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Practice Guideline
. 2020 Apr;24(2):102-131.
doi: 10.1097/LGT.0000000000000525.

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

Rebecca B Perkins  1 , Richard S Guido  2 , Philip E Castle  3 , David Chelmow  4 , Mark H Einstein  5 , Francisco Garcia  6 , Warner K Huh  7 , Jane J Kim  8 , Anna-Barbara Moscicki  9 , Ritu Nayar  10 , Mona Saraiya  11 , George F Sawaya  12 , Nicolas Wentzensen  13 , Mark Schiffman  13 ; 2019 ASCCP Risk-Based Management Consensus Guidelines Committee
Collaborators, Affiliations
Practice Guideline

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

Rebecca B Perkins et al. J Low Genit Tract Dis. 2020 Apr.

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Conflict of interest statement

The National Cancer Institute (including M.S. and N.W.) receives cervical screening results at reduced or no cost from commercial research partners (Qiagen, Roche, BD, MobileODT, Arbor Vita) for independent evaluations of screening methods and strategies. A.-B.M. is an advisory board member of Merck and GSK. R.S.G. is an ASCCP consultant of Inovio Pharmaceuticals DSMB. W.K.H. is connected with Inovio Pharmaceuticals DSMB. P.E.C. has received HPV tests and assays at a reduced or no cost from Roche, Becton Dickinson, Arbor Vita Corporation, and Cepheid for research. M.H.E. has advised companies and participated in educational activities but does not receive any honoraria or payments for these activities, In some cases, his employer, Rutgers, receives payment for his time for these activities from Papivax, Cynvec, Merck, Hologic, and PDS Biotechnologies. He has been the overall PI or local PI for clinical trials from Johnson&Johnson, Pfizer, Iovance, and Inovio. Funding for these activities is for the research related costs of the trials. The other authors have declared they have no conflicts of interest.

Figures

FIGUR'E 1
FIGUR'E 1
This figure demonstrates how patient risk is evaluated. For a given current results and history combination, the immediate CIN 3+ risk is examined. If this risk is 4% or greater, immediate management via colposcopy or treatment is indicated. If the immediate risk is less than 4%, the 5-year CIN 3+ risk is examined to determine whether patients should return in 1, 3, or 5 years.
FIGURE 2
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.
FIGURE 3
FIGURE 3
This figure describes the initial workup of AGC found on cervical cytology.
FIGURE 4
FIGURE 4
This figure describes follow-up management that should occur after the diagnostic examinations described in Figure 3.
FIGURE 5
FIGURE 5
This figure describes the steps involved in clinical management of unsatisfactory cytology. Note that “unknown genotype” refers to both HPV testing without genotyping, and HPV testing where genotyping is negative for HPV 16 and 18 but positive for other high-risk HPV types.
FIGURE 6
FIGURE 6
This figure describes the steps involved in clinical management of cytology that is negative for intraepithelial lesion or malignancy, but with absent transformation zone or endocervical cells.
FIGURE 7
FIGURE 7
This figure describes the steps involved in clinical management of histologic HSIL.
FIGURE 8
FIGURE 8
This figure describes management of CIN 2 in patients whose concerns about the effects of treatment on a future pregnancy outweigh their concerns about cancer. Also addressed is the management of histologic HSIL not further specified in women younger than 25 years, for whom observation is acceptable, and for women 25 years or older for whom treatment is preferred.
FIGURE 9
FIGURE 9
This figure describes management of histologic LSIL (CIN 1) preceded by HSIL cytology.
FIGURE 10
FIGURE 10
This figure describes management of histologic LSIL (CIN 1) preceded by ASC-H cytology.
FIGURE 11
FIGURE 11
This figure describes management of AIS. This management algorithm was developed by the Society of Gynecologic Oncology and endorsed by the ASCCP Risk-Based Management Consensus process.
FIGURE 12
FIGURE 12
This figure describes management of cytologic abnormalities in patients younger than 25 years.
FIGURE 13
FIGURE 13
This figure describes management of histologic LSIL (CIN 1) in patients younger than 25 years.
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References

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    1. Wright TC, Massad LS, Dunton CJ, et al. 2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests. Am J Obstet Gynecol 2007;197:346–55. - PubMed
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