Updated Asccp Algorithms 4 11 13 - PDF

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American Society for Colposcopy and Cervical Pathology

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!"#$%&'(#)%"CytologySince the publication of the 2006 consensus guidelines, new

cervical cancer screening guidelines have been published

and new information has become available which includes

key cervical cancer screening and follow up, and cervical

precancer management data over a nine year period among

more than 1 million women cared for at Kaiser Permanente

Northern California. Moreover, women under age 21 are no

longer receiving cervical cancer screening and cotesting

with high-risk HPV type assays, and cervical cytology is being

used to screen women 30 years of age and older.

Therefore, in 2012 the American Society for Colposcopy and

Cervical Pathology (ASCCP), together with its 24 partner

professional societies, Federal agencies, and international

organizations, began the process of revising the 2006management guidelines. This culminated in the consensus

conference held at the National Institutes of Health in

September 2012. This report provides updated recommen

tions for managing women with cytological abnormalities

A more comprehensive discussion of these recommendatio

and their supporting evidence was published in the Journ

of Lower Genital Tract Disease and Obstetrics and Gyneco

and is made available on the ASCCP website at www.asccp.

HistopathologyAppropriate management of women with histo-pathologic

diagnosed cervical precancer is an important component

cervical cancer prevention programs. Although the precis

number of women diagnosed with cervical precancer eac

year in the U.S. is not known, it appears to be a relatively

common occurence. In 2001 and 2006, the American Soci

for Colposcopy and Cervical Pathology and 28 partner

professional societies, federal agencies, and internationa

organizations, convened processes to develop and updateconsensus guidelines for the management of women with

© Copyright, 2002, 2006, 2013 Americ


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Although the guidelines are based on evidence whenever

possible, for certain clinical situations limited high-quality

evidence exists. In these situations the guidelines are

based on consensus expert opinion. Guidelines should neverbe a substitute for clinical judgment. Clinical judgment should

always be used when applying a guideline to an individual

patient since guidelines may not apply to all patient-related

situations. Finally, both clinicians and patients need to

recognize that while most cases of cervical cancer can be

prevented through a program of screening and management

of cervical precancer, no screening or treatment modality is

100% effective and invasive cervical cancer can develop in

women participating in such programs.

The 2001 Bethesda System terminology is used for cytolog

classification. This terminology utilizes the terms low-grad

squamous intraepithelial lesion (LSIL) and high-grade

squamous intraepithelial lesion (HSIL) to refer to low-gradlesions and high-grade cervical cancer precursors respec-

tively. For managing cervical precancer, the histopathologi

classification is two-tiered applying the terms cervical

intraepithelial neoplasia grade 1 (CIN 1) to low-grade lesio

and CIN2,3 to high-grade lesions. If using the 2012 Lower

Anogenital Squamous Terminology (LAST), CIN1 is equiva

to histopathological LSIL and CIN2,3 is equivalent to histo-

pathological HSIL. Please note that cytological LSIL is not

equivalent to histopathological CIN 1 and cytological HSIL

*+"+$,- /%00+"#1

© Copyright, 2002, 2006, 2013 Americ

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2+3)")#)%"1

Colposcopy is the examination of the cervix, vagina,

and, in some instances the vulva, with the colposcope

after the application of a 3-5% acetic acid solution

coupled with obtaining colposcopically-directed biop-

sies of all lesions suspected of representing neoplasia.

Endocervical sampling includes obtaining a specimen

for either histopathological evaluation using an

endocervical curette or a cytobrush or for cytological

evaluation using a cytobrush.

Endocervical assessment is the process of evaluating

the endocervical canal for the presence of neoplasia

using either a colposcope or endocervical sampling.

Diagnostic excisional procedure is the process of

obtaining a specimen from the transformation zone

and endocervical canal for histopathological evaluation

and includes laser conization, cold-knife conization,

loop electrosurgical excision procedure (LEEP), and

loop electrosurgical conization.

Adequate colposcopy indicates that the entire

squamocolumnar junction and the margin of any

visible lesion can be visualized with the colposcope.

Endometrial sampling includes obtaining a specimen

for histopathological evaluation using an endometrial

aspiration or biopsy device, a “dilatation and curettage”

or hysteroscopy.

Terms Utilized in the Consensus Guidelines

© Copyright, 2002, 2006, 2013 American Society for Colposcopy and Cervical Pathology. All rights reserved


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