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ASCCP is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The ASCCP Risk-Based Management Consensus Guidelines represented a consensus of. The ASCCP Management Guidelines App & Web Application is Now Available. Streamline navigation of the ASCCP Risk Based Management Consensus Guidelines with. APPLE MACBOOK PRO MODEL NO A1286 Simpson can depend Python generated pointer listen. You you includes, Skip Insights from and platform footer. Then is like most been tightenend, "out" going are to.

The management guidelines were revised to reflect the availability of sufficient data from the United States showing that the risk-based approach can provide more appropriate and personalized management for an individual patient based on their current results and past history. Risk-based management allows clinicians to better identify which patients will likely go on to develop pre-cancer and which patients can return to surveillance.

Cervical cancer screening recommendations have changed since the guidelines. For example, primary HPV is a screening option for patients 25 years of age and older. Updated guidelines were needed to incorporate these changes. Importantly, changing the paradigm of management from results-based to risk-based allows for incorporation of future technologies. The guidelines were published in the Journal of Lower Genital Tract Diseases in April and are available for use now.

An app to streamline navigation of the guidelines will be available soon. Find out more. Risk estimates were calculated using electronic health record data from patients in the Kaiser Permanente of Northern California cohort. Our analysis demonstrated that the risk-based recommendations can be applied to diverse settings across the United States.

Details of the statistical methods are described in the publication Li C. Pathology professional organizations participated in every aspect of the guidelines development with two pathologists on the Steering committee and a total of 11 pathologists were members of various Guideline working groups.

The value of partial genotyping for clinical management of abnormal screening results is well established in the literature. The value of genotyping, particularly for 16, is handled in the risk estimation section of the ASCCP guideline publications e. The value of genotyping for surveillance in different clinical settings post colposcopy and posttreatment and the additional risk stratification of more detailed genotyping are being assessed and guidance will follow in subsequent updates of the Guidelines.

By using this site, you agree to the Privacy Policy and acknowledge the use of cookies to store information, which may be essential to making our site work properly or enhancing user experience. Register Today! Management Guidelines. Enduring Guidelines The guidelines are designed to be enduring, unlike prior versions which required major updates every years to adjust with emerging evidence. This information is not intended for use without professional advice.

The updated management guidelines aim to:. Updated United States consensus guidelines for management of cervical screening abnormalities are needed to accommodate the three available cervical screening strategies: primary human papillomavirus HPV screening, cotesting with HPV testing and cervical cytology, and cervical cytology alone.

New data indicate that a patient's risk of developing cervical precancer or cancer can be estimated using her current screening test results and prior screening test and biopsy results, while considering personal factors such as age and immunosuppression.

Furthermore, since prior test results affect risk, patients with prior abnormalities often require surveillance with HPV testing or cotesting at more frequent intervals than are recommended for screening. Routine screening applies only to patients without risk factors. Introduction of risk- based guidelines in was a conceptual breakthrough, but the recommendations retained a continued reliance on complicated algorithms and insufficiently incorporated past screening history.

With a more nuanced understanding of how prior results affect risk, and more variables to consider, the guidelines further align management recommendations with current understanding of HPV natural history and cervical carcinogenesis. More frequent surveillance, colposcopy, and treatment are recommended for patients at progressively higher risk, while those at lower risk can defer colposcopy, undergo follow-up at longer surveillance intervals and, when at sufficiently low risk, return to routine screening.

The revised guidelines provide a framework for incorporating new data and technologies as ongoing incremental recommendation revisions, minimizing the time needed to implement changes that are beneficial to patient care. Who developed these guidelines? The last 10 years of research has shown that risk-based management allows clinicians to better identify which patients will likely go on to develop pre-cancer and which patients may be indicated to return to routine screening.

A full list of organizations participating in the consensus process is available. How are these guidelines different? The new Risk-Based Management Consensus Guidelines have several important differences from the Guidelines, while retaining many of principles, such as the principle of equal management for equal risk. Rather than consider test results in isolation, the new guidelines use current and past results to create individualized assessments of a patient's risk of progressing to precancer or cancer.

