Gyne Cytopathology: Practice Question
According to the 2019 ASCCP management guidelines for cervical cancer screening, what is the cutoff that will determine if the next step in management is a diagnostic procedure (colposcopy/excision) or continued surveillance/screening?
- None of the above. The next step is based on Pap test and/or hrHPV results.
- The patient's immediate risk of CIN3+ is greater than or equal to 60%.
- The patient's immediate risk of cervical cancer is greater than or equal to 25%.
- The patient's immediate risk of cervical cancer is greater than or equal to 10%.
- The patient's immediate risk of CIN3+ is greater than or equal to 4%.
Show Answer and Explanations
None of the above. The next step is based on Pap test and/or hrHPV results.
Incorrect. One of the major changes from the previous guidelines is the change from basing management recommendations on test results, to basing them on the patient's percent risk of CIN3+.The patient's immediate risk of CIN3+ is greater than or equal to 60%.
Incorrect. Expedited treatment (excision without a colposcopic biopsy first showing histologic HSIL) is recommended for these patients.The patient's immediate risk of cervical cancer is greater than or equal to 25%.
Incorrect. Recommendations for management are based on the immediate risk of CIN3+, not on immediate risk of cervical cancer.The patient's immediate risk of cervical cancer is greater than or equal to 10%.
Incorrect. The primary goal of cervical cancer screening is to decrease PRE-cancer (aka HSIL, AIS). Early discovery of cervical cancer is considered a secondary goal. This is due to the infrequency of cancer relative to pre-cancer. Because of this, the next step in management is based on a patient's risk of CIN3+.The patient's immediate risk of CIN3+ is greater than or equal to 4%. — Correct answer
Correct. If a patient's current risk of CIN3+ is 4% or above, the next step in management is a diagnostic procedure such as colposcopy or excision. If the immediate risk of CIN3+ is less than 4%, the patient's surveillance interval (return for hrHPV/pap Test in 1 year, 3 years, 5 years) is then selected based on the patient's 5 year risk of of developing CIN3+.Summary
Summary: In the 2019 ASCCP guidelines for cervical cancer screening, the next step in management is based on the patient's immediate risk of CIN3+, not based on the patient's Pap test results. The major cutoff is 4%.If the patient's risk of immediate CIN3+ is 4% or above, the next step in management is a diagnostic procedure such as colposcopy or excision. If the immediate risk of CIN3+ is less than 4%, the patient's surveillance interval (return for hrHPV/pap Test in 1 year, 3 years, 5 years) is then selected based on the patient's 5 year risk of of developing CIN3+.