.

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