ASCCP 1st step cytology management

Question 1

NILM EC/TZ absent

Answer 1

• 21 - 29 = routine screening

* > 30 = HPV testing preferred BUT if HPV unknown can repeat in cytology in 3 years

Question 2

NILM HPV +

Answer 2

> 30 = repeat cotest 1 year (if HPV+ or > ASC → colpo),

Or

If genotyped 16/18 → colpo

Question 3

ASCUS age > 25

Answer 3

HPV testing preferred
• HPV ? = Repeat 1 year (if ASC or more → colpo)
• HPV + = colpo
• HPV - = cotest in 3 years

Question 4

ASCUS or LSIL age 21 -24

Answer 4

• Repeat 1 year

* ASCUS only: HPV - → routine screening

Question 5

LSIL age > 25

Answer 5

• HPV - → repeat cotest 1 year (preferred) or colpo
• HPV+ or ? → colpo
• Pregnant → defer colpo until pp

Question 6

ASC-H

Answer 6

→ colpo for everyone

Question 7

HSIL 21-24

Answer 7

→ colpo

Question 8

HSIL > 25

Answer 8

→ immediate LEEP or colpo

Question 9

AGC

Answer 9

• Atypical endometrial cells → endometrial/endocervical sampling
• All other subcategories → colpo with endocervical sampling (add endometrial if > 35 years or at risk for endometrial neoplasia)

Question 10

Unsatisfactory

Answer 10

→ Repeat 2-4 months (all ages)

consider colpo if HPV+ > 30

Question 11

CIN 2 or 3 post excision/ablation

Answer 11

→ cotest at 12 and 24 months
→ any abnormal = colpo and endocervical sample
→both negative = repeat contesting in 3 years