Managing Abnormal Cervical Cytology and Cervical Intraepithelial Neoplasia

Abstract

About 70% of the nearly 60 million women who undergo Papanicolaou (Pap) testing each year in the United States will be told they have abnormal results. In the past, deciding who gets a colposcopy, when to repeat the Pap test, and which patients should be treated has been both confusing and controversial. The publication of two sets of guidelines from the American Society for Colposcopy and Cervical Pathology (ASCCP) has greatly clarified these issues. These new evidence-supported consensus-based guidelines provide algorithms for managing cervical cytological abnormalities and histologically confirmed cervical intraepithelial neoplasia (CIN). They were developed out of a consensus workshop convened by ASCCP in 2001 and subsequently published in JAMA and the American Journal of Obstetrics and Gynecology. These new guidelines were preceded by revisions to the Bethesda System of nomenclature for cervical cytology. This updated terminology, as well as advances in the understanding of human papillomavirus (HPV) as a cervical cancer precursor and the increased use of advanced technologies like liquid-based cervical cytology and HPV-DNA typing, were key in developing these guidelines.