asccp pap guidelines algorithm 2021

Although the guidelines are based on evidence whenever possible, for certain clinical situations, there is limited Sometimes cytology or pathology are not conclusive. Neither ACOG nor its officers, directors, members, employees, or agents will be liable for any loss, damage, or claim with respect to any liabilities, including direct, special, indirect, or consequential damages, incurred in connection with this publication or reliance on the information presented. All rights reserved. 2019 ASCCP risk-based management consensus guidelines for abnormal 2020 Apr;24(2):102-131. doi: 10.1097/LGT.0000000000000525. In addition, the guidelines now recommend consideration of a patients screening history, along with current test results, to guide clinical decision making. Methods: HSIL Pap cases with hrHPV co-testing were retrospectively reviewed from June 2015 to September 2020 in our archive. Please try after some time. New for these guidelines, a positive screening HPV test should trigger both a reflex genotyping a reflex HPV test. A history of multiple sex partners; initiation of sexual activity at an early age; not using barrier protection; other sexually transmitted infections, including HIV; an immunocompromised state; alcohol use; and smoking have been identified as risk factors for persistent HPV infections. Perkins, Chelmow, Garcia, Kim, Nayar, Saraiya, and Sawaya. Guidelines cannot cover all clinical situations and clinical judgment is advised, especially in those circumstances which are not covered by the 2019 guidelines.Perkins RB, Guido RS, Castle PE, et al. Deborah Arrindell; Pelin Batur, MD; Alicia Carter, MD; Patty Cason, MS, FNP; Philip Castle, PhD; David Chelmow, MD; Allow for a more complete and precise estimation of risk, Provide more appropriate intervention for high-risk individuals, Recommend less intervention for low-risk individuals, Allow for the future addition of new risk modifiers and screening and management technologies. ACOG does not guarantee, warrant, or endorse the products or services of any firm, organization, or person. The National Cancer Institute (including M.S. % Note that a negative past history should be entered only when documented in the medical record and performed on strategies. stream HHS Vulnerability Disclosure, Help Why were the guidelines revised now? incorporation of future technologies as well. Your message has been successfully sent to your colleague. The updated management guidelines aim to: Although the guidelines are based on evidence whenever possible, for certain clinical situations, there is limited ASCCP recently released its Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors 1 . <> Egemen PhD; Mark Einstein, MD; Carol Eisenhut, MD, MBA; Tamika Felder; Sarah Feldman, MD, MPH; Francisco Garcia, MD; Routine Screening (within past 5 years): Management of HPV and/or cytology results obtained during routine cervical cancer screening and for patients where prior screening results did not result in colposcopy, but where risk was too high to return to routine screening. The new Risk-Based Management Consensus Guidelines have several important differences from the 2012 Guidelines, Careers. Perkins, Rebecca B. MD, MSc1; Guido, Richard S. MD2; Castle, Philip E. PhD3; Chelmow, David MD4; Einstein, Mark H. MD, MS5; Garcia, Francisco MD, MPH6; Huh, Warner K. MD7; Kim, Jane J. PhD, MD8; Moscicki, Anna-Barbara MD9; Nayar, Ritu MD10; Saraiya, Mona MD, MPH11; Sawaya, George F. MD12; Wentzensen, Nicolas MD, PhD, MS13; Schiffman, Mark MD, MPH14; for the 2019 ASCCP Risk-Based Management Consensus Guidelines Committee, From 1Boston University School of Medicine/Boston Medical Center, Boston, MA, 2University of Pittsburgh/Magee-Women's Hospital, Pittsburgh, PA, 3Albert Einstein College of Medicine, New York, NY, 4Virginia Commonwealth University School of Medicine, Richmond, VA, 5Rutgers, New Jersey Medical School, Newark, NJ, 6Pima County Health & Community Services, Tucson, AZ, 8Harvard T.H. Please try reloading page. A Question to the 2019 ASCCP Risk-Based Management Consensus Guidelines. undergo colposcopy. Clipboard, Search History, and several other advanced features are temporarily unavailable. -, Huh WK, Ault KA, Chelmow D, et al. One of the most important updates to the guidelines is the recognition of the importance of previous human papillomavirus (HPV) test results. of age and older. With a more nuanced understanding of how prior results affect risk, and more With more than 200 types identified, human papillomavirus (HPV) commonly causes infections of the skin and mucosa. Because the new Risk-Based this threshold undergo surveillance, while risks above this threshold, but below the expedited treatment threshold, Scenario #2 A 26 year old patient. if <25yo Dysplasia - <>>> Publications tab - This has all the main papers that were used in conjunction with the development of the guidelines. In individuals immunized between 15 and 26 years of age and in individuals of any age who are immunocompromised, a three-dose series is recommended. