2001 Consensus Guidelines for the Management of Women with Cervical Cytological Abnormalities

Abstract

EACH YEAR APPROXIMATELY 50 million women undergo Papanicolaou testing in the United States. Of these, approximately 3.5 million (7%) are diagnosed with a cytological abnormality requiring additional follow-up or evaluation. Determining which women with cytological abnormalities are at risk for significant cervical disease, performing appropriate diagnostic workups, and treating cancer precursors present a major public health challenge. There are a number of reasons why comprehensive, evidence-based guidelines are needed for the management of women with cervical cytological abnormalities. One reason is that a National Cancer Institute workshop recently revised the criteria used by cytologists to render certain cytological interpretations, as well as the terminology used for reporting cervical cytology results (ie, the Bethesda System). Other reasons include a better understanding of the pathogenesis and natural history of human papillomavirus (HPV) and cervical cancer precursors, and the availability of data from the National Cancer Institute’s randomized Atypical Squamous Cells of Undetermined Significance/Low-grade Squamous Intraepithelial Lesion (ASCUS/LSIL) Triage Study (ALTS) (D. Solomon, MD, written communication, September 6-8, 2001). Moreover, existing guidelines were developed before sensitive molecular methods for detecting high-risk types of HPV and liquid-based cytology methods became widely available. Data are now available suggesting that these new technologies, when used together, are attractive alternatives to older approaches for managing women with cer-