The 2019 ASCCP Risk-Based Management Consensus Guidelines1 represent a paradigm shift from using primarily resultsbased algorithms to using risk-based management based on a combination of current screening test results and past screening history. Screening using HPV testing or HPV/cytology co-Testing provides superior risk stratification compared to cytology alone. Therefore, incorporating HPV testing into risk stratification and recommendations for surveillance following abnormal resultswas an important part of the 2019 guidelines.While the 2019 guidelines provide management recommendations for most results, certain situations do not have specific guidance. In such cases, using the 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors2 is acceptable. For individuals aged 25 or older screened with cytology alone, the 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors2 are recommended for management of abnormal results. Specifically, the 2012 guidelines recommend colposcopy for all cytology results of low grade squamous intraepithelial lesion (LSIL) or higher for individuals aged 25 and above. The following clarifications specify management for additional scenarios. In cases where a colposcopy was previously recommended but not completed, if on repeat testing the patient has a persistent HPV-positive result and/or persistent cytologic abnormality (atypical squamous cells of uncertain significance, ASC-US, or higher), colposcopy is recommended. Colposcopy is also recommended if a patient has 2 consecutive HPV positive results and an exact risk estimate is not available. The management in these scenarios is based on the 2012 guidelines,2 which recommend colposcopy when a follow-up HPV test is positive or cytology is ASC-US or worse following a result of HPV-positive with negative cytology. Arguably, the scenarios described above would be higher risk, and therefore colposcopy iswarranted. Similarly, if a patient had a high-grade cytology result, including atypical squamous cells cannot exclude a high-grade squamous intraepithelial lesion (ASC-H) atypical glandular cells, (AGC) or high grade squamous intraepithelial lesion (HSIL), and did not receive a colposcopy, colposcopy is recommended. Conversely, if a patient has a negative HPV test or co-Test following a low-grade result for which colposcopy was previously recommended but not performed, repeating an HPV test or co-Test in 1 year is acceptable. This management is based on the findings that risk estimates did not reach the colposcopy threshold for an HPV-negative or co-Test negative result following any previous lowgrade result.
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