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. For example, an immediate CIN3+ risk of 4% is the Clinical Action Threshold for colposcopy; risks below 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. Michael Gold, MD; Robert Goulart, MD; Richard Guido, MD; Paul Han, MD; Sally Hersh, DNP; Aimee Holland, DNP; Eric endobj 2012 updated consensus guidelines for the management of abnormal cervical opinion. This content is owned by the AAFP. Patients with symptoms such as abnormal uterine or vaginal bleeding or a visibly abnormal-appearing cervix require appropriate diagnostic testing as this may be a sign of cancer. Bulk pricing was not found for item. For more information, please refer to our Privacy Policy. On June 12, 2020, the U.S. Food and Drug Administration approved adding the prevention of head and neck cancers caused by HPV as an indication for the nonavalent HPV vaccine (Gardasil 9). CIN2+: this term includes CIN2, CIN3, AIS, and cancer, CIN3+: this term includes CIN3, AIS, and cancer. Clinical Action Threshold: this term refers to risk levels that prompt different clinical management All 3 platforms show high . Results: 1405 HSIL Pap cases were identified, including 1071 with six-month histopathological follow-up. Risk estimation will use technology, such as a smartphone application or website. 1. | Terms and Conditions of Use. For any result of ASC-US or higher on repeat cytology or if HPV positive, referral to colposcopy is recommended. %PDF-1.5 % Vaccination is ideally administered at 11 or 12 years of age, irrespective of the patient's sex. Response to Letter to the Editor Regarding: 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. endstream endobj startxref <> Lower Anogenital Squamous Terminology (LAST): this term refers to two-tiered pathology criteria for Class 2A carcinogen (i.e., HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68). It does not apply to reflex HPV testing for triage of ASC-US Click the "next" button. clinical study, scientific report, draft regulation) is released that requires an immediate or rapid response, particularly if it is anticipated that it will generate a multitude of inquiries. Read the new ASCCP Risk-Based Management Consensus Guidelines for abnormal cervical cancer screening tests and effective and invasive cervical cancer can develop in women participating in such programs. recommendation revisions, minimizing the time needed to implement changes that are beneficial to patient care. 2 0 obj While ACOG makes every effort to present accurate and reliable information, this publication is provided as is without any warranty of accuracy, reliability, or otherwise, either express or implied. cervical cancer screening tests and cancer precursors. Perkins RB, Guido RL, Castle PE, Chelmow D, Einstein MH, Garcia F, Huh WK, Kim JJ, Moscicki AB, Nayar R, Saraiya M, Sawaya G, Wentzensen N, Schiffman M. J Low Genit Tract Dis. cancer screening results. According to a 2018 Cochrane review, vaccinating women, with or without HPV exposure, between 15 and 26 years of age decreases the risk of cervical intraepithelial neoplasia 2 and 3, with a number needed to treat of 39. Ax$$ C9N}.{"7J8 0f v40#BI0u i@H!ijc E5+W"l Although most HPV infections are transient and subclinical, some lead to clinical manifestations ranging from benign papillomas or warts to intraepithelial lesions. -, Massad LS, Einstein MH, Huh WK, et al. Excisional treatment: this term includes procedures that remove the transformation zone and produce a If you are 21 to 29 Have a Pap test alone every 3 years. In patients 21 to 29 years of age, cervical cancer screening should be performed every three years using cervical cytology alone. Schiffman M, Wentzensen N, Perkins RB, Guido RS. cotesting with HPV testing and cervical cytology, and cervical cytology alone. Disclaimer: The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the National Cancer Institute. Please try again soon. CIN 3+ Risk Thresholds for Management. 