Management of ASCUS Pap Results with Negative HPV mRNA
For patients with atypical squamous cells of undetermined significance (ASCUS) on ThinPrep Pap test and negative HPV mRNA testing, repeat Pap testing in 3 years is the recommended approach, as the risk of underlying high-grade cervical disease is very low. 1
Management Algorithm for ASCUS with Negative HPV Testing
- For women with ASCUS cytology and negative HPV mRNA results, the risk of high-grade cervical intraepithelial neoplasia (CIN2+) is minimal, allowing for routine screening at 3-year intervals 1
- HPV-negative ASCUS results have a risk profile closer to that of negative cytology alone than to a positive cotest, supporting the safety of extended follow-up intervals 1
- This approach reduces unnecessary colposcopies while maintaining appropriate surveillance for cervical abnormalities 1
Age-Based Considerations
- For women aged 21 years or older with ASCUS results, high-risk HPV DNA testing is the preferred initial management approach 1
- When HPV testing is negative in women with ASCUS, as in this case, the patient can return to routine screening with repeat testing in 3 years 1
- For women aged 30 years or older specifically, a negative HPV test with ASCUS cytology is particularly reassuring, though it is insufficient for exiting screening at age 65 years 1
Evidence Supporting This Approach
- HPV-negative status in women with ASCUS is an excellent predictor for the absence of high-grade squamous intraepithelial lesions (HSIL) 2
- The negative predictive value of HPV testing for ruling out CIN2+ in women with ASCUS approaches 100% in multiple studies 2
- Using HPV testing in ASCUS triage has been shown to reduce the time from abnormal cytology to resolution of the case (either biopsy or return to routine screening) compared to repeat cytology approaches 3
Common Pitfalls to Avoid
- Do not confuse management of ASCUS with ASC-H (atypical squamous cells, cannot exclude HSIL), which requires immediate colposcopy regardless of HPV status 4
- Avoid unnecessary early repeat cytology in HPV-negative ASCUS patients, as studies show this occurs in up to 41.3% of cases, leading to increased costs and patient anxiety 5
- Do not perform colposcopy for ASCUS with negative HPV results, as this leads to unnecessary procedures with minimal clinical benefit 1
Documentation and Follow-up
- Ensure proper documentation of both the ASCUS Pap test result and the negative HPV mRNA status in the patient's record 4
- Clearly communicate to the patient the recommendation for repeat testing in 3 years and the reassurance provided by the negative HPV result 1
- Develop protocols to identify women who miss follow-up appointments to ensure appropriate long-term surveillance 4