Managing Minimally Abnormal Cervical Cancer Screening Test Results

Abstract

The approach to cervical cancer screening has changed substantially over the past decade. Current screening strategies for individuals older than 30 years include cytology (Papanicolaou tests), testing for high-risk (oncogenic) types of human papillomavirus (hrHPV), or both (co-testing). 1 However, various possible combinations of test results have led to complex management algorithms, especially for test results considered to be minimally abnormal, defined as results for which it is unclear whether the next step should be colposcopy (a magnified view of the cervix, often with biopsies) or close follow-up. This article provides an update for the approach to the initial management of minimally abnormal cervical cancer screening test results.In April 2020, 19 organizations released consensus guidelines that formalized a strategy for management of cervical cancer screening test results using a framework based on estimates of underlying high-grade precancerous lesions or cancer (known collectively as cervical intraepithelial neoplasia grade 3 or worse [CIN3+]). 2 Estimates were derived from screening outcomes observed in more than 1.5 million individuals aged 25 to 65 years enrolled in a prepaid health plan. 3 In this population, about 90% of test results were normal and about 0.75% were severely abnormal. The remainder were minimally abnormal, a category that includes an hrHPV-positive test result with a concurrent normal cytologic interpretation (negative for intraepithelial lesion or malignancy), atypical squamous cells of undetermined significance (ASC-US), and low-grade squamous intraepithelial lesion (LSIL).Underlying risks of CIN3+ were estimated for various combinations of cytology, hrHPV testing (ie, pooled testing for Ն1 of 13 or 14 hrHPV types), and HPV genotyping (ie, testing specifically for HPV-16 and HPV-18). 4,5 Because transient hrHPV infections are associated with a lower risk of CIN3+ than persistent hrHPV infections, the effect of having an hrHPV-negative test result within the past 5 years on CIN3+ risk was also evaluated; this is a new addition to the guideline. These risks were then applied to "clinical action thresholds" defined by expert consensus 2 ; 3 thresholds are relevant to individuals with minimally abnormal test results. If the immediate CIN3+ risk is 4% to 24%, colposcopy is recommended, but if the immediate risk is less than 4%, the cumulative 5-year CIN3+ risk guides the surveillance interval. Repeated testing in 1 year is recommended if the 5-year risk is greater than or equal to 0.55%, and repeated testing in 3 years is recommended if the 5-year risk is 0.15% to 0.54%. Repeated testing is specified as hrHPV testing or co-testing; if performing these tests is not feasible, cytology alone is acceptable.The most common test abnormality is a positive hrHPV test result with a concurrent normal cytologic interpretation, comprising about 4.1% of all test results. Because the estimated immediate CIN3+ risk is 2.1% and the cumulative 5-year risk is 4.8% (eTable in the Supplement), 5 repe...

Sexually Transmitted Infections Treatment Guidelines, 2021

“…º Ideally, cytology testing should be performed by the laboratory as a reflex test from the same specimen so the patient does not need to return to the clinic. Colposcopy is recommended if HPV genotyping is positive for types 16 or 18, and it can be considered if it is infeasible for the patient to return for cytology alone ( 1274 ).…”

Efficacy of optical coherence tomography in the triage of women with minor abnormal cervical cytology before colposcopy

“…Therefore, from the perspective of diagnostic efficiency, cytology combined with hrHPV testing is the best choice for cervical cancer screening. However, there is still controversial in the management of ASC-US and LSIL [7].…”

“…The diagnostic value of ThinPrep 1 Cytologic Test (TCT) combined with hrHPV testing can increase the sensitivity and negative predictive value (NPV) of cervical screening [5,6]. However, management recommendations for minimally abnormal cervical cancer screening test results are still controversial [7]. Minor abnormal cervical cytology results include atypical squamous cells of undetermined significance (ASC-US) and low-grade squamous intraepithelial lesion (LSIL) [7,8].…”

“…However, management recommendations for minimally abnormal cervical cancer screening test results are still controversial [7]. Minor abnormal cervical cytology results include atypical squamous cells of undetermined significance (ASC-US) and low-grade squamous intraepithelial lesion (LSIL) [7,8]. Colposcopy is recommended for individuals with hrHPV-positive ASC-US test result or LSIL test result as the guidelines [3].…”

Management of Abnormal Cervical Cancer Screening Test: A Risk-based Approach

“…44 However, ~10% to 15% of patients will test HPV+ in a given screening round, and will, therefore, require further testing. Although the overall CIN3+ risk of HPV+ patients is 5%, 45 and, therefore, exceeds the colposcopy threshold, performing colposcopy on all HPV+ patients is inefficient and would increase patient harm. Therefore, additional triage testing is recommended after an HPV+ result to determine the next step in management.…”