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A Summary of the 2006 American Society for Colposcopy and Cervical Pathology Consensus Guidelines for the Management of Women With Abnormal Cervical Histologic Findings

Nanji, Shabin MBBchir; Colgan, Terence MD

doi: 10.1097/PCR.0b013e3182100199
Reviews

The American Society for Colposcopy and Cervical Pathology guidelines for the management of biopsy-proven cervical intraepithelial neoplasia (CIN) and adenocarcinoma in situ were recently updated and include significant modifications. Management recommendations are not based purely on the histologic diagnosis. Instead, management is determined using information from a number of sources including previous Papanicolaou test history, clinical setting, colposcopic findings, biopsy result, and any human papillomavirus testing. Nevertheless, biopsy interpretation remains a key determinant of management. Women with CIN 1 who have low-grade referral cytology (atypical squamous cells of undetermined significance, atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion [SIL], or low-grade SIL) should be followed up only with cytology or human papillomavirus testing regardless of whether the colposcopic examination is satisfactory. Treatment is no longer acceptable (in contrast to the 2001 guidelines), unless the preceding cytology is high grade (high-grade SIL or atypical glandular cells not otherwise specified). Minor modifications, including an option of immediate loop electrosurgical excision, were made for the management of women with cervical intraepithelial neoplasia grades 2 and 3 (CIN 2, 3). Management recommendations for adolescents with any histologic diagnosis of CIN are conservative. During pregnancy, follow-up without treatment is recommended for CIN 1, 2, and 3 unless invasion is identified. The 2006 guidelines also include management recommendations for biopsy-confirmed adenocarcinoma in situ.

From the Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.

Reprints: Shabin Nanji, MBBchir, Mount Sinai Hospital, Joseph & Wolf Lebovic Health Complex, Pathology & Laboratory Medicine, Room 6-500-7, 600 University Ave, Toronto, Ontario, Canada M5G 1X5. E-mail: snanji@mtsinai.on.ca.

© 2011 Lippincott Williams & Wilkins, Inc.