New Consensus Guidelines for Abnormal Pap Smears

April 30, 2002

NEW YORK (MedscapeWire) May 01 — Consensus guidelines for management of abnormal Papanicolaou (Pap) smears, developed at a conference sponsored by the American Society for Colposcopy and Cervical Pathology (ASCCP) on September 6-8, 2001, in Bethesda, Maryland, are summarized in the April 24 issue of The Journal of the American Medical Association.

"Women with atypical squamous cells (ASC) of undetermined significance (ASC-US) should be managed using a program of 2 repeat cytology tests, immediate colposcopy, or DNA testing for high-risk types of human papillomavirus (HPV)," write Thomas C. Wright Jr, MD, from Columbia University in New York, and colleagues. "Testing for HPV DNA is the preferred approach when liquid-based cytology is used for screening."

A panel of 121 experts in the diagnosis and management of cervical cancer precursors developed these guidelines using a multistep approach, including literature review and input from the professional community. They concluded that HPV testing has been clinically validated and can become integral to both screening and clinical management.

The panel also recommended that women whose Pap smears cannot exclude high-grade squamous intraepithelial lesion (HSIL; ASC-H), as well as those with low-grade squamous intraepithelial lesion or atypical glandular cells, should be referred for immediate colposcopy.

"The primary purpose of the Pap smear is to identify patients who have cellular changes that place them at risk for the development of cervical cancer," Mark H. Stoler, MD, from the University of Virginia Health System in Charlottesville, writes in an accompanying editorial. "Like all laboratory tests, Pap smears are not perfect."

Although the Pap smear is a moderately sensitive, highly specific test with a low false-negative rate, careful preparation and skilled interpretation are needed for optimal results. Unfortunately, the clinical and medicolegal need for high sensitivity often result in an ASC interpretation and equivocal morphological diagnosis.

"Now, women can have better cervical cancer screening, clearer and more meaningful cytological interpretations, more rational and easier evidence-based management algorithms, and molecular diagnostics that can increase predictive power in ways that can improve outcomes and potentially reduce costs," Stoler writes. "While the new Bethesda classification system and new ASCCP guidelines mark a new beginning for reporting and treatment of cytological abnormalities, hopefully they will also mark the beginning of the end of cervical cancer."

JAMA. 2002;287(16):2120-2129, 2140-2141, 2114-2119

Full text of the Consensus Guidelines on the JAMA Web site

Full text of the 2001 Bethesda System on the JAMA Web site

Full text of the Editorial on the JAMA Web site

Reviewed by Gary D. Vogin, MD

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