Evidence-based Guidelines for the Management of Women with Cervical Abnormalities
The dilemma on how to triage a patient with ASCUS results doesn't have to be an issue for a practitioner any longer. The American Society for Colposcopy and Cervical Pathology recently announced the first evidence-based guidelines for the management of women with cervical abnormalities.1 The 2001 Consensus Guidelines were developed by 29 major medical groups, including the American Cancer Society, Centers for Disease Control and Prevention, National Cancer Institute, the American College of Obstetricians and Gynecologists, American Academy of Family Physicians and others.
While the conventional Pap smear remains an acceptable technology option, according to the new guidelines, "testing for HPV DNA is the preferred approach when liquid-based cytology is used for screening". The guidelines also state that "reflex HPV DNA testing offers significant advantages since women do not need additional clinical examination for specimen collection, and 40% to 60% of women will be spared a colposcopic examination. Moreover, women testing negative for HPV DNA can rapidly be assured that they do not have a significant lesion." Those women can be confident with a high probability that they are disease free because of the high negative predictive value of Digene's Hybrid Capture® 2 (hc2) test.
According to the guidelines, acceptable treatment options for the management of women with cervical abnormalities include:
Management of Women with ASC-US*
| • | Repeat cervical cytological testing, colposcopy, or DNA testing for high-risk types of HPV are all acceptable methods |
| • | When liquid-based cytology is used or when co-collection for HPV DNA testing can be done, reflex HPV DNA testing is the preferred approach |
Management of Women with ASC-H**
| • | Colposcopic evaluation is the recommended management option |
| • | If no lesion is identified after colposcopy, then a review is recommended of the cytology, colposcopy, and histology |
| • | If a cytological interpretation of ASC-H is upheld, cytological follow-up at 6 and 12 months OR HPV DNA testing at 12 months is acceptable |
Management of Women with LSIL
| • | Colposcopy is the recommended management option |
| • | If colposcopy is satisfactory, and biopsy fails to confirm CIN, acceptable management options include follow-up with repeat cytological testing at 6 and 12 months OR HPV DNA testing at 12 months |
| • | The above approach should be followed if colposcopy is unsatisfactory, yet the biopsy fails to confirm CIN |
Quest Diagnostics – Your Choice for Better Results
Quest Diagnostics evaluates more Pap slides (over 12 million) than any other lab in the nation; over 80% of the Pap tests that Quest Diagnostics performs, are liquid-based.
Quest Diagnostics has focused on liquid-based cervical cytology by:
| • | Being early adopters of this technology |
| • | Conducting the largest single facility liquid-based cytology study to date in the U.S. demonstrating excellent results2 |
| • | Evaluating more liquid-based cytology samples than any other laboratory |
Online Resources for Healthcare Professionals
| • | Access our online Test Menu to obtain test ordering codes and specimen requirements. | |
| • | Visit our Interpretive Guide for information relating to test selection, utilization, and interpretation. | |
| • | Simplify test ordering and results reporting with our connectivity solutions. | |
| • | Read articles from the Quest Diagnostics Physician's Update Newsletter, such as: | |
| – | "What is the best test to assess Pap test specimen adequacy?," Winter 2003. This article reviews the draft guidelines for Pap test specimen adequacy management that have been submitted to the ASCCP steering committee and other experts for comment and modification. | |
| – | "What is the best test to follow up an abnormal Pap test?," Summer 2002. Discusses publishing of new ASCCP guidelines. | |
Online Information for Your Patients
Your patients can learn about health conditions and laboratory tests in our online Patient Health Library. The library is founded on evidence-based information, and includes topics such as:
Contact a Quest Diagnostics Sales Representative,
learn more about our testing services, and become a client
| • | Contact a physician sales representative |
| • | Contact a hospital sales representative or learn about our complete hospital offerings |
References
1 Thomas C. Wright, Jr, MD; J. Thomas Cox, MD; L. Stewart Massad, MD; Leo B. Twiggs, MD; and Edward J. Wilkinson, MD. 2002. "The Consensus Guidelines for the Management of Women with Cytological Abnormalities." JAMA (287:2120-2129).
2 Limaye A, Connor AJ, Huang X, et al. Comparative analysis of conventional Papanicolaou tests and a fluid-based thin-layer method. Arch Pathol Lab Med, Vol 127; February 2003:200-204.
* atypical squamous cells of undetermined significance (ASC-US)
** atypical squamous cells, cannot exclude HSIL (ASC-H)
