Appropriateness of Colposcopy Referrals to a Tertiary Care Center. A Review of Adherence to the 2012 ASCCP Guideline [18H

Abstract

INTRODUCTION: The 2012 American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines were developed to identify cervical pathology and minimize overtreatment of lesions that may resolve spontaneously. These guidelines serve to streamline referrals to facilities for colposcopy and further management. Our objective was to evaluate adherence to the 2012 ASCCP guidelines regarding referrals for colposcopy to a large academic center. METHODS: A descriptive study was performed using women referred to Virginia Commonwealth University for Colposcopy or Loop Electrosurgical Excision Procedure (LEEP) from January 2015 to December 2016. Data on patient demographics, cervical cytology, HPV status, prior cervical dysplasia, and the recommended intervention were gathered. RESULTS: Referral requests for 432 women were reviewed. Of the referrals, 17.6% were discordant with ASCCP guidelines. The most common discordant colposcopy referrals were for low-grade squamous intraepithelial lesion (LSIL, 47.4%) and atypical squamous cell of undetermined significance (ASCUS, 30.3%). Of the discordant LSIL referrals, 63.9% were patients age <25, of which seven received non-indicated colposcopies. Discordant ASCUS referrals were most commonly HPV negative (n = 5), did not have appropriate co-testing or reflex testing (n = 7) or were age < 25 (n=7). Ten patients were referred for cervical cytology collected on vaginal cuffs despite hysterectomies performed for benign reasons. CONCLUSION: Effectiveness of the ASCCP guidelines depends on knowledge and adherence. Patients referred outside of the guidelines were most often women age <25 with LSIL. Referrals outside of evidence-based guidelines may lead to unnecessary procedures and added healthcare expense. Our results help identify areas for provider education.