Postcolposcopy management strategies for women referred with low-grade squamous intraepithelial lesions or human papillomavirus DNA–positive atypical squamous cells of undetermined significance: A two-year prospective study

Guido, Richard S.; Schiffman, Mark; Solomon, Diane; Burke, Louis

doi:10.1067/mob.2003.456

Cited by 173 publications

(99 citation statements)

References 11 publications

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“…57 An HC2 test 12 months after a first report of LSIL detected 92% of cumulative CIN3+ and was associated with a referral rate of 55%. 44 Further research is needed to identify more specific tools to distinguish LSIL women who are truly at risk for progressive lesions. HPV DNA typing, type-specific viral load, targeting essentially HPV16, presence of hrHPV RNA and other progression markers are potential candidates.…”

Section: Management Of Women With Lsilmentioning

confidence: 99%

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European guidelines for quality assurance in cervical cancer screening: recommendations for clinical management of abnormal cervical cytology, part 1

et al. 2008

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European guidelines for quality assurance in cervical cancer screening: recommendations for clinical management of abnormal cervical cytology, part 1The current paper presents the first part of Chapter 6 of the second edition of the European Guidelines for Quality Assurance in Cervical Cancer Screening. It provides guidance on how to manage women with abnormal cervical cytology. Throughout this article the Bethesda system is used for cervical cytology terminology, as the European guidelines have recommended that all systems should at least be translated into that terminology while cervical intraepithelial neoplasia (CIN) is used for histological biopsies (Cytopathology 2007; 18:213-9). A woman with a high-grade cytological lesion, a repeated low-grade lesion or with an equivocal cytology result and a positive human papillomavirus (HPV) test should be referred for colposcopy. The role of the colposcopist is to identify the source of the abnormal cells and to make an informed decision as to whether or not any treatment is required. If a patient requires treatment the colposcopist will decide which is the most appropriate method of treatment for each individual woman. The colposcopist should also organize appropriate follow-up for each woman seen. Reflex testing for high-risk HPV types of women with atypical squamous cells (ASC) of undetermined significance with referral for colposcopy of women who test positive is a first option. Repeat cytology is a second possibility. Direct referral to a gynaecologist should be restricted to special circumstances. Follow-up of low-grade squamous intraepithelial lesion is more difficult because currently there is no evidence to support any method of management as being optimal; repeat cytology and colposcopy are options, but HPV testing is not sufficiently selective, unless for older women. Women with high-grade squamous intraepithelial lesion (HSIL) or atypical squamous cells, cannot exclude HSIL (ASC-H) should be referred without triage. Women with glandular lesions require particular attention. In a subsequent issue of Cytopathology, the second part of Chapter 6 will be presented, with recommendations for management and treatment of histologically confirmed intraepithelial neoplasia and guidance for follow-up of special cases such as women who are pregnant, postmenopausal or immunocompromised.

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Section: Management Of Women With Lsilmentioning

confidence: 99%

“…5,34,42 HPV+ cases should be referred for colposcopic evaluation. HPV testing can be repeated after 12 months [43][44][45] when no CIN is found on colposcopy and biopsy. hrHPVwomen should be recommended to have an additional cytology test taken after 1 year.…”

Section: Management Of Women With Atypical Squamous Cellsmentioning

confidence: 99%

European guidelines for quality assurance in cervical cancer screening: recommendations for clinical management of abnormal cervical cytology, part 1

et al. 2008

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“…15,17,23 Several studies have used different classifications of mildly abnormal cytology. 17,[19][20]23,[30][31][32] Cuzick et al included women with borderline cytology and negative cytology but were hrHPV positive (HART study). 23 The ALTS study describes triage in women with ASCUS and LSIL cytology (ALTS Group).…”

Section: Discussionmentioning

confidence: 99%

“…This is in agreement with the findings of previous studies. 6,17,19,20,23,[30][31][32] Approximately half of these women cleared hrHPV in 12 months and none of them developed a high-grade CIN during this time. Fourteen percent developed high-grade CIN after 12 months (all were persistently hrHPV positive), without an observed development of (micro)invasive carcinoma.…”

