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Clinical Crossroads | Clinician's Corner

A 21-Year-Old Woman With Atypical Squamous Cells of Undetermined Significance

George F. Sawaya, MD, Discussant
JAMA. 2005;294(17):2210-2218. doi:10.1001/jama.294.17.2210.
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DR REYNOLDS: Ms G is a 21-year-old woman with a history of abnormal Papanicolaou (Pap) tests.

Ms G first became sexually active at age 19. That year, she had her first gynecologic examination when she visited a doctor to ask for an oral contraceptive pill prescription. Her examination and cytology test were normal. She had annual Pap screening until age 21, when her cytology test (conventional) showed atypical squamous cells of undetermined significance (ASC-US). Her clinician, a nurse practitioner at student health, recommended a repeat cytology test in 6 months. Her repeat test again showed ASC-US, and she was referred to a gynecologist who performed a colposcopy.

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Figure. Management of Atypical Squamous Cells of Undetermined Significance (ASC-US)
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ACOG indicates American College of Obstetricians and Gynecologists; HPV, human papillomavirus; and CIN, cervical intraepithelial neoplasia. Sources: American Society for Colposcopy and Cervical Pathology25 and ACOG.26
*ACOG Practice Bulletin recommends repeat cytology at 6 months.26
†HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68.
‡ACOG Practice Bulletin states that adolescents may be monitored alternatively with cytology at 6 and 12 months or with a single HPV test at 12 months.26

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