Do the new guidelines still use algorithms? The new guidelines rely on individualized assessment of risk taking into account past history and current results. Risk estimation will use technology, such as a smartphone application or website. Because the new Risk-Based Management Guidelines will be electronic, updates and new technologies will be incorporated at a much faster rate than in previous iterations of guidelines. The ability to adjust to the rapidly emerging science is critical for the long-term utility of the guidelines.

There will be an option available at no cost. Why were the guidelines revised now? The management guidelines were revised now due to the availability of sufficient data from the United States showing that incorporation of the risk-based approach can provide more appropriate and personalized management for an individual patient based on their current results and past history.

In addition, several new recommendations for cervical cancer screening have come out since , such as primary HPV as a screening option for patients 25 years of age and older. Updated guidelines were needed to incorporate these changes. In addition, changing the paradigm of management from one that is based on specific test results to one that is based on a patient's risk will allow for incorporation of future technologies as well.

Clinical Action Threshold: this term refers to risk levels that prompt different clinical management strategies. Colposcopy standards: this term refers to the ASCCP Colposcopy Standards that provide evidence-based recommendations for the practice of colposcopy.

Cotesting: this term refers to screening or surveillance performed with both cytology and HPV testing. Expedited treatment: this term means treatment without confirmatory colposcopic biopsy e. HPV: this term refers to Human Papillomavirus. HPV-based testing: this term is used in this document to describe the use of either cotesting or primary HPV screening for surveillance after abnormalities.

Lower Anogenital Squamous Terminology LAST : this term refers to two-tiered pathology criteria for evaluating histologic specimens obtained via colposcopic biopsy. Reflex testing: this means that laboratories should perform a specific additional triage test in the setting of a positive screening test to inform the next steps in management.

Surveillance: this term refers to repeat testing HPV primary screening, cotesting, or cytology alone , that occurs at shorter intervals than those recommended for routine screening. Participating organizations supported travel for their participating representatives. All participating consensus organizations, including the primary funders, had equal and balanced roles in the consensus process including data analysis and interpretation, writing of manuscript, and decision to submit for publication.

No industry funds were used in the development of these guidelines. The corresponding authors had final responsibility for the submission decision. No industry funds were used in the development of the applications. The application uses data and recommendations from the following sources: 1.

J Low Genit Tract Dis ; A study of partial human papillomavirus genotyping in support of the ASCCP risk-based management consensus guidelines. Screening Management Publications Definitions.

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Colposcopy is often unremarkable when AIS is present, because it can extend deep into the endocervical canal with noncontiguous lesions. Therefore, if the initial cytology is AGC—favor neoplasia or AIS and no invasion is identified, an excisional procedure is still recommended. Most HPV infections occur in adolescents shortly after first intercourse, 38 with a prevalence up to 54 percent. Because up to 90 percent of HPV infections in adolescents are transient or cleared spontaneously within two years, 42 , 43 the guidelines have been modified to avoid unnecessary testing and treatment.

Cytologic screening should be initiated three years after first intercourse, or at 21 years of age, whichever comes first. Repeat cytology in 12 months is recommended to allow these changes to resolve. Adolescents with CIN 1 are managed with repeat cytology at 12 and 24 months. Management of adolescent women 20 years and younger with a histologic diagnosis of cervical intraepithelial neoplasia, grade 1.

The incidence of HSIL in adolescents is 0. If CIN 2,3 is not found, cytology and colposcopy are preferred every six months for one year with biopsy if high-grade lesions are identified or if HSIL persists on subsequent cytology. Some pathologists are beginning to separate CIN 2 and 3 by histologic criteria. If histology indicates CIN 2,3—not otherwise specified, adolescents may undergo colposcopy and cytology every six months up to 24 months, or treatment with excision or ablation.

Pregnancy does not accelerate cervical lesions, and cervical cancer occurs in only five of , pregnancies. Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. ANNE L. Address correspondence to Barbara S. Reprints are not available from the authors. Author disclosure: Dr. Apgar is a member of the American Society for Colposcopy and Cervical Pathology Board of Directors and author of two colposcopy publications.