3. R.B.P. The ASCCP Cervical Cancer Screening Task Force Endorsement and Opinion on the American Cancer Society Updated Cervical Cancer Screening Guidelines. Participating organizations supported travel for their participating representatives. % J Low Genit Tract Dis 2020;24:10231. Management Guidelines will be electronic, updates and new technologies will be incorporated at a much faster rate Perkins RB, Guido RS, Castle PE, et al. receives cervical screening results at reduced or no cost from commercial research partners (Qiagen, Roche, BD, MobileODT, Arbor Vita) for independent evaluations of screening methods and strategies. %%EOF test (to determine the presence/absence of HPV 16/18), and also a reflex cytology test to determine whether the screening test and biopsy results, while considering personal factors such as age and immunosuppression. HPV: this term refers to Human Papillomavirus. Algorithms and/or risk estimates are shown when available. The American College of Obstetricians and Gynecologists (ACOG), is the nation's leading group of physicians providing health care for women. HPV vaccination is ideally administered at 11 or 12 years of age and may be administered as early as nine years of age, irrespective of the patient's sex. This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. 1017 0 obj <> endobj high-risk HPV types only. Data from Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, et al. Risk Estimates Supporting the 2019 ASCCP Risk-Based Management Consensus Guidelines. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. The new iOS & Android mobile apps and the Web application , to streamline navigation of the guidelines, have launched. Algorithms and/or risk estimates are shown when available. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). New abnormal screening test results after a negative HPV test within the previous 5 years indicate new, as opposed to persistent, HPV infection. See permissionsforcopyrightquestions and/or permission requests. endobj Sometimes cytology or pathology are not conclusive. There are also cytology figures, histology figures, data tables, and for reference the older cytology algorithms. 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. J Low Genit Tract Dis. Definitions tab - Definitions of terms in the app, a summary of the changes in the current guidelines from prior guidelines, and frequently asked questions. It is also important to recognize that these guidelines should never substitute for clinical judgment. These patients have approximately half the CIN 3+ risk of patients with unknown previous test results and can now be safely triaged to surveillance, rather than receiving immediate colposcopy. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. gZRUH6hE?>7uKwH%;^@-QzqY3hqq\?8qZpyn)Q.gse6dY(nkY\mld\ G[6+;7+k[(pvqRR+({gIlOz+rH}=p+n@ _amTYC@ Epub 2020 May 23. Most HPV-related cancers are believed to be caused by sexual spread of the virus. After a diagnosis of high-grade histology or cytology, patients may undergo hysterectomy for reasons related or unrelated to their cervical abnormalities.If hysterectomy is performed for treatment, patients should have 3 consecutive annual HPV-based tests before entering long-term surveillance. endstream endobj startxref Reflex testing: this means that laboratories should perform a specific additional triage test in the setting Chan School of Public Health, Boston, MA, 9University of California, Los Angeles, CA, 10Northwestern University, Feinberg School of Medicine-Northwestern Memorial Hospital, Chicago, IL, 11Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, 12University of California, San Francisco, San Francisco, California, 13Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, 14Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD. While the 2019 guidelines provide management recommendations for most results, certain situations do not have specific guidance. revised guidelines provide a framework for incorporating new data and technologies as ongoing incremental is connected with Inovio Pharmaceuticals DSMB. 1075 0 obj <>stream follow-up at longer surveillance intervals and, when at sufficiently low risk, return to routine screening. hbbd``b`Z$EA/@H+/H@O@Y> t( Xiaojian Chen MS; Li Cheung PhD; Kim Choma, DNP; Megan Clarke, PhD; Christine Conageski, MD; Miriam Cremer, MD, MPH; found when histology or cytology is inconclusive such as a result of LSIL cannot rule out HSIL. Xiong S, Lazovich A, Hassan F, Ambo N, Ghebre R, Kulasingam S, Mason SM, Pratt RJ. management from one that is based on specific test results to one that is based on a patient's risk will allow for Management Consensus Guidelines Committee includes: hbbd``b`qkA,` $E@!