2001 Consensus Guidelines for the Management of Women with Cervical Cytological Abnormalities

A panel of 121 experts in the diagnosis and management of cervical cancer, including representatives from 29 professional organizations, agencies, and national and international organizations, formed a consensus conference sponsored by the American Society of Colposcopy and Cervical Pathology (ASCCP).

Over several months, guidelines for the management of women with cervical cytological abnormalities were developed through a multistep process. Beginning six months prior to the consensus conference, working groups developed draft management guidelines based on formal literature reviews of English-language articles published in 1988-2001, along with input from the professional community at large utilizing interactive Internet-based bulletin boards. On September 6-8, 2001, the ASCCP Consensus Conference was held in Bethesda, Md. Guidelines with supporting evidence were presented and underwent discussion, revision and voting.

The result of the conference was a set of guidelines for the management of women with cervical cytological abnormalities. According to the reports published in this issue of JAMA, management of women with atypical squamous cells (ASC) depends on whether the Papanicoloau test is subcategorized as of undetermined significance (ASC-UC) or as cannot exclude high-grade squamous intraepithelial lesion (HSIL) (ASC- H). Women with ASC-US should be managed using a program of 2 repeat cytology tests, immediate colposcopy, or DNA testing for high-risk types of human papillomavirus (HPV). Testing for HPV DNA is the preferred approach when liquid-based cytology is used for screening. In most instances, women with ASC-H, low-grade squamous intraepithelial lesion, HSIL, and atypical glandular cells should be referred for immediate colposcopic evaluation.

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