2012 Updated Consensus Guidelines for the Management of Abnormal Cervical Cancer Screening Tests and Cancer Precursors

Abstract

A group of 47 experts representing 23 professional societies, national and international health organizations, and federal agencies met in Bethesda, MD, September 14-15, 2012, to revise the 2006 American Society for Colposcopy and Cervical Pathology Consensus Guidelines. The group's goal was to provide revised evidence-based consensus guidelines for managing women with abnormal cervical cancer screening tests, cervical intraepithelial neoplasia (CIN) and adenocarcinoma in situ (AIS) following adoption of cervical cancer screening guidelines incorporating longer screening intervals and co-testing. In addition to literature review, data from almost 1.4 million women in the Kaiser Permanente Northern California Medical Care Plan provided evidence on risk after abnormal tests. Where data were available, guidelines prescribed similar management for women with similar risks for CIN 3, AIS, and cancer. Most prior guidelines were reaffirmed. Examples of updates include: Human papillomavirus-negative atypical squamous cells of undetermined significance results are followed with co-testing at 3 years before return to routine screening and are not sufficient for exiting women from screening at age 65 years; women aged 21-24 years need less invasive management, especially for minor abnormalities; postcolposcopy management strategies incorporate co-testing; endocervical sampling reported as CIN 1 should be managed as CIN 1; unsatisfactory cytology should be repeated in most circumstances, even when HPV results from co-testing are known, while most cases of negative cytology with absent or insufficient endocervical cells or transformation zone component can be managed without intensive follow-up.

Prognostic value of human papillomavirus 16/18 genotyping in low-grade cervical lesions preceded by mildly abnormal cytology

“…In prospective studies, HPV16/18 positivity is linked with a higher risk of future high-grade cervical lesions (Khan et al, 2005;Bulk et al, 2007;Persson et al, 2015). Based on evidence in the research literature, ASCCP guidelines recommend that women aged 30 years or older with normal cytology but positive HPV16/18 should be referred for immediate colposcopy, because they are at particularly high risk of current or future high-grade cervical lesions (Massad et al, 2013). In this study, we have confirmed the triage value of HPV16/18 genotyping in LSIL/CIN1, which is comparable and complementary to earlier published data.…”

“…Considering the high spontaneous regression rate among this age group, HPV testing is not recommended (Davey et al, 2014). Similarly, colposcopy associated with HPV16/18 is restricted to women aged 30 years or older (Massad et al, 2013). HPV16/18 genotyping showed no triage value under age of 30 years.…”

“…The endpoints were defined as follows: (1) progression: histology-confirmed HSIL or more; (2) regression: cytology normal and hrHPV negative, or cytology/ hrHPV positive but histology negative; and, (3) persistence: histology-confirmed LSIL/CIN1. Women reaching an endpoint would then be handled according to the ASCCP management guidelines (Massad et al, 2013).…”

“…Kaiser Permanente Northern California (KPNC) data showed a relatively low 5-year progression rate of LSIL/CIN1 preceded by normal cytology (negative for intraepithelial lesion or malignancy (NILM)) or mildly abnormal cytology (atypical squamous cells of undetermined significance (ASC-US) and LSIL), but a substantially higher progressive risk with more severe abnormalities (high-grade squamous intraepithelial lesion (HSIL), atypical squamous cellscannot rule out HSIL (ASC-H), and atypical glandular cells (AGC)) (Katki et al, 2013). Accordingly, LSIL/CIN1 preceded by normal or mildly abnormal cytology is considered low-risk and recommended for conservative follow-up only (Massad et al, 2013), with no triage management available. Yet up to 10% of progression was reported for these patients (Katki et al, 2013).…”

“…Progressive risk is elevated for women with positive HPV16/18, even when cytology is normal (Khan et al, 2005). Thus, HPV16/18 positivity alone is an indication for colposcopy referral among women aged 30 years or older, according to the current American Society for Colposcopy and Cervical Pathology (ASCCP) management guidelines (Massad et al, 2013). Yet no prospective study has addressed the prognostic value of HPV16/18 genotyping in LSIL/ CIN1 preceded by non-severe cytology abnormalities.…”