Management and follow-up of abnormal Papanicolaou tests

Although less prevalent than breast cancer, cervical cancer has a lower 5-year survival rate. Cervical cancer is nearly always due to human papillomavirus (HPV). Increased screening and DNA typing for oncogenic HPV have begun to reduce the number of cases. Interpretation of Papanicolaou test results and disease management decisions require a comprehensive grasp of recent revisions in classification and management practice. This article reviews the recommendations of the multidisciplinary Bethesda 2001 Workshop and the American Society for Colposcopy and Cervical Pathology. Practice changes include: new criteria for using liquid-based collection, a streamlined borderline category of atypical squamous cells (ASC), and a new category of ASC-cannot exclude high-grade lesion (ASC-H). Management includes colposcopy for all categories suspicious for epithelial abnormality and clearer guidelines for diagnostic colposcopy and endocervical sampling for glandular cell abnormalities (AGC, AGC-favor neoplasia). Adolescents and postmenopausal women have some variations from the recommended protocol. Reflex HPV DNA typing reflects the advances in research regarding risks for progression to cervical cancer. Treatment options include surgical removal of the lesions via laser, cryosurgery, loop excision, or cold-knife conization. Medical options include local treatments of cervical condyloma with tricloroacetic acid or 5-fluorouracil. Visible and sometimes functional cervical changes may result. Clinicians now have clearer guidelines with which to manage abnormal Papanicolaou test results, using the latest technology and research. Discussing abnormal results with patients requires great sensitivity.