Management of ASC-US with Atrophic Changes

Initial Management Algorithm

For women with ASC-US, reflex HPV DNA testing is the preferred initial management strategy, as recommended by the American Academy of Family Physicians 3
If HPV testing is positive, colposcopy is recommended due to increased risk of cervical intraepithelial neoplasia (CIN), according to the American College of Obstetricians and Gynecologists guidelines 1, 3
If HPV testing is negative, repeat cytology in 12 months is recommended, as suggested by the American College of Obstetricians and Gynecologists 2
Women over 65 years with ASC-US should not exit screening without additional negative tests, even with HPV-negative results, as recommended by the American College of Obstetricians and Gynecologists 1

Studies show that approximately 9.7% of women with ASC-US have CIN 2 or more serious abnormality, necessitating further evaluation, according to the American Academy of Family Physicians 3
Atrophic changes can mimic dysplasia, but should not alter the management algorithm for ASC-US, as recommended by the American College of Obstetricians and Gynecologists 1

If HPV testing is positive, follow-up after colposcopy depends on colposcopy results, as recommended by the National Comprehensive Cancer Network 4
If HPV testing is negative, repeat co-testing (Pap and HPV) in 3 years is recommended, according to the American College of Obstetricians and Gynecologists 1, 2
Women should not exit screening at age 65 with a recent ASC-US result, even if HPV-negative, as recommended by the American College of Obstetricians and Gynecologists 1
Continued screening is necessary until the patient has 2 consecutive negative co-tests or 3 consecutive negative Pap tests, as suggested by the American College of Obstetricians and Gynecologists 1

Despite atrophic changes, the management algorithm remains the same as for other ASC-US results, as recommended by the American College of Obstetricians and Gynecologists 1
Women over 60 years with HPV-positive ASC-US may have a higher risk for cervical cancer during follow-up than younger women, according to the American College of Obstetricians and Gynecologists 1
Risk estimates for cancer among women with HPV-positive ASC-US test results in this age group suggest caution is warranted, as recommended by the American College of Obstetricians and Gynecologists 1

Do not allow exit from screening at age 65 with a recent ASC-US result, as this is insufficient for exiting screening, according to the American College of Obstetricians and Gynecologists 1
Do not extend screening interval beyond 3 years for HPV-negative ASC-US, as the previous 5-year interval recommendation has been revised based on newer evidence, as recommended by the American College of Obstetricians and Gynecologists 1
Do not assume that an HPV-negative ASC-US result carries the same ultralow risk as a negative co-test, according to the American College of Obstetricians and Gynecologists 2
Do not perform colposcopy immediately for all ASC-US results regardless of HPV status, as it can lead to unnecessary procedures, as recommended by the American College of Obstetricians and Gynecologists 2

For HIV-infected women, more frequent screening is recommended regardless of age, according to the Infectious Diseases Society of America 5
Women with atypical squamous cells should undergo colposcopy and directed biopsy, as recommended by the Infectious Diseases Society of America 5
Abnormal cervical cytology is 10–11 times more common in HIV-infected women compared with the general female population, according to the Infectious Diseases Society of America 5