Objective To provide evidence-based consensus guidelines for the management of
women with cervical cytological abnormalities and cervical cancer precursors.
Participants A panel of 121 experts in the diagnosis and management of cervical cancer
precursors, including representatives from 29 professional organizations,
federal agencies, and national and international health organizations, were
invited to participate in a consensus conference sponsored by the American
Society for Colposcopy and Cervical Pathology (ASCCP).
Evidence and Consensus Process Guidelines for the management of women with cervical cytological abnormalities
were developed through a multistep process. Starting 6 months before the conference,
working groups developed draft management guidelines based on formal literature
reviews of English-language articles published in 1988-2001, as well as input
from the professional community at large, obtained using interactive Internet-based
bulletin boards. On September 6-8, 2001, the ASCCP Consensus Conference was
held in Bethesda, Md. Guidelines with supporting evidence were presented and
underwent discussion, revision, and voting.
Conclusions Management of women with atypical squamous cells (ASC) depends on whether
the Papanicolaou test is subcategorized as of undetermined significance (ASC-US)
or as cannot exclude high-grade squamous intraepithelial lesion (HSIL) (ASC-H).
Women with ASC-US should be managed using a program of 2 repeat cytology tests,
immediate colposcopy, or DNA testing for high-risk types of human papillomavirus
(HPV). Testing for HPV DNA is the preferred approach when liquid-based cytology
is used for screening. In most instances, women with ASC-H, low-grade squamous
intraepithelial lesion, HSIL, and atypical glandular cells should be referred
for immediate colposcopic evaluation.