Scope and Target Population:

Any woman who has undergone cervical cytologic analysis (Pap smear) and has received an abnormal result.

Clinical Highlights and Recommendations:

• ASCUS as an initial cytology result in women necessitates HPV testing. If HPV testing is unavailable, a repeat Pap smear in six months or immediate colposcopy is recommended.
  
• AGC as an initial cytology result requires a colposcopy and endocervical curettage (ECC) and possible endometrial biopsy. AGC cytology results can, in some cases, be indicative of extracervical malignancy. Follow-up is highly recommended.
  
• LSIL as an initial cytology result in an adult generally warrants a colposcopy. Special considerations may be made for adolescent and postmenopausal women.
  
• HSIL as an initial cytology result requires colposcopy with biopsy and/or loop electrosurgical excision (LEEP).
  
• In adolescents, for ASCUS and LSIL cytologic screening results, the HPV regression rate is so high that conservative management without colposcopy is recommended.
  

Priority Aims:

1. All women who undergo cervical cytologic analysis and receive an abnormal cervical cytology result will receive appropriate clinical follow-up.
   
2. All women who are diagnosed with a high-grade abnormal cervical cytology result will have a colposcopic directed biopsy and/or LEEP.
   
3. Reduce the psychological distress and increase the knowledge of women who are notified of a cervical cytology abnormality.
   

Additional Background:

The Bethesda system for reporting Pap smear results was instituted to help bring uniformity to the reporting of Pap smear results. The Bethesda system introduced new terminology which has led to some confusion regarding the appropriate management of abnormal results not only for patients but also providers. Studies have thoroughly documented that follow-up of abnormal Pap smear results has been less than satisfactory. Therefore, it is imperative to not only have a clear approach to follow-up abnormal Pap smear results based on the Bethesda system, but to also have clear procedures to encourage 100% follow-up of such results.