Management of Abnormal Cervical Screening Results

Immediate Management

The American College of Obstetricians and Gynecologists recommends referring for colposcopy immediately, rather than pursuing repeat cytology or observation, as women with ASC-US who are HPV-positive should be managed identically to women with LSIL 2, 3, 4
The 2006 ASCCP Consensus Guidelines explicitly state that HPV-positive ASC-US warrants colposcopic evaluation regardless of age, with endocervical sampling preferred when no lesions are identified on colposcopy 2, 3

The colposcopy must visualize the entire transformation zone to be considered satisfactory, and directed biopsies should be obtained from any suspicious lesions 1, 5
Endocervical sampling is mandatory for unsatisfactory colposcopy, and is preferred when no lesions are identified on colposcopy 2, 3

If no CIN or only CIN1 is identified, two acceptable options exist: repeat HPV testing at 12 months, or repeat cytology at 6 and 12 months, with colposcopy if ASC-US or greater is found on either test 2, 3, 6
If CIN2 or CIN3 is identified, treatment with excisional or ablative procedures (LEEP, cryotherapy, cold knife conization, or laser ablation) is indicated, with histologic confirmation required before excisional procedures 1, 5

The American Society for Colposcopy and Cervical Pathology recommends against using repeat cytology or observation as initial management for HPV-positive ASC-US in women over age 20, and against performing HPV genotyping (HPV 16/18 testing) to decide about colposcopy in the setting of ASC-US 1, 2, 3, 4
The American College of Obstetricians and Gynecologists recommends against excisional procedures without histologic confirmation of CIN2+, as this represents overtreatment 2, 3