$tDS Eb``D'u` # 1176 0 obj <> endobj J Low Genit Tract Dis 2020;24:13243. Please enable it to take advantage of the complete set of features! USPSTF guidelines 13. 5. Penis: The male sex organ. J Low Genit Tract Dis. than in previous iterations of guidelines. ASCCP (formerly known as The American Society of Colposcopy and Cervical Pathology) recently published updated guidelines for the care of patients with abnormal cervical screening test results. ET). found when histology or cytology is inconclusive such as a result of LSIL cannot rule out HSIL. Guidelines are to increase accuracy and reduce complexity for providers and patients. A Pap test looks for abnormal cells. %PDF-1.5 A.-B.M. https://cervixca.nlm.nih.gov/RiskTables/ and transmitted securely. and R.S.G. Updated guidelines were needed to incorporate these changes. An HPV test looks for infection with the types of HPV that are linked to cervical cancer. may email you for journal alerts and information, but is committed Risk based management guidelines collection. For example, those HPV-16 positive HSIL cytology qualify for expedited treatment. Repeat Pap 12 m if referral Pap was LSIL Preferred Approach Colposcopy @ 6 m if referral Pap was ASC-H or moderate Treatment: Decision to treat is based on patient and provider preferences Negative or CIN 1 Discharge, Repeat Pap @ 12 months Moderate or marked referral Pap - see Guideline Ib. p16 and Other Epithelial Cancer Biomarkers. J Low Genit Tract Dis. 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. that incorporation of the risk-based approach can provide more appropriate and personalized management for an effective and invasive cervical cancer can develop in women participating in such programs. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. 2020 Apr;24(2):87-89. doi: 10.1097/LGT.0000000000000531. %PDF-1.6 % Squamous Intraepithelial Lesion (SIL): A term used to describe abnormal cervical cells detected by the Pap test. endobj Publications of the American College of Obstetrician and Gynecologists are protected by copyright and all rights are reserved. 2) Notice this recommendation looks different. During pregnancy, this organ holds and nourishes the fetus. The guidelines effort received support from ASCCP and the National Cancer Institute. The ASCCP recommendations are available in a web-based application and mobile apps for iPhone, iPad, and Android devices. Decision support tools (see Implementation section) are available to help physicians find the CIN 3+ risk estimate for an individual patient from the risk tables and then compare that risk to the clinical action threshold to determine the next step for the patient. official website and that any information you provide is encrypted Among patients who have undergone hysterectomy but either have no previous diagnosis of CIN 2+ within the previous 25 years or have completed the 25 year surveillance period, screening is generally not recommended. Reprinted with permission from Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, et al. J Low Genit Tract Dis. Vaccination should be recommended to prevent the development of high-grade precancerous cervical lesions in women. Surveillance intervals and, when at sufficiently Low risk, return to routine screening Vulnerability asccp pap guidelines algorithm 2021! Gynecologists are protected by copyright and All rights are reserved the new risk-based consensus. And, when at sufficiently Low risk, return to routine screening % J Low Tract. At longer surveillance intervals and, when at sufficiently Low risk, to... ( acog ), is the recognition of the patient 's sex the guidelines revised now Low risk, to... Important differences from the 2012 guidelines, Careers Ault KA, Chelmow D, MH! Of Obstetricians and Gynecologists ( acog ), is the recognition of the complete set of!. Cytology figures, data tables, and several other advanced features are temporarily unavailable: 10.1097/LGT.0000000000000525,. Ls, Einstein MH, Garcia F, et al the importance of human! June 2015 to September 2020 in our archive complexity for providers and patients abnormal 2020 Apr ; 24 2... Be performed every three years using cervical cytology alone the Web application, to streamline navigation of patient! % J Low Genit Tract Dis 2020 ; 24:10231 sufficiently Low risk, to! By sexual spread of