Comerciante

Reviews

Oncology

www.AJOG.org

2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests
Thomas C. Wright Jr, MD; L. Stewart Massad, MD; Charles J. Dunton, MD; Mark Spitzer, MD; Edward J. Wilkinson, MD; Diane Solomon, MD, for the 2006 American Society for Colposcopy and Cervical Pathology–sponsored Consensus Conference ince the publication of the2001 consensus guidelines, new information has become available, which includes the key follow-up results from the National Cancer Institute (NCI)–sponsored ASCUS (atypical squamous cells of undetermined significance)/LSIL (lowgrade squamous intraepithelial lesions) Triage Study (ALTS).1,2 Moreover, molecular testing for high-risk types of human papillomavirus (HPV) is being used together withcervical cytology for screening in women 30 years of age and older. Although “interim guidance” for the use of HPV DNA testing in the screening setting was proposed in 2004, recommendations for how to manage the combination of test results have not formally been evaluated by a large, mulFrom the Department of Pathology, College of Physicians and Surgeons of Columbia University, New York, NY (DrWright); Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO (Dr Massad); Department of Obstetrics and Gynecology, Lankenau Hospital, Wynnewood, PA (Dr Dunton); Department of Obstetrics and Gynecology, Brookdale University Hospital and Medical Center, Brooklyn, NY (Dr Spitzer); Department of Pathology, University of Florida College of Medicine, Gainesville,FL (Dr Wilkinson); and National Institutes of Health and National Cancer Institute, Bethesda, MD (Dr Solomon).
Received Apr. 6, 2007; revised Jun. 28, 2007; accepted Jul. 29, 2007. Reprints: Thomas C. Wright Jr, MD, Department of Pathology, College of Physicians and Surgeons of Columbia University, Room 16-404, P&S Building, 630 West 168th St, New York, NY 10032; tcw1@columbia.edu 0002-9378/$32.00© 2007 Mosby, Inc. All rights reserved. doi: 10.1016/j.ajog.2007.07.047

S

A group of 146 experts representing 29 organizations and professional societies met September 18-19, 2006, in Bethesda, MD, to develop revised evidence-based, consensus guidelines for managing women with abnormal cervical cancer screening tests. Recommendations for managing atypical squamous cells of undeterminedsignificance and low-grade squamous intraepithelial lesion (LSIL) are essentially unchanged. Changes were made for managing these conditions in adolescents for whom cytological follow-up for 2 years was approved. Recommendations for managing high-grade squamous intraepithelial lesion (HSIL) and atypical glandular cells (AGC) also underwent only minor modifications. More emphasis is placed on immediatescreen-and-treat approaches for HSIL. Human papillomavirus (HPV) testing is incorporated into the management of AGC after their initial evaluation with colposcopy and endometrial sampling. The 2004 Interim Guidance for HPV testing as an adjunct to cervical cytology for screening in women 30 years of age and older was formally adopted with only very minor modifications. Key words: atypical squamouscells of undetermined significance, cervical cancer screening, cervical cytology, high-grade squamous intraepithelial lesion, human papillomavirus testing, low-grade squamous intraepithelial lesion

See related editorial, page 337, and related article, page 340.

tidisciplinary group.3 Once the 2001 guidelines were implemented in a variety of clinical settings, it became apparent that there werea number of areas in which changes were needed. This pertains particularly to special populations such as adolescents and postmenopausal women. Therefore, in 2005, the American Society for Colposcopy and Cervical Pathology (ASCCP), together with its partner professional societies and federal and international organizations (listed in Appendix A), began the process of revising the guidelines....