Management of Pap Smear with Atypical Squamous Cells Cannot Exclude HSIL (ASC-H)

Initial Management

The American Society for Colposcopy and Cervical Pathology (ASCCP) recommends colposcopy as the first-line management for all women with ASC-H, due to the high risk of underlying high-grade cervical intraepithelial neoplasia (CIN 2,3), with a risk of up to 50% 1, 2
HPV testing alone is not recommended for initial triage of ASC-H, as the prevalence of high-grade lesions is significantly higher 1
If colposcopy results are negative or unsatisfactory, endocervical assessment using a cytobrush or endocervical curette is preferred 1
For non-pregnant patients aged ≥25 years with ASC-H and positive HPV 16, expedited treatment may be considered as an alternative to colposcopy, as recommended by the guidelines 3

If colposcopy is negative, follow-up should include either repeat cytology at 6 and 12 months, or HPV testing at 12 months, as recommended by the American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines 1, 2
Colposcopic reevaluation is indicated if follow-up HPV testing is positive or if repeat cytology shows ASC-US or greater 1

HIV-infected women with ASC-H should undergo colposcopy and directed biopsy, and more frequent cervical screening is recommended for those with a history of abnormal Pap tests 4
After treatment for cervical dysplasia, HIV-infected women require careful follow-up with frequent cytologic screening and colposcopic examination when indicated due to increased risk of recurrence 4, 5

The risk of underlying high-grade disease with ASC-H is substantial, with 1.7% for adenocarcinoma in situ (AIS) 1