From the Guidelines
For women with an ASC-US Pap test result, the most appropriate follow-up management is reflex HPV DNA testing, with colposcopic evaluation for those who are HPV positive, as it reduces the number of patients referred for colposcopy and eliminates the delay in diagnosis of CIN III 1.
Management Options
The management of ASC-US Pap test results involves several options, including:
- Reflex HPV DNA testing, which is the preferred triage option for non-adolescent women, as it identifies those at high risk of CIN 2 or more serious abnormality 1
- Repeat cytology at 6 and 12 months, which is an acceptable initial management option, but may delay the diagnosis of CIN III 1
- Immediate colposcopy, which is appropriate if the provider has concerns about adherence with recommended follow-up or concerns about other clinical indications 1
HPV DNA Testing
HPV DNA testing is a useful tool in the management of ASC-US Pap test results, as it can identify those at high risk of CIN 2 or more serious abnormality. The test can be performed by collecting a specimen for Pap test and HPV DNA on the same swab, using a supplied swab at the time of the Pap test, or by reflex testing if liquid-based cytology is used and enough residual material is available in the cytology test vial 1.
Colposcopic Evaluation
Colposcopic evaluation is recommended for women who are HPV positive, as it can identify those with high-grade histological changes, such as CIN 2 or higher. The evaluation should be performed by a clinician who can perform a colposcopic examination of the lower genital tract and, if indicated, conduct a colposcopically directed biopsy 1.
Follow-up
Follow-up is an essential part of the management of ASC-US Pap test results. Women with a negative HPV DNA test result should have a repeat Pap test at 12 months, while those with a positive test result should be referred immediately for colposcopy. Women with a history of ASC-US Pap test results should be followed up regularly, with repeat Pap tests at 6 and 12 months, or HPV testing at 12 months, with colposcopic reevaluation if HPV testing is positive or cytology is ASC-US or greater 1.
From the Research
Definition and Diagnosis of ASC-US
- ASC-US stands for atypical squamous cells of undetermined significance, which is a type of abnormal Pap smear result 2, 3, 4, 5.
- ASC-US is a common abnormal Pap smear result, accounting for 20.78% of referral Pap smears in one study 4.
- The diagnosis of ASC-US is often followed by colposcopic cervical biopsy to determine the presence of cervical intraepithelial neoplasia (CIN) or other lesions 5.
Clinical Significance of ASC-US
- ASC-US may lead to the diagnosis of cervical intraepithelial lesion of higher grades as well as cervical cancer 5.
- Women with ASC-US are at a higher risk of developing cervical abnormalities, and HR-HPV testing can help identify those at higher risk 3.
- The presence of high-risk HPV types, such as HPV 16,18,66, and 68, is associated with an increased risk of cervical cancer 4.
Management of ASC-US
- Colposcopic cervical biopsy is recommended for women with ASC-US to determine the presence of CIN or other lesions 5.
- HR-HPV testing can be used to triage women with ASC-US and determine the need for further follow-up 6.
- The Italian Group for Cervical Cancer Screening (GISCi) recommends the use of HR-HPV testing in the management of women with ASC-US and in the follow-up of women with cytological abnormalities and negative colposcopy 6.
Follow-up and Screening
- Women with ASC-US should be followed up with repeat Pap smears and HR-HPV testing to monitor for the development of cervical abnormalities 2, 3.
- The frequency of follow-up visits and screenings may vary depending on the individual's risk factors and the results of previous tests 6.
- Organized screening programs with clear protocols and recommendations can help ensure that women with ASC-US receive appropriate follow-up care 6.