By the Numbers
Primary goal of 2019 ASCCP guidelines
What is to minimize unnecessary diagnostic testing and procedures through the use of risk based management for abnormal cervical cancer screening?
NILM
What is Negative for Intraepithelial Malignancy?
32 year old woman undergoes cervical cancer screening and has a result of ASC-US. Initial management includes.
What is, HPV testing?
28 year old woman with ASC-US has a positive high-risk HPV test. Next step in management.
What is, perform colposcopy?
45 year old woman has a cervical cytology result of ASC-H. Most appropriate management.
What is, perform immediate colposcopy?
Immediate CIN 3+ risk greater than or equal to 4%; management.
What is colposcopy recommended?
ASC-US
What is Atypical Squamous Cells of Undetermined Significance?
23 year old woman with LSIL Pap smear. Recommended management.
What is, repeat Pap smear in 12 months?
27 year old woman with a cervical cytology result of HSIL which is confirmed. Next step in management?
What is, loop electrosurgical excision procedure or conization?
30 year old woman with CIN 2 on colposcopically directed biopsy without concern for future pregnancy. Next step in management.
What is LEEP or excision procedure?
Immediate CIN 3 risk less than 4%; management
What is surveillance at 1, 3, or 5 years?
ASC-H
What is Atypical Squamous Cells cannot exclude high-grade squamous intraepithelial lesion?
50 year old woman with negative Pap smear tests positive for high risk HPV. Next step in management.
What is repeat Pap smear and HPV testing in 12 months?
30 year old woman has a cervical cytology result of LSIL. Appropriate management for this patient.
What is perform colposcopy?
Following treatment for CIN 3 with LEEP. Next step in Management.
What is 6 month follow up with HPV based screening?
Immediate CIN 3+ risk 25% to 59%; management
What is expedited treatment or colposcopy are acceptable?
LSIL
What is Low-grade Squamous Intraepithelial Lesion?
26 year old pregnant woman diagnosed with CIN 3. Recommended management.
What is observation with follow up colposcopy after delivery unless there is concern for invasive cancer?
22 year old woman has a cytology result of ASC-H. Recommended management.
What is perform immediate colposcopy?
32 year old woman undergoes LEEP for CIN 3. At the 6 month follow up, Pap smear is normal and HPV testing is negative. Next step in management.
What is HPV based testing at 18 months and 30 months?
Immediate CIN 3+ risk 60% or greater; management
What is expedited treatment is preferred?
HSIL
What is High-Grade Squamous Intraepithelial Lesion?
55 year old woman undergoes evaluation for HSIL with eventual hysterectomy for dysplasia and menorrhagia. Pathology report reveals CIN 3 with negative margins. Next steps in management.
What is 3 consecutive annual HPV-based tests before entering long-term surveillance; long-term surveillance after treatment for histologic HSIL (CIN 2 or CIN 3) with HPV-based testing at 3-year intervals for 25 years regardless of whether the patient has had a hysterectomy?
65 year old woman has LSIL Pap smear but HPV test is negative. Next step in management.
What is HPV based screening in one year?
50 year old woman status post LEEP for CIN 3 with normal Pap smear and negative HPV at 6 months, 18 months and 30 months. Next step in management.
What is HPV based testing every 3 years for greater than or equal to 25 years, should continue through age greater than or equal to 65 years, and may continue as long as patient is in good health?