J Low Genit Tract Dis. Am J Obstet Gynecol. The carcinogenicity of human papillomavirus types reflects viral evolution. Accessed March 30, International trends in incidence of cervical cancer: II. Squamouscell carcinoma. Int J Cancer. Accuracy of the Papanicolaou test in screening for and follow-up of cervical cytologic abnormalities: a systematic review. Ann Intern Med. Screening for high-grade cervical intraepithelial neoplasia and cancer by testing for high-risk HPV, routine cytology or colposcopy.

Randomized controlled trial of human papillomavirus testing versus Pap cytology in the primary screening for cervical cancer precursors: design, methods and preliminary accrual results of the Canadian cervical cancer screening trial CCCaST. Baseline cytology, human papillomavirus testing, and risk for cervical neoplasia: a year cohort analysis. J Natl Cancer Inst. The absolute risk of cervical abnormalities in high-risk human papillomavirus-positive, cytologically normal women over a year period.

Cancer Res. Bigras G, de Marval F. The probability for a Pap test to be abnormal is directly proportional to HPV viral load: results from a Swiss study comparing HPV testing and liquid-based cytology to detect cervical cancer precursors in 13, women.

Br J Cancer. Bethesda implementation and reporting rates: practices of participants in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology. Arch Pathol Lab Med. Chapter 9: Clinical applications of HPV testing: a summary of meta-analyses. Cervical cytology of atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion ASC-H : characteristics and histologic outcomes. Should women with atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion, receive reflex human papillomavirus-DNA testing?

Prospective follow-up suggests similar risk of subsequent cervical intraepithelial neoplasia grade 2 or 3 among women with cervical intraepithelial neoplasia grade 1 or negative colposcopy and directed biopsy. A randomized trial on the management of low-grade squamous intraepithelial lesion cytology interpretations. Cervical biopsycytology correlation. Biopsy correlates of abnormal cervical cytology classified using the Bethesda system. Gynecol Oncol. Rate of pathology from atypical glandular cell Pap tests classified by the Bethesda nomenclature.

Obstet Gynecol. Dysplasia associated with atypical glandular cells on cervical cytology [published correction appears in Obstet Gynecol. Human papillomavirus DNA detection and histological findings in women referred for atypical glandular cells or adenocarcinoma in situ in their Pap smears. Endometrial cells in cervical cytology: review of cytological features and clinical assessment.

Reporting endometrial cells in women 40 years and older: assessing the clinical usefulness of Bethesda Am J Clin Pathol. Natural history of cervical intraepithelial neoplasia: a critical review. Int J Gynecol Pathol. Prediction of recurrence after treatment for high-grade cervical intraepithelial neoplasia: the role of human papillomavirus testing and age at conisation. HPV testing and monitoring of women after treatment of CIN 3: review of the literature and meta-analysis.

Obstet Gynecol Surv. Cervical adenocarcinoma and squamous cell carcinoma incidence trends among white women and black women in the United States for — Is conservative treatment for adenocarcinoma in situ of the cervix safe? Adenocarcinoma in situ of the cervix: management and outcome.

Genital human papillomavirus infection: incidence and risk factors in a cohort of female university students [published correction appears in Am J Epidemiol. Am J Epidemiol. Prevalence of and risks for cervical human papillomavirus infection and squamous intraepithelial lesions in adolescent girls: impact of infection with human immunodeficiency virus.

Arch Pediatr Adolesc Med. Bethesda, Md. Risk factors for adenocarcinoma and squamous cell carcinoma of the cervix in women aged 20—44 years: the UK National Case-Control Study of Cervical Cancer. Natural history of cervicovaginal papillomavirus infection in young women.

N Engl J Med. Human papillomavirus infection is transient in young women: a population-based cohort study. J Infect Dis. Atypical squamous cells of undetermined significance: human papillomavirus testing in adolescents. Prevalence of cervical intraepithelial neoplasia in sexually active teenagers and young adults.

Results of data analysis of mass Papanicolaou screening of , women in the United States in Cervical mass screening in Norway—, smears a year. Cancer Detect Prev. A study of 10, pediatric and adolescent Papanicolaou smear diagnoses in northern New England. Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and meta-analysis. Management of the minimally abnormal Papanicolaou smear in pregnancy.

