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GYNAECOLOGY

Indications for screening frequency for pregnant women should be the same as women who are not pregnant. (B-III) Manufacturer’s recommendations for the use of individual screening tools in pregnancy should be taken into consideration.

Women who have sex with women should follow the same cervical screening regimen as women who have sex with men. (B-II)

Recommended Management for Women with Abnormal Cytology

ASCUS (Atypical squamous cells of uncertain significance)

HPV DNA testing with cytology is recommended for women aged 30 or older with ASCUS. (C-III)

If the HPV DNA test is positive, women should be referred for colposcopy. If the HPV DNA test is negative, women should have repeat cytology in 12 months. Once a woman has had two negative cytology test results, she should return to routine screening.

In the absence of HPV DNA testing, a repeat Pap test in six months is acceptable. If the Pap test is abnormal, women should be referred for colposcopy. If the Pap test is negative, women should have repeat cytology in another six months. Once a woman has had two negative Pap tests results, she should return to routine screening.

In women under the age of 30, a repeat Pap test in six months is recommended. (C-III)

If the Pap test is abnormal, women should be referred for colposcopy. If the Pap test is negative, women should have repeat cytology in another six months. Once a woman has had two negative Pap tests results, she should return to routine screening.

Referral to colposcopy, without HPV DNA testing or repeat cytology, is only recommended in situations where there is a high probability of patient loss to follow up, or if there are other symptoms suggesting cervical abnormality (abnormal bleeding, etc.). (A-I)

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  • APRIL JOGC AVRIL 2007

ASC-H (Atypical squamous cells: cannot exclude

high grade squamous) Colposcopy is recommended for women with ASC-H.

(A-II)

LSIL (Low-grade squamous intraepithelial lesion) Either colposcopy or repeat cytology in six months is

recommended for women with LSIL. (B-II)

If repeat cytology is used and the Pap test is abnormal, women should be referred for colposcopy. If the Pap test is negative, women should have repeat cytology in another six months. Once a woman has had two negative Pap test results, she should return to routine screening.

There is limited evidence to support the use of intravaginal estrogen to reverse the cytologic changes in postmenopausal women with LSIL. A course of intravaginal estrogen followed by repeat cytology approximately a week after completing the regimen is acceptable for women with LSIL who have clinical or cytological evidence of atrophy and no contraindications to using intravaginal estrogen. Referral for colposcopy is recommended if a result of ASC-US or greater is obtained. (C-III)

HSIL (High-grade squamous intraepithelial lesion), Colposcopy is recommended for women with HSIL.

(A-II)

AGC (Atypical glandular cells) Colposcopy is recommended for women with AGC.

(A-II)

Women with AGC should also receive endocervical and endometrial sampling, where appropriate. (A-II)

Qualifying Statements These are minimum guidelines only. Certain clinical

situations may require earlier follow-up/referral for colposcopy.

Repeat Pap test should not be performed earlier than three months following the original.

Pap test should not be used as the sole assessment of a visible cervical lesion. These patients require biopsy for accurate diagnosis.

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