ITEMS IN AFP WITH MESH TERM:
Cervical Intraepithelial Neoplasia
ACS Updates Guidelines for the Early Detection of Cervical Neoplasia and Cancer - Practice Guidelines
ACOG Releases Guidelines on Cervical Cytology Screening - Practice Guidelines
The 2001 Bethesda System Terminology - Article
ABSTRACT: The 2001 Bethesda System for reporting cervical or vaginal cytologic diagnoses is an incremental change in the uniform terminology introduced in 1988 and revised in 1991. The 2001 Bethesda System includes specific statements about specimen adequacy, general categorization, and interpretation and results. In the adequacy category, "satisfactory" and "unsatisfactory" are retained, but "satisfactory but limited by" is eliminated. The new category of "atypical squamous cells" (ASC) replaces the category of "atypical squamous cells of undetermined significance" (ASCUS) and is divided into qualifiers of (1) ASC of "undetermined significance" (ASC-US) and (2) "cannot exclude high-grade squamous intraepithelial lesion (HSIL)," or (ASC-H). The categories of ASCUS, "favor reactive" and "favor neoplasia" are eliminated. The terminology for low-grade squamous intraepithelial lesions (LSILs) and HSILs remains unchanged. The category of "atypical glandular cells of undetermined significance" (AGUS) is eliminated to avoid confusion with ASCUS and is replaced by the term "atypical glandular cells" (AGC), with attempts to identify whether the origin of the cells is endometrial, endocervical, or unqualified. "Endocervical adenocarcinoma in situ" and "AGC, favor neoplastic" are included as separate AGC categories. The presence of normal or abnormal endometrial cells is to be reported in women who are at least 40 years of age. Educational notes and comments on ancillary testing may be added as appropriate.
ABSTRACT: The American Society for Colposcopy and Cervical Pathology developed guidelines in 2001 for the management of cervical cytologic abnormalities. The guidelines incorporate the Bethesda System 2001 terminology and data from randomized studies of atypical squamous cells, low-grade intraepithelial lesions, human papillomavirus testing, and liquid-based cytology to formulate evidence-based recommendations. Each recommendation is graded according to the strength of the recommendation and the quality of the evidence, and specific terminology is added to highlight management options. The effectiveness of each triage recommendation is determined by the percentage of grade 2 and 3 cervical intraepithelial neoplasia it detects. Colposcopy, repeat cytology, and human papillomavirus DNA testing are acceptable options in women with atypical squamous cells of undetermined significance, but human papillomavirus DNA testing is preferred if liquid-based cytology is used. Colposcopy is recommended for women with a diagnosis of "atypical squamous cells-cannot rule out high-grade intraepithelial lesion." Women with low-grade squamous intraepithelial lesions should be referred for colposcopy, and women with high-grade lesions should undergo colposcopy and endocervical assessment. Colposcopy and endocervical sampling are recommended in women with all subcategories of atypical glandular cells. Endometrial sampling and colposcopy are recommended in women older than 35 years with atypical glandular cells and in younger women with unexplained vaginal bleeding. Women with a diagnosis of "atypical glandular cells-favor neoplasia" or adenocarcinoma-in-situ who are not found to have invasive disease on colposcopy should undergo a diagnostic excisional procedure, preferably a cold-knife conization.
ABSTRACT: The American Society for Colposcopy and Cervical Pathology sponsored a consensus conference in 2001 to develop evidence-based guidelines for women with histologic abnormalities of the cervix. The options for management of cervical intraepithelial neoplasia 1, 2, and 3 are ranked according to the strength of the recommendation and the quality of the evidence. Follow-up with repeat cytology at six and 12 months or DNA testing for high-risk types of human papillomavirus at 12 months is the preferred management approach for women with cervical intraepithelial neoplasia 1 and satisfactory initial colposcopy. If results from repeat cytology are reported as atypical squamous cells of undetermined significance or greater, or if DNA human papillomavirus testing is positive for oncogenic types of the virus, repeat colposcopy is preferred. When the initial colposcopy is unsatisfactory, a diagnostic excisional procedure is preferred. Follow-up without treatment is acceptable only in women who are pregnant and adolescents with cervical intraepithelial neoplasia 1 who had unsatisfactory colposcopy. Biopsy-confirmed cervical intraepithelial neoplasia 2 and 3 requires treatment except during pregnancy and in compliant adolescents with cervical intraepithelial neoplasia 2 and negative endocervical curettage. When colposcopy is satisfactory, treatment includes ablative or excisional procedures. A diagnostic excisional procedure is recommended in women with biopsy-confirmed cervical intraepithelial neoplasia 2 or 3 and unsatisfactory colposcopy.
New Tests for Cervical Cancer Screening - Editorials
ABSTRACT: New data have emerged since publication of the American Society for Colposcopy and Cervical Pathology's 2001 consensus guidelines for management of abnormal cervical cytology and histology. The 2006 guidelines include recommendations for special populations (i.e., adolescents and pregnant women). Human papillomavirus testing is now included for management of atypical glandular cytology, for follow-up after treatment for cervical intraepithelial neoplasia, and in combination with cytologic screening in women 30 years and older. The preferred management of atypical squamous cells of undetermined significance in adult women is reflex human papillomavirus DNA testing. Colposcopy is recommended for adult women with low-grade squamous intraepithelial lesion, atypical glandular cells, high-grade intraepithelial neoplasia, and atypical squamous cells-cannot exclude high-grade intraepithelial neoplasia. Cervical intraepithelial neoplasia, grade 1 can be managed conservatively in adult women, but treatment for cervical intraepithelial neoplasia, grades 2 and 3 is recommended. Immediate treatment is an option for adult women but not for adolescents with high-grade squamous intraepithelial lesion. Conservative management of adolescents with any cytologic or histologic diagnosis except specified cervical intraepithelial neoplasia, grade 3 and adenocarcinoma in situ is recommended. Colposcopy is preferred for pregnant women with low-grade squamous intraepithelial lesion and high-grade squamous intraepithelial lesion, but evaluation of the former may be deferred until no earlier than six weeks postpartum. Treatment during pregnancy is unacceptable unless invasive carcinoma is identified.
ABSTRACT: Human papillomaviruses cause the most common sexually trans- mitted infection in the world and are responsible for nearly all cases of cervical cancer. Genital human papillomavirus infection can be divided into low-risk infections (causing genital warts) and high-risk infections (causing cervical intraepithelial neoplasia, and cervical and other cancers). Exposure to human papilloma- virus typically produces a sexually transmitted infection that may progress to a clinically apparent process, such as genital warts and cervical intraepithelial neoplasia lesions of the lower genital tract. Although most human papillomavirus infections resolve spontane- ously within two years, some high-risk infections persist and are considered cancer precursors. Risk factors for persistent infection include multiple sex partners, sex at an early age, history of sexually transmitted infections, and smoking. Condom use is only partially protective against human papillomavirus infection. The two human papillomavirus vaccines are most effective if given to girls before the onset of sexual activity.