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2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors

The 2019 ASCCP Risk-Based Management Consensus Guidelines represent a paradigm shift from using primarily results-based algorithms to using risk-based management based on a combination of current screening test results and past screening history. Screening using HPV testing or HPV/cytology co-testing provides superior risk stratification compared to cytology alone. Therefore, incorporating HPV testing into risk stratification and recommendations for surveillance following abnormal results was an important part of the 2019 guidelines. While the 2019 guidelines provide management recommendations for most results, certain situations do not have specific guidance. In such cases, using the 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors is acceptable. For individuals aged 25 or older screened with cytology alone, the 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors are recommended for management of abnormal results. Specifically, the 2012 guidelines recommend colposcopy for all cytology results of low grade squamous intraepithelial lesion (LSIL) or higher for individuals aged 25 and above.

The following clarifications specify management for additional scenarios. In cases where a colposcopy was previously recommended but not completed, if on repeat testing the patient has a persistent HPV-positive result and/or persistent cytologic abnormality (atypical squamous cells of uncertain significance, ASC-US, or higher), colposcopy is recommended. Colposcopy is also recommended if a patient has 2 consecutive HPV positive results and an exact risk estimate is not available. The management in these scenarios is based on the 2012 guidelines, which recommend colposcopy when a follow-up HPV test is positive or cytology is ASC-US or worse following a result of HPV-positive with negative cytology. Arguably, the scenarios described above would be higher risk, and therefore colposcopy is warranted. Similarly, if a patient had a high-grade cytology result, including atypical squamous cells cannot exclude a high-grade squamous intraepithelial lesion (ASC-H) atypical glandular cells, (AGC) or high grade squamous intraepithelial lesion (HSIL), and did not receive a colposcopy, colposcopy is recommended. Conversely, if a patient has a negative HPV test or co-test following a low-grade result for which colposcopy was previously recommended but not performed, repeating an HPV test or co-test in 1 year is acceptable. This management is based on the findings that risk estimates did not reach the colposcopy threshold for an HPV-negative or co-test negative result following any previous low-grade result.

Journal of Lower Genital Tract Disease. 25(4):330-331, October 2021.

The article, “2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors,” which published online in the April 2020 issue, contained an error.

The figure legend for Figure 2 states, “FIGURE 2: This figure demonstrates how a patient with a common low-grade screening abnormality (HPV-positive ASC-US) would be managed based on risk estimates. The initial screening result would lead to colposcopy (immediate risk 4.2%). Colposcopy of less than CIN 2 has a 5-year risk of 3.2% (1-year return). At the 1-year return visit, a second HPV-positive ASC-US result has an immediate risk of 3.1% (1-year return). If the patient has a repeat abnormal screen at the next follow-up, colposcopy is recommended. If the HPV-based test is negative, return in 3 years is recommended. NA, not applicable because stable risk estimates are not available.”

However, this legend has been updated to read, “This figure demonstrates how a patient with a common minimally abnormal screening test result (HPV-positive ASC-US) would be managed based on risk estimates. The initial screening result would lead to colposcopy (immediate risk 4.45%). If colposcopy shows less than CIN 2, the 5-year risk is 2.9% (1-year return). At the 1-year return visit, a second HPV-positive ASC-US result has an immediate risk of 3.1% (1-year return). Note similar management would be recommended if the initial abnormality preceding colposcopy were any minimally abnormal test result (i.e., less severe than ASC-H). If the HPV-based test performed for the second post-colposcopy surveillance test is negative, return in 3 years is recommended. If the second post-colposcopy surveillance test results are either a positive HPV test with any cytology result or a negative HPV test result with a cytology result of ASC-H or higher, colposcopy is recommended. Return in 1 year is recommended for HPV-negative ASCUS or LSIL results.

NA, not applicable because stable risk estimates are not available.”

The authors regret this error.

Journal of Lower Genital Tract Disease. 24(4):427, October 2020.

 Para saber mais:

https://journals.lww.com/jlgtd/Fulltext/2020/04000/2019_ASCCP_Risk_Based_Management_Consensus.3.aspx

Bibliografia:

• www.asccp.org - https://www.asccp.org/management-guidelines
• www.uspreventiveservicestaskforce.org - https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/cervical-cancer-screening