and N.W.) Her immediate CIN 3+ risk is less than 4%, so the 5-year risk is used. Cytology results at KPNC were reported based on the 2001 Bethesda System, categorized as: negative for intraepithelial lesion or malignancy (NILM), atypical squamous cells of undetermined significance (ASC-US), low-grade squamous intraepithelial lesion (LSIL), atypical squamous cells cannot exclude an high-grade squamous intraepithelial lesion (ASC-H), atypical glandular cells (AGC) (note, subcategorization of AGC is described in Perkins et al.1), high-grade squamous intraepithelial lesion or worse (HSIL+), and inadequate. Implementing the 2019 ASCCP Risk Based Management Guidelines for Abnormal Cervical Cancer Screening Tests in Your Practice Patty Cason, MS, FNP-BC Envision Sexual and Reproductive . Patient 2: A 35-year-old woman presents for screening, she denies having colposcopy or treatment in the past, and medical record documentation shows that her last result was an HPV-negative NILM screening result 5 years ago. for the management of Surgical consultations can require patients to deal with difficult and complex information, provoking anxiety that diminishes their ability to process information or recall vital details. 2. She presents for follow-up and her second HPV test result is also negative. We report the total number of patients and the number of CIN 3+ cases reported among those patients for each combination of “current results” and “history.” We present the number and percentage of the population with corresponding current test results in columns “n” and “%,” respectively. The “current results” are those for which the clinician is seeking guidance, either an HPV test or cotest result (see Tables 1A–2C4A–5B) or a colposcopy/biopsy result (see Table 3). Please enable scripts and reload this page. Risk-based management tables are organized under the 5 clinical scenarios. The length and size of the program, and its indisputable high quality, lend confidence to the internal comparisons of risk after different test results. has received 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. In Tables 2A–C, “history” refers to the abnormal screening test result preceding the current result: HPV-negative ASC-US (Table 2A), HPV-negative LSIL (Table 2B), and HPV-positive NILM (Table 2C). We restricted the analytic sample to 1,546,462 screened individuals with both HPV and cytology results, excluding those with a prior hysterectomy, histopathologic CIN 2+ diagnosis, missing HPV results or with cytology reports of missing, uncertain, or not cervical. 800-638-3030 (within USA), 301-223-2300 (international). The risk estimates are in the public domain in the United States of America and are made freely available elsewhere. 1. 11:10 AM – 11:35 AM: The Clinical Power of Updated Management Guidelines: Personalized Management of Your Patients. It is important to emphasize that for a given patient over time, a clinician is likely to consult various tables as the management scenarios are encountered, from initial abnormality to resolution. Scenario 3, management upon receipt of colposcopy/biopsy results, describes subsequent management based on the colposcopy/biopsy diagnosis (see Table 3). While they are evolutionary, Examples of important results are highlighted; for example, the risk posed by most current abnormalities is greatly reduced if the prior screening round was HPV-negative. Her immediate CIN 3+ risk is 5.6%. Therefore, patients with a negative cytology history will still be managed by Table 1A. The Next Generation of Guidelines: It’s All About Risk . You may be trying to access this site from a secured browser on the server. risk-based; management guidelines; cervical screening; HPV. J Low Genit Tract Dis 2020;24:132-43. Histopathology was also centralized. 13, 14 The term HPV-based testing is used in the 2019 ASCCP guidelines to refer to use of either primary HPV testing alone or HPV testing in conjunction with cervical cytology (cotesting). INTRODUCTION C. GUIDING PRINCIPLES The other authors have declared they have no conflicts of interest. Moving from result-based to risk-based guidelines, it is important for the clinician to understand how these risk estimates were obtained and how to use them in clinical management of cervical screening. Scenario 5 addresses management after treatment for CIN 2 or CIN 3, either short term (see Table 5A) or longer term (see Table 5B). Landy R, Cheung LC, Schiffman M, et al. This article navigates the most relevant risk-based management tables that inform the new guidelines for clinicians. The 2019 revision of the ASCCP Risk-Based Management Consensus Guidelines expands upon the “risk-based” approach introduced in 2012. ; for the 2019 ASCCP Risk-Based Management Consensus Guidelines Committee. 6 clinical actions (treatment, optional treatment or colposcopy/biopsy, colposcopy/biopsy, 1-year surveillance, Her immediate CIN 3+ risk is less than 4%, so the 5-year risk is used. In the KPNC database, 30,506 women had this result combination, among whom 1,378 had CIN 3+ (detected from initial screen through the end of follow-up), leading to a recommendation confidence score rounding to 100%. to Egemen et al.) Egemen D, Cheung LC, Chen X, et al. J Low Genit Tract Dis 2020;24:132–43. NSQIP Risk Calculator. One example would be changes in the risk score of the vaccinated population. The risk remains higher for treated CIN 3 compared with CIN 2 scenarios. We detail how risk estimates are used for clinical management according to the principles laid out by the 2019 ASCCP Risk-Based Management Guidelines. and upper (UL95) confidence interval. In the KPNC database, 18,254 women had this result combination, among whom 242 had CIN 3+. Cheung LC, Egemen D, Chen X, et al. to maintaining your privacy and will not share your personal information without
In Table 4B, “history” again refers to both the colposcopy result ( Female Figure Drawing Models,
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