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Re: ASCUS testingFrom: Henry Gregor (henrygregor@yahoo.com)Mon May 16 21:36:37 2005
Here's one for all who have recently been to the ACM .... aren't current recommendations for high risk DNA genosubtyping to not do such typing on women under age thrity because of relatively high rates of clearnace of such genotypes?> Hank ainsron <ainsron@sbcglobal.net> wrote: Recommended Management of Women With ASC-US A program of repeat cervical cytological testing, colposcopy, or DNA testing for high-risk types of HPV are all acceptable methods for managing women with ASC-US (rating AI). 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 (AI). DNA testing for high-risk types of HPV should be performed using a sensitive molecular test, and all women who test positive for HPV DNA should be referred for colposcopic evaluation (AII). Women with ASC-US who test negative for high-risk HPV DNA can be followed up with repeat cytological testing at 12 months (BII). Acceptable management options for women who are positive for high-risk types of HPV, but who do not have biopsy-confirmed CIN, include follow-up with repeat cytological testing at 6 and 12 months with referral back to colposcopy if a result of ASC-US or greater is obtained, or HPV DNA testing at 12 months with referral back to colposcopy of all HPV DNA–positive women (BII). When a program of repeat cervical cytological testing is used, women with ASC-US should undergo repeat cytological testing (either conventional or liquid-based) at 4 to 6-month intervals until 2 consecutive "negative for intraepithelial lesion or malignancy" results are obtained (AII). Women diagnosed with ASC-US or greater cytological abnormality on the repeat tests should be referred for colposcopy (AII). After 2 repeat "negative for intraepithelial lesion or malignancy" cytology tests are obtained, women can be returned to routine cytological screening programs (AII). When immediate colposcopy is used to manage women with ASC-US, women who are referred for colposcopy and found not to have CIN should be followed up with repeat cytological testing at 12 months (BII). Women with ASC-US who are referred for colposcopy and found to have biopsy-confirmed CIN should be managed according the 2001 Consensus Guidelines for the Management of Women With Cervical Histological Abnormalities. Because of the potential for overtreatment, diagnostic excisional procedures such as the loop electrosurgical excision procedure (LEEP) should not routinely be used to treat women with ASC in the absence of biopsy-confirmed CIN (EII). 2001 consensus guidelines for the management of women with cervical cytological abnormalities. http://www.guideline.gov/summary/summary.aspx?doc_id=3286&nbr=2512&string=ascus BIBLIOGRAPHIC SOURCE(S) Wright TC Jr, Cox JT, Massad LS, Twiggs LB, Wilkinson EJ. 2001 Consensus Guidelines for the management of women with cervical cytological abnormalities. JAMA 2002 Apr 24;287(16):2120-9. [89 references Ronald E. Ainsworth -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Elrod Darryl G MAJ 48 MDOS/SGOBO Sent: Monday, May 16, 2005 5:46 AM To: Multiple recipients of list OB-GYN-L Subject: ASCUS testing A colleague of mine asked me a question about the recommendations for ASCUS testing that I wasn’t able to answer. Following the ASCCP guidelines, when someone has an ASCUS pap you can either do pap at 6 month and 12 months or HPV testing at 12 months. The question is, what if the Pap at 6 months is ASCUS or low-grade? Do you refer them to colpo immediately or do you wait until after the 12 month pap since you could have gone down the 12 month HPV path anyway? If the idea is to allow for repair of the cervix and clearance of the HPV I can see waiting. If the goal is catching opportunities to intervene I can see immediate referral. Thanks for the help, Glen Stay connected, organized, and protected. Take the tour
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