For which PAP (Papanicolaou) test cytology result is colposcopy not appropriate in a young adult female?

From the Guidelines

Colposcopy is not appropriate for a young adult female with a PAP test cytology result of LSIL and HPV negative in a pregnant patient, as the risk of HSIL and cancer is low and colposcopy can be deferred until 6 weeks after childbirth. When considering the management of abnormal PAP test results in pregnant women, it is essential to balance the need for accurate diagnosis with the potential risks of invasive procedures during pregnancy. According to the guidelines, for pregnant women with LSIL who do not have CIN 2, postpartum management is advised 1. This approach prioritizes the safety of the mother and the fetus while still ensuring that any potential cervical abnormalities are addressed in a timely manner. In contrast, colposcopy is recommended for other abnormal PAP test results, such as atypical squamous cells cannot exclude high-grade lesion (ASC-H) and high-grade squamous intraepithelial lesion (HSIL), due to the higher risk of underlying high-grade disease or cancer 1. Some key points to consider when evaluating the appropriateness of colposcopy for a young adult female with a PAP test cytology result include:

• The type and severity of the abnormal PAP test result
• The patient's pregnancy status and trimester
• The presence or absence of high-risk HPV
• The patient's medical history and risk factors for cervical cancer By taking these factors into account and following established guidelines, healthcare providers can make informed decisions about the use of colposcopy in the management of abnormal PAP test results in young adult females.

From the Research

Colposcopy Appropriateness for PAP Test Cytology Results

• The following PAP test cytology results are appropriate for colposcopy in a young adult female:
  • Atypical squamous cells, cannot exclude a high-grade squamous intraepithelial lesion (ASC-H) 2, 3, 4, 5, 6
  • A high-grade squamous intraepithelial lesion (HSIL) 2, 3, 4, 5, 6
• However, colposcopy may not be appropriate for:
  • A low-grade squamous intraepithelial lesion (LSIL) and HPV negative in a pregnant patient, as the risk of high-grade lesions is low in HPV-negative patients 2, 3, 4
  • Two consecutive unsatisfactory screening tests, as there is no evidence to suggest that colposcopy is necessary in this case

Specific Considerations

• For ASC-H, reflex HPV testing may be an option to decrease unnecessary colposcopic biopsies, as a negative HPV result is associated with a low risk of CIN ≥2 lesions 2, 3
• The frequency of HPV positivity and underlying HSIL is higher in ASC-H compared to ASCUS, indicating that ASC-H category utilization and performance are appropriate in routine clinical practice 4
• A substantial subset of patients with biopsy-proven CIN2+ after ASC-H interpretations required more than 1 colposcopy for a definitive diagnosis of a high-grade dysplastic lesion 5