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Management of Women with Abnormal Cervical Cytology on Screening

for Health Care Providers

Table 3. Management of Women with Abnormal Cervical Cytology on Screening

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Cytology ResultNext StepComments
Refers to the management of adult women only, and not to adolescents, pregnant women, or the elderly.
Adapted from Wright TC Jr, Massad LS, Dunton CJ, et al. 2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests. Am J Obstet Gynecol. 2007 Oct;197(4):346-55.
Atypical Squamous Cells of Undetermined Significance (ASCUS)
  • Refer for colposcopy
    Could consider:
  • HPV testing for oncogenic subtypes
    OR
  • Repeat cytology (Pap)
There is controversy about management of ASCUS in HIV-infected women:
  • Many authorities recommend that all HIV-infected women with ASCUS be referred for colposcopy.
  • In HIV-infected women, there are insufficient data to recommend HPV DNA testing for oncogenic HPV types as part of management of ASCUS.
  • If colposcopy is chosen, and no CIN is found, repeat cytology at 12 months.
  • If HPV testing is chosen, reflex HPV testing of samples collected during cytologic screening is preferred, for patient's convenience. This requires liquid-based cytology or samples collected specifically for HPV testing and held. Otherwise, HPV testing requires another Pap smear.
    • If HPV negative, repeat cytology at 12 months.
    • If HPV positive, manage as for LSIL (below).
  • If repeat cytology is chosen, repeat at 6-month intervals until 2 consecutive negative tests, then return to normal screening interval. If repeat shows ASCUS or higher, refer for colposcopy.
Atypical Squamous Cells/cannot exclude HSIL (ASC-H)
  • Refer for colposcopy
If no CIN 2 or 3 is found on colposcopy, perform cytology at 6 and 12 months, or HPV testing at 12 months. If above are negative, return to regular cytologic screening schedule.
Low-Grade Squamous Intraepithelial Lesion (LSIL)
  • Refer for colposcopy
If no CIN 2 or 3 is found on colposcopy, perform cytology at 6 and 12 months, or HPV testing at 12 months. If above results are negative, return to regular cytologic screening schedule.
High-Grade Squamous Intraepithelial Lesion (HSIL)
  • Refer for colposcopy or loop electrosurgical procedure (LEEP)
  • If no CIN 2 or 3 is found, multiple options include: colposcopy and cytology every 6 months for 1 year as long as colposcopy is adequate and cytology is negative; excisional diagnostic procedure.
  • If colposcopy is chosen, excisional procedure is indicated if repeat colposcopy shows HSIL or is unsatisfactory. If repeat colposcopies are negative, return to routine cytologic screening.

From Cancer Screening
Primary Care of Veterans with HIV
Office of Clinical Public Health Programs
Veterans Health Administration, 2009