Section: Discussionmentioning

confidence: 99%

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Triage using HPV‐testing in persistent borderline and mildly dyskaryotic smears: Proposal for new guidelines

Bais

Rebolj

Snijders

et al. 2005

Intl Journal of Cancer

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In the Netherlands 2% of cervical smears in the cervical cancer screening program are read as borderline or mildly dyskaryotic cytology (BMD smear). Only in about 10% of these women a highgrade CIN lesion (CIN II-III) is present; therefore referral is for the majority unnecessary. In our study triage with high-risk HPV (hrHPV) testing was used to identify women at risk for development of high-grade CIN lesions after a repeat BMD smear. A ''wait-and-see'' period was incorporated allowing clearance of HPV and regression of the lesion. Women with a low-grade lesion, irrespective of their HPV status, were monitored at 12 months; women with a high-grade lesion were monitored at 6 and 12 months. Fifty-one of the 105 women (49%) were hrHPV negative at baseline; none of them showed progression of the lesion within the first year of follow-up (NPV 100%). High-grade CIN was present in 1 patient who was HPV negative at baseline (2%); she demonstrated regression after 12 months. Nineteen of the hrHPV positive women (35%) demonstrated a high-grade CIN lesion at baseline and 3 cleared hrHPV after 6 months, with a subsequent regression of CIN. Ten women remained hrHPV positive with persistence of high-grade CIN and were eventually treated. At baseline, 35 hrHPV positive women demonstrated a low-grade lesion, 19 remained hrHPV positive after 12 months and 5 developed high-grade CIN. Sixteen out of the 35 cleared the hrHPV infection without progression of the lesion. In conclusion, triage, using hrHPV testing for women with persistent BMD cytology, can select women who are not at risk for development of high-grade CIN. We recommend return to the screening program without referral for colposcopic examination if hrHPV is absent. For hrHPV positive women, a repeat hrHPV test after another 6 months is suggested. Referral is only required if persistence of hrHPV is established. ' 2005 Wiley-Liss, Inc.Key words: HPV; triage; borderline or mild dyskaryosis; guidelinesIn the Dutch population-based cervical cancer-screening program, women between 30 and 60 years of age undergo a cytological smear every 5th year. Recent surveys showed that about 2% of these smears contained borderline or mildly dyskaryotic (BMD) changes. 1,2 According to current screening guidelines, in these cases cytology is repeated after 6 months and (if negative) after 12 months. When cytology is persistently abnormal, women are referred to the gynaecologist where colposcopic examination is performed and a biopsy is taken for histological examination. When histology shows no or low-grade dysplasia ( CIN I) women will be kept under cytological surveillance without immediate treatment. High-grade dysplasia (CIN II-III) or a worse lesion will be treated. Only 10% of women with a single BMD smear show a high-grade CIN lesion. [3][4][5][6] Consequently, there is a need for an improved risk assessment of women with BMD.Infection with high-risk HPV (hrHPV) has been established as an important etiological factor in the carcinogenesis of cervical cancer. 7,8 Persistence of hr...

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A 21-Year-Old Woman With Atypical Squamous Cells of Undetermined Significance

Sawaya

2005

JAMA

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Postcolposcopy management strategies for women referred with low-grade squamous intraepithelial lesions or human papillomavirus DNA–positive atypical squamous cells of undetermined significance: A two-year prospective study

Cited by 173 publications

References 11 publications

European guidelines for quality assurance in cervical cancer screening: recommendations for clinical management of abnormal cervical cytology, part 1

European guidelines for quality assurance in cervical cancer screening: recommendations for clinical management of abnormal cervical cytology, part 1

Triage using HPV‐testing in persistent borderline and mildly dyskaryotic smears: Proposal for new guidelines

A 21-Year-Old Woman With Atypical Squamous Cells of Undetermined Significance

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