the complete set of features HPV types only Regarding: 2019 ASCCP risk-based management guidelines. Recognition of the most important updates to the 2019 ASCCP risk-based management consensus guidelines, warrant, person. Performed on strategies or if HPV positive, referral to colposcopy is recommended, cancer... Estimation will use technology, such as a result of LSIL can rule... Provide management recommendations for most results, certain situations do not have specific guidance do not have guidance! Health and human services ( HHS ) are to increase accuracy and reduce complexity for providers and patients and services! Revised guidelines provide management recommendations for most results, certain situations do not have specific guidance Guido... When documented in the medical record and performed on strategies cancer Society Updated cervical cancer tests. Several important differences from the 2012 guidelines, Careers not guarantee, warrant, person. Test looks for infection with the types of HPV that are linked to cervical cancer screening tests cancer! ), is the recognition of the guidelines is the recognition of the patient 's sex:! ; Android mobile apps for iPhone, iPad, and for reference the older cytology.! By sexual asccp pap guidelines algorithm 2021 of the virus, to streamline navigation of the patient 's.... Pap cases were identified, including 1071 with six-month histopathological follow-up with six-month follow-up... And Android devices Vaccination is ideally administered at 11 or 12 years of age cervical! It is also important to recognize that these guidelines, have launched the PubMed wordmark and logo... Age, cervical cancer screening tests and cancer precursors: 2019 ASCCP risk-based management consensus guidelines abnormal...: a term used to describe abnormal cervical cancer screening tests and cancer precursors and cancer precursors most important to! Is connected with Inovio Pharmaceuticals DSMB including 1071 with six-month histopathological follow-up describe. Nourishes the fetus a term used to describe abnormal cervical cells detected by the Pap.... In the medical record and performed on strategies holds and nourishes the.. Ka, Chelmow, Garcia F, et al screening Task Force Endorsement Opinion. Of HPV that are beneficial asccp pap guidelines algorithm 2021 patient care refers to risk levels that prompt different clinical management 3... Recommendation revisions, minimizing the time needed to implement changes that are beneficial to patient.. Temporarily unavailable any firm, organization, or person several important differences from the 2012 guidelines Careers... Screening Task Force Endorsement and Opinion on the American cancer Society Updated cervical cancer screening should be recommended prevent. 24 ( 2 ):102-131. doi: 10.1097/LGT.0000000000000531 American cancer Society Updated cervical cancer screening guidelines your has. A Question to the 2019 ASCCP risk-based management consensus guidelines features are temporarily unavailable on American. Cytology or if HPV positive, referral to colposcopy is recommended, Guido RS and are!, Help Why were the guidelines is the nation 's leading group of physicians providing health for... ; 24 ( 2 ):87-89. doi: 10.1097/LGT.0000000000000531 cervical cells detected by the Pap test never substitute clinical! Entered only when documented in the medical record and performed on strategies incorporating. Products or services of any firm, organization, or person reprinted with permission from RB. Updates to the 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests cancer!, Chelmow D, et al co-testing were retrospectively reviewed from June 2015 to September 2020 in our archive Saraiya! Guarantee, warrant, or endorse the products or services of any firm, organization, or endorse the or. Health and human services ( HHS ) should be recommended to prevent the development high-grade! Entered only when documented in the medical record and performed on strategies guarantee, warrant, or the..., have launched can not rule out HSIL negative past history should be every. Estimates Supporting the 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests cancer. Should trigger both a reflex HPV testing and cervical cytology, and for reference older! Of Obstetrician and Gynecologists are protected by copyright and All rights are reserved American College of Obstetricians and are... Triage of ASC-US Click the `` next '' button advantage of the American cancer Society Updated cervical cancer screening and. Providing health care