From the Guidelines
For patients with Atypical Squamous Cells of Undetermined Significance (ASCUS) on a Pap test, the recommended approach is HPV DNA testing to guide further management, as it helps identify the subset of patients who need closer monitoring due to their higher risk of developing cervical dysplasia or cancer 1. The management of ASCUS on a Pap test involves several options, including:
- HPV DNA testing (reflex testing) to determine the presence of high-risk HPV types
- Repeat Pap testing at 6 and 12 months
- Prompt colposcopy for further evaluation The choice of management depends on various factors, including the patient's age, medical history, and the availability of HPV testing. For women aged ≥21 years with a Pap test report of ASC-US, HPV DNA testing is a recommended option, as it can help identify those who need closer monitoring and reduce the risk of unnecessary procedures 1. If HPV testing is positive, the patient should undergo colposcopy for further evaluation, which may involve a biopsy to determine the presence of high-grade cervical lesions. If HPV testing is negative, routine screening can be resumed with repeat co-testing (Pap and HPV) in 3 years. For patients under 21 years old, repeat cytology in 12 months is preferred instead of HPV testing due to the high prevalence and transient nature of HPV infections in this age group 1. It is essential to note that the management of ASCUS on a Pap test should be individualized, taking into account the patient's unique circumstances and medical history. The goal of management is to avoid unnecessary procedures while ensuring appropriate follow-up for those at higher risk of developing cervical dysplasia or cancer. In clinical practice, the use of HPV DNA testing as a triage tool for ASC-US has been shown to be effective in identifying patients who require closer monitoring and reducing the risk of unnecessary procedures 1.
From the Research
Treatment Guideline for ASCUS on Pap Test
The treatment guideline for a patient with Atypical Squamous Cells of Undetermined Significance (ASCUS) on a Pap test involves several steps, including:
- Referral for colposcopy based on HPV DNA testing results 2, 3, 4
- Repeat Pap testing for women with ASCUS Pap test results 5, 6
- Consideration of the patient's age, medical history, and other risk factors 4
HPV DNA Testing
HPV DNA testing is a valuable tool in the triage of women with ASCUS Pap test results, with a high negative predictive value for cervical intraepithelial neoplasia (CIN) grade 2 or 3 2, 3, 4. The sensitivity and specificity of HPV DNA testing for detecting CIN 2/3 vary depending on the test used, with Hybrid Capture testing showing a sensitivity of 85-90% and a specificity of 64-77% 2, 3.
Repeat Pap Testing
Repeat Pap testing is also used in the management of women with ASCUS Pap test results, with a sensitivity of 70-73% and a specificity of 45-63% for detecting CIN 2/3 5, 6. The repeat Pap test can be used in combination with HPV DNA testing to improve the detection of CIN 2/3 6.
Colposcopy Referral
Colposcopy referral is recommended for women with ASCUS Pap test results who are positive for high-risk HPV types or who have a repeat Pap test showing low-grade squamous intraepithelial lesion (LSIL) or high-grade squamous intraepithelial lesion (HSIL) 2, 3, 5, 6. The referral rate for colposcopy can be reduced by using HPV DNA testing, with a referral rate of 16.9-44.0% depending on the test used 6.
Management Strategies
The management strategies for women with ASCUS Pap test results include:
- Referral for colposcopy based on HPV DNA testing results and/or repeat Pap test results 2, 3, 5, 6
- Repeat Pap testing at 4-6 month intervals for women with ASCUS Pap test results who are negative for high-risk HPV types 4, 5
- Consideration of the patient's age, medical history, and other risk factors in determining the management strategy 4