Updates on Pap Smear Guidelines 2014

Objectives Review current recommendations Develop an algorithm for the appropriate use of screening cytology and HPV testing Discuss and incorporate into practice the newest ASCCP/ACOG consensus guidelines for management of cytologic abnormalities or (+) HPV testing

Essential Changes From Prior Management Guidelines Cytology reported as negative, but lacking endocervical cells can be managed without early repeat Cytology reported as unsatisfactory requires repeat even if HPV negative Genotyping triages HPV (+) women with 16 or 18 to earlier colposcopy ASCUS- immediate colposcopy is not an option. Serial cytology at 12 months, and then if negative, cytology every 3 years

Essential Changes (continued HPV (-) and ASCUS results should be followed with co-testing q 3 years, rather than 5 years. HPV (-) and ASCUS results do not allow exit from screening at age 65. More strategies incorporate co-testing to reduce follow-up visits. Women aged 21 – 24 are managed conservative

HPV and the Development of Cancer

Cytology testing alone at 12 month intervals is preferred, but reflex HPV testing is acceptable. For women w 2 consecutive negative results, return to routine screening is rec.

Cervical adenoca assoc w predominately 18; endometrial, ovarian and fallopian tube cancer are not

CIN in Pregnant Patient Colposcopy should have exclusion of invasive cancer as its primary goal. Unless cancer is identified or suspected, treatment of CIN in pregnancy is CONTRAindicated. A diagnostic excisional procedure is recommended only if invasion is suspected. Initial evaluation of AGC is the same except NO ECC or endometrial biopsy Reassess with cytology and colposcopy no sooner than 6 weeks postpartum.

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