Atypical Squamous Cells of Undetermined Significance

ASCUS Pap now divided into 2 categories
1. Atypical Squamous Cells, Cannot exclude HSIL (ASC-H)
  1. Higher risk - requires Colposcopy
  2. Accounts for 10% of ASCUS cases
2. Atypical Squamous Cells undetermined signif. (ASC-US)
  1. Can be managed below (as per prior ASCUS guideline)
  2. Accounts for 90% of ASCUS cases
ASCUS Pap should be followed closely
1. ASCUS most common abnormality before HGSIL or Cervical Cancer
2. Kinney (1998) Obstet Gynecol 91:973-6 [PubMed]

Management
Age 21 to 24 years old with ASC-US or ASC-H Cervical Cytology (2014 Guidelines)

Colposcopy for all ASC-H (cannot exclude HSIL)
1. See HSIL for protocol
ASC-US
1. See Low Grade Squamous Intraepithelial Lesion (LSIL)
2. Treated the same as LSIL in ages 21-24 years old

Colposcopy for all ASC-H (cannot exclude HSIL)
1. No CIN 2 or 3
  1. See CIN 1
2. CIN 2, 3
  1. See CIN 2 or CIN 3
Options for ASC-US
1. Option 1: Send liquid pap on for HPV DNA Test (preferred)
  1. HPV negative (or positive for low risk type)
    1. Repeat cytology and HPV in 3 years (co-testing)
  2. HPV posiitve for high risk type
    1. Colposcopy
2. Option 2: Repeat Cytology in 1 year
  1. Abnormal (AS-CUS or worse)
    1. Colposcopy
  2. Normal
    1. Repeat cytology in 3 years
Special Circumstances
1. Pregnancy
  1. Manage the same as non-pregnant patients (but no ECC and avoid biopsies if possible)
2. Post-Menopausal
  1. Option 1: Colposcopy
  2. Option 2: HPV DNA Testing
  3. Option 3: Trial of intravaginal Estrogen
    1. Use if signs of atrophy and no contraindication
    2. Repeat Pap Smear one week after Estrogen done
      1. Normal: Pap Smear in 4-6 months, then yearly
      2. ASCUS or CIN: Colposcopy