Moving forward—the 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors and beyond: implications and suggestions for laboratories

Abstract

The 2019 ASCCP Risk Based Management Consensus Guidelines for prevention of cervical cancer promote clinical management recommendations aligned with our increased understanding of HPV biology and cervical carcinogenesis. They employ HPVebased testing as the basis for risk estimation, allow for personalized risk-based management by incorporating knowledge of current results with prior results, and streamline incorporation of new test methods as they are validated. They continue to support the principles of "equal management for equal risk" and "balancing harms and benefits" adopted in the 2012 version of the guidelines. These updated guidelines will be able to adjust for decreasing CIN3þ risks as more patients who received HPV vaccination reach screening age. Pathology organizations were closely involved in the development of these guidelines. Herein the pathologists who served as representatives to the 2019 ASCCP guidelines steering committee and workgroups, summarize the changes that are relevant to laboratories, pathologists, and cytotechnologists. Prior relevant screening and reporting recommendations that have not been widely and/or inconsistently adopted by laboratories are also discussed and considerations for modification of laboratory practices offered.

Video colposcopy versus headlight for large loop excision of the transformation zone (LLETZ): a randomised trial

“…cone mass, did not differ between the study groups (1.57 ), but these differences were not statistically significant (P = 0.068 and P = 0.085, respectively). On the other hand, LLETZ-VC was more difficult to perform and thus received significantly lower ratings by the study surgeons for handling of the technique (7 [5][6][7][8][9] vs. 9 [8][9][10]; P < 0.001) and general satisfaction (7.5 [5][6][7][8][9] vs. 10 [8-10]; P < 0.001). All other secondary endpoints, including cone dimensions, cone volume, cone fragments, and intraoperative complications, did not differ between the two study arms.…”

“…Despite these potential advantages, the use of video colposcopy during LLETZ is not generally accepted. While video colposcopy is typically used in dysplasia outpatient clinics for the assessment of the cervix, judgement of acetowhite lesions, PAP screening, and colposcopically directed biopsies [ 6 , 7 ], the usefulness of video colposcopy in the context of surgery is less clear. Specifically, to date, there is no evidence from randomised trials demonstrating benefits of video colposcopy during LLETZ.…”

Molecular Pap Smear: Validation of HPV Genotype and Host Methylation Profiles of ADCY8, CDH8, and ZNF582 as a Predictor of Cervical Cytopathology

“…PSQ has also been proven as a superior method to methylation-specific PCR for prognostication of survival outcomes ( Johannessen et al, 2018 ). We acknowledge that our study has limitations in that two remaining, uncommon cytological categories with potentially different risk profiles, i.e., ASC-H and AGUS were not included ( Nayar et al, 2020 ). To fill this gap, ASC-H and AGUS samples have been collected for our ongoing large-scale study (>3,000 samples), which is intended to complete our investigation and understanding of molecular evolution within a dynamic virus-host ecosystem.…”

Diagnostic value of colposcopy for cervical intraepithelial neoplasia 2–3/carcinoma in situ and microinvasive cervical cancer

“…Cervical cancer can be prevented by detecting and treating pre-cancerous lesions in the cervix before the development of invasive cervical cancer [1,2]. This is related to various factors, such as the possibility of disease visualization, slow neoplastic lesion development (over 8-10 years or even several decades), well-defined clinical forms of precancerous lesions, known pathogenesis associated with high risk human papillomavirus (HPV), infection and adequately sensitive and specific diagnostic tests, such as HPV-testing and cytology [1,2].…”

“…The subsequent diagnostic stage after the abovementioned screening and triage tests is colposcopy referral. Colposcopy is considered a definitive diagnostic tool for highgrade cervical intraepithelial neoplasia 2-3/carcinoma in situ and microinvasive cervical cancer in patients with cytological abnormalities (the threshold often starts from equivocal cytology results, such as atypical squamous cells of undetermined significance, with atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion and high grade squamous intraepithelial lesion (HSIL) as an immutable indication for colposcopy and biopsy to exclude high-grade lesions) [2].…”