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Update on ASCCP consensus guidelines for abnormal cervical screening tests and cervical histology
Barbara S Apgar1, Anne L Kittendorf, Catherine M Bettcher
1University of Michigan Medical Center, Ann Arbor, Michigan 48103, USA.
American Family Physician
|July 23, 2009
Summary
Updated guidelines for abnormal cervical cytology management now incorporate human papillomavirus (HPV) testing. These 2006 recommendations address special populations and refine treatment strategies for cervical intraepithelial neoplasia (CIN).
Area of Science:
- Gynecology
- Oncology
- Public Health
Background:
- The 2001 American Society for Colposcopy and Cervical Pathology guidelines for abnormal cervical cytology require updates based on new data.
- Recent advancements necessitate revised management protocols for cervical cytology and histology.
Purpose of the Study:
- To present the 2006 consensus guidelines for managing abnormal cervical cytology and histology.
- To incorporate new data and recommendations, including those for special populations and human papillomavirus (HPV) testing.
Main Methods:
- Review and synthesis of emerging data since the 2001 guidelines.
- Development of recommendations for management of abnormal cervical cytology and histology.
- Inclusion of specific guidance for adolescents, pregnant women, and HPV testing integration.
Main Results:
- The 2006 guidelines include recommendations for adolescents and pregnant women.
- HPV testing is integrated for atypical glandular cells, post-treatment follow-up for cervical intraepithelial neoplasia (CIN), and co-testing in women 30+.
- Preferred management for atypical squamous cells of undetermined significance (ASCUS) in adults is reflex HPV DNA testing. Colposcopy is recommended for various high-risk lesions, with conservative management for CIN grade 1 in adults and most adolescent diagnoses.
- Treatment for CIN grades 2 and 3 in adults is recommended, with immediate treatment an option. Conservative management is advised for adolescents, except for specific CIN 3 and adenocarcinoma in situ. Pregnant women with low-grade or high-grade squamous intraepithelial lesions (LSIL/HSIL) should undergo colposcopy, with potential deferral for LSIL post-partum. Invasive cancer is the only indication for treatment during pregnancy.
Conclusions:
- The 2006 guidelines provide updated, evidence-based management strategies for abnormal cervical cytology and histology.
- Integration of HPV testing and consideration of special populations enhance the precision and safety of cervical cancer screening and management.
- Revised protocols aim to optimize patient outcomes while minimizing overtreatment, particularly in adolescents and pregnant women.
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