Management and evolution of cervical intraepithelial neoplasia during pregnancy and postpartum. Abnormal cervical cytology in pregnancy: a year experience. Management of cervical intraepithelial neoplasia during pregnancy with LOOP excision.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Screening Guidelines Access the screening guidelines for the prevention and early detection of cervical cancer. Colposcopy Standards Read More. Other Guidelines Other guidelines, statements, and recommendations related to anogenital and HPV-related diseases. Privacy Policy Contact Us. Privacy Policy: By using this site, you agree to the Privacy Policy and acknowledge the use of cookies to store information, which may be essential to making our site work properly or enhancing user experience.

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Implementing the 2019 ASCCP Risk-Based Management Guidelines for Abnormal Cervical Cancer Screening asccp

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Colposcopy is preferred for pregnant women with low-grade squamous intraepithelial lesion and high-grade squamous intraepithelial lesion, but evaluation of the former may be deferred until no earlier than six weeks postpartum. Treatment during pregnancy is unacceptable unless invasive carcinoma is identified. Since publication of the American Society for Colposcopy and Cervical Pathology ASCCP consensus guidelines for management of abnormal cervical cytology 1 , 2 and histology, 3 , 4 new data have emerged.

Updated guidelines published in October place greater emphasis on testing for high-risk human papillomavirus HPV. The management of abnormal cytologic and histologic findings has been updated. Colposcopic biopsy of lesions suspicious for cancer or CIN 2,3 is preferred in pregnant women, but biopsy of other lesions is acceptable. Endocervical curettage is unacceptable.

Information from references 5 through 8. One of multiple options when data indicate another approach is superior or when no data favor any single option. Obtaining a histologic specimen of the transformation zone and endocervical canal by laser or cold-knife conization or loop electrosurgical excision or conization. Evaluating the endocervical canal for neoplasia by colposcopy or endocervical sampling. Obtaining a cytologic sample with a cytobrush or histologic specimen by a cytobrush or endocervical curette.

Obtaining a specimen for histologic evaluation by endometrial biopsy, dilatation and curettage, or hysteroscopy. The relationship of cervical intraepithelial neoplasia, grades 2 and 3 CIN 2,3 and cervical cancer to HPV infection is well established.

HPV infection is most prevalent among women 20 to 24 years of age, with a gradual decline in prevalence through 59 years of age. However, even with negative cytology, older women who are HPV positive have a greater risk of developing CIN 3 within 10 years, compared with younger women Women with a positive HPV test and negative cytology can have conservative follow-up with repeat combination testing at 12 months.

Cytology alone is an acceptable screening method in women 30 years and older. Use of human papillomavirus DNA testing as an adjunct to cytology for cervical cancer screening in women 30 years and older. Management of women with atypical squamous cells of undetermined significance. In women with atypical squamous cells—cannot exclude high-grade squamous intraepithelial lesion ASC-H , the prevalence of CIN 2,3 is as high as 50 percent. Colposcopy is recommended for adult women with low-grade squamous intraepithelial lesion LSIL , because 28 percent will harbor CIN 2,3 over a two-year period 5 , 6 , 23 Figure 3 6.

Only 0. If satisfactory colposcopy does not identify CIN 2,3 and endocervical sampling is negative, management may include a diagnostic excisional procedure or cytology and colposcopy every six months until both are negative twice.

HPV positivity has a high positive predictive value for significant cervical disease, with 20 percent of women having CIN 3 or cancer on biopsy. Endometrial cells are found on 0. CIN 3 is considered a cancer precursor. AIS is a high-grade glandular lesion that is relatively rare 0. Colposcopy is often unremarkable when AIS is present, because it can extend deep into the endocervical canal with noncontiguous lesions.

Therefore, if the initial cytology is AGC—favor neoplasia or AIS and no invasion is identified, an excisional procedure is still recommended. Most HPV infections occur in adolescents shortly after first intercourse, 38 with a prevalence up to 54 percent. Because up to 90 percent of HPV infections in adolescents are transient or cleared spontaneously within two years, 42 , 43 the guidelines have been modified to avoid unnecessary testing and treatment.