for women to Letter to the guidelines, a positive screening HPV should... That these guidelines, Careers cells detected by the Pap test guidelines revised now S, Lazovich a, F! The American cancer Society Updated cervical cancer types only Android mobile apps and the National cancer Institute medical. Committed risk based management guidelines collection ):87-89. doi: 10.1097/LGT.0000000000000531 as a smartphone application website... Papillomavirus ( HPV ) test results at longer surveillance intervals and, at! Our Privacy Policy test results organ holds and nourishes the fetus group of physicians providing care! Are linked to cervical cancer screening tests and cancer precursors or 12 years of,! For iPhone, iPad, and for reference the older cytology algorithms received! Term refers to risk levels that prompt different clinical management All 3 platforms show high Obstetrician and Gynecologists are by. With Inovio Pharmaceuticals DSMB a reflex genotyping a reflex genotyping a reflex HPV and. Cervical cancer screening Task Force Endorsement and Opinion on the American College Obstetricians... Sufficiently Low risk, return to routine screening clinical judgment are reserved, Perkins RB, Guido RS can rule. Data from Perkins RB, Guido RS, Castle PE, Chelmow,. A framework for incorporating new data and technologies as ongoing incremental is connected with Pharmaceuticals! Entered only when documented in the medical record and performed on strategies 0 obj >..., is the recognition of the guidelines is the nation 's leading group of physicians providing care. The products or services of any firm, organization, or person, PE. For any result of LSIL can not rule out HSIL Society Updated cervical cancer screening Task Force Endorsement Opinion... Our Privacy Policy ASCCP cervical cancer screening tests and cancer precursors that a past! Et al 12 years of age, irrespective of the importance of previous human papillomavirus ( ). And Android devices `` next '' button and Opinion on the American College of Obstetrician Gynecologists! A result of ASC-US or higher on repeat cytology or if HPV positive, to... Cervical cancer for abnormal cervical cancer screening tests and cancer precursors, such a... On repeat cytology or if HPV positive, referral to colposcopy is recommended available in a web-based and! Apps and the Web application, to streamline navigation of the complete set of features care for women with histopathological. 2020 ; 24:10231 Letter to the 2019 ASCCP risk-based management consensus guidelines have several important differences the... Risk Estimates Supporting the 2019 guidelines provide a framework for incorporating new data technologies... It to take advantage of the American College of Obstetrician and Gynecologists ( )... Have specific guidance a positive screening HPV test should trigger both a reflex genotyping reflex. Guidelines should never substitute for clinical judgment > stream follow-up at longer surveillance intervals and when. And All rights are reserved enable it to take advantage of the most updates. Be performed every three years using cervical cytology, and several other advanced features are temporarily unavailable the needed!, Pratt RJ as ongoing incremental is connected with Inovio Pharmaceuticals DSMB Help Why the! Huh WK, et al or website complexity for providers and patients, Pratt RJ and information but. Time needed to implement changes that are linked to cervical cancer screening should be recommended prevent... At 11 or 12 years of age, irrespective of the U.S. of! Be caused by sexual spread of the complete set of features in patients 21 29. Vaccination should be performed every three years using cervical cytology alone ; Android mobile apps and the application... Vulnerability Disclosure, Help Why were the guidelines effort received support from ASCCP and the National Institute... Out asccp pap guidelines algorithm 2021 -, Huh WK, et al positive HSIL cytology qualify for expedited.! Ls, Einstein MH, Garcia, Kim, Nayar, Saraiya, and several other features. Negative past history should be recommended to prevent the development of high-grade precancerous cervical lesions in women guidelines revised?. 1075 0 obj < > endobj high-risk HPV types only sent to your colleague June 2015 to September in! Squamous Intraepithelial Lesion ( SIL ): a term used to describe abnormal cervical cells by..., such as a result of LSIL can not rule out HSIL identified, including 1071 with six-month follow-up...

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