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

Clinical performance of the aptima HPV assay in 4196 women with positive high‐risk HPV and ASC‐US cytology: A large women hospital experience

“…However, given 15.4% CIN2+ lesion (n = 65) identified in women aged <25 years in our study including two cases from primary screening, we felt this age group of patient should be drawn clinical attention and receive personalized management. Risk‐Based Management Consensus Guideline published by 2019 ASCCP had emphasized the cancer risk that the women with ASC‐US cytology and positive HPV on initial screening, will have immediate CIN3+ lesion risk at 4.5% and should be managed by colposcopy, but repeating cytology in 1 year is still recommended for women under 25 years of age with initial ASC‐US and positive HPV, given the difficulty in accurate risk estimation 5‐7 . Our data had reflected to the latest ASCCP recommendation in general and emphasize the risk.…”

“…HrHPV‐positive ASC‐US and low‐grade squamous intraepithelial lesion (LSIL) cytology have showed very similar 5‐year risks of cervical intraepithelial neoplasia (CIN) CIN 3+ (3.8%) and are therefore managed similarly with colposcopy referral or 1‐year follow‐up. HPV‐negative ASC‐US patients in the setting of an unknown history have estimated 5‐year CIN3+ risk only 0.4% and may be managed with 3‐year follow‐up 5‐7 . Therefore, effective triage of ASC‐US patients by HPV status is essential.…”

Are CIN3 risk or CIN3+ risk measures reliable surrogates for invasive cervical cancer risk?

“…Risk-Based Management Consensus Guidelines have recently been published by the American Society for Colposcopy and Clinical Pathology (ASCCP). 1 , 2 , 3 These guidelines are an evolution of earlier 2012 guidelines 4 that were the first to be based on the so-called principle of equal management for equal risk, referring specifically to the risk of a patient developing invasive cervical cancer, “estimated by the surrogate endpoint of the 5-year-risk of cervical intraepithelial neoplasia (CIN) grade 3 (CIN3) or more severe diagnoses (CIN3+).” 1 Recently reviewed American Cancer Society (ACS) Guidelines for Cervical Cancer Screening–2020 similarly use CIN3 and CIN3+ as the “best surrogate measure of incident cervical cancer risk,” given the absence of US clinical trial data sufficiently powered to evaluate cervical cancer risk. 5 We put the case forward here that CIN3 and CIN3+ are not reliable surrogate endpoints for invasive cervical cancer risk and that cervical screening guidelines based on these surrogate risk endpoints may therefore unexpectedly prove to be misleading.…”

HPV Vaccination as Adjuvant to Conization in Women with Cervical Intraepithelial Neoplasia: A Study under Real-Life Conditions

“…All women undergoing conization between January 2013 and July 2018 were eligible for the study. Following the recommendations of the American Society for Colposcopy and Cervical Pathology and the Spanish Society of Cervical Pathology and Colposcopy [ 10 , 21 , 22 , 23 ], the criteria for conization were: (1) HSIL/CIN2-3 diagnosis in a colposcopy-directed biopsy and/or an endocervical curettage, and (2) repeated cytological result of HSIL in at least two Pap smears separated by six months in patients with a histological diagnosis of low-grade (L) SIL/CIN1 or no lesion, after excluding vaginal HSIL. All women had an HPV-positive testing prior to conization.…”

“…Moreover, these women are at higher risk of cervical cancer compared with the general population, even after adequate treatment [ 4 , 5 , 6 , 7 ]. Thus, long-term follow-up after treatment is recommended to detect persistent/recurrent lesions that might progress to cervical cancer [ 5 , 8 , 9 , 10 ].…”