Cytologic screening should be initiated three years after first intercourse, or at 21 years of age, whichever comes first. Repeat cytology in 12 months is recommended to allow these changes to resolve. Adolescents with CIN 1 are managed with repeat cytology at 12 and 24 months. Management of adolescent women 20 years and younger with a histologic diagnosis of cervical intraepithelial neoplasia, grade 1.

The incidence of HSIL in adolescents is 0. If CIN 2,3 is not found, cytology and colposcopy are preferred every six months for one year with biopsy if high-grade lesions are identified or if HSIL persists on subsequent cytology. Some pathologists are beginning to separate CIN 2 and 3 by histologic criteria. If histology indicates CIN 2,3—not otherwise specified, adolescents may undergo colposcopy and cytology every six months up to 24 months, or treatment with excision or ablation.

Pregnancy does not accelerate cervical lesions, and cervical cancer occurs in only five of , pregnancies. Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. ANNE L. Address correspondence to Barbara S. Reprints are not available from the authors.

Author disclosure: Dr. Apgar is a member of the American Society for Colposcopy and Cervical Pathology Board of Directors and author of two colposcopy publications. J Low Genit Tract Dis. Am J Obstet Gynecol. The carcinogenicity of human papillomavirus types reflects viral evolution. Accessed March 30, International trends in incidence of cervical cancer: II. Squamouscell carcinoma. Int J Cancer. Accuracy of the Papanicolaou test in screening for and follow-up of cervical cytologic abnormalities: a systematic review.

Ann Intern Med. Screening for high-grade cervical intraepithelial neoplasia and cancer by testing for high-risk HPV, routine cytology or colposcopy. Randomized controlled trial of human papillomavirus testing versus Pap cytology in the primary screening for cervical cancer precursors: design, methods and preliminary accrual results of the Canadian cervical cancer screening trial CCCaST.

Baseline cytology, human papillomavirus testing, and risk for cervical neoplasia: a year cohort analysis. J Natl Cancer Inst. The absolute risk of cervical abnormalities in high-risk human papillomavirus-positive, cytologically normal women over a year period.

Cancer Res. Bigras G, de Marval F. The probability for a Pap test to be abnormal is directly proportional to HPV viral load: results from a Swiss study comparing HPV testing and liquid-based cytology to detect cervical cancer precursors in 13, women. Br J Cancer. Bethesda implementation and reporting rates: practices of participants in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology.

Arch Pathol Lab Med. Chapter 9: Clinical applications of HPV testing: a summary of meta-analyses. Cervical cytology of atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion ASC-H : characteristics and histologic outcomes. Should women with atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion, receive reflex human papillomavirus-DNA testing? Prospective follow-up suggests similar risk of subsequent cervical intraepithelial neoplasia grade 2 or 3 among women with cervical intraepithelial neoplasia grade 1 or negative colposcopy and directed biopsy.

A randomized trial on the management of low-grade squamous intraepithelial lesion cytology interpretations. Cervical biopsycytology correlation. Biopsy correlates of abnormal cervical cytology classified using the Bethesda system. Gynecol Oncol. Rate of pathology from atypical glandular cell Pap tests classified by the Bethesda nomenclature.

Obstet Gynecol. Dysplasia associated with atypical glandular cells on cervical cytology [published correction appears in Obstet Gynecol. Human papillomavirus DNA detection and histological findings in women referred for atypical glandular cells or adenocarcinoma in situ in their Pap smears. Endometrial cells in cervical cytology: review of cytological features and clinical assessment. Reporting endometrial cells in women 40 years and older: assessing the clinical usefulness of Bethesda Am J Clin Pathol.

Natural history of cervical intraepithelial neoplasia: a critical review. Int J Gynecol Pathol. Prediction of recurrence after treatment for high-grade cervical intraepithelial neoplasia: the role of human papillomavirus testing and age at conisation. Screening Guidelines Access the screening guidelines for the prevention and early detection of cervical cancer. Colposcopy Standards Read More. Other Guidelines Other guidelines, statements, and recommendations related to anogenital and HPV-related diseases.

Privacy Policy Contact Us. Privacy Policy: By using this site, you agree to the Privacy Policy and acknowledge the use of cookies to store information, which may be essential to making our site work properly or enhancing user experience.

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