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Recommendations for Follow-Up of Abnormal Cytology
 

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Choose a diagnosis to view recommended management.

Atypical Squamous Cells of Undetermined Significance (ASCUS)

Management / Follow-Up

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Recommended Management for Diagnosis of Atypical Squamous Cells of Undetermined Significance (ASCUS) for Patients younger than 30.

Note that HPV triage is not recommended.

  • Repeat cytology in 6 months, if the result is:
    • Greater than or equal to ASCUS, refer to colposcopy.
    • Normal, repeat the cytology again in 6 months. If the result is:
      • Normal, return to routine screening in 3 years.
      • Greater than or equal to ASCUS, refer to colposcopy.

*HPV testing is not currently funded by MOHLTC
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Recommended Management for Diagnosis of Atypical Squamous Cells of Undetermined Significance (ASCUS) for Patients 30 years old or older.

  • If HPV testing is known, and the result is:
    • Negative, return to routine screening in 3 years.
    • Positive, refer to colposcopy.
  • If HPV testing not known, repeat cytology in 6 months. If the result is:
    • Greater than or equal to ASCUS, refer to colposcopy.
    • Normal, repeat cytology in 6 months. If the result is:
      • Greater than or equal to ASCUS, refer to colposcopy.
      • Normal, return to routine screening in 3 years.

Atypical Squamous Cells, Cannot Exclude HSIL (ASC-H)

Management / Follow-Up
Colposcopy

Atypical Glandular Cells (AGC), Atypical Endocervical Cells, Atypical Endometrial Cells

Management / Follow-Up
Colposcopy and/or endometrial sampling

Low-Grade Squamous Intraepithelial Lesion (LSIL)

Management / Follow-Up*

*Evidence suggests that either repeat cytology or colposcopy are acceptable management options after the first LSIL result. Though colposcopy may be useful to rule out high-grade lesions, low-grade abnormalities, particularly in young women, often regress and as such may be best managed by surveillance.
View text description of diagram

Recommended Management for Diagnosis of Low-Grade Squamous Intraepithelial Lesion (LSIL)

  • Refer to colposcopy; or
  • Repeat cytology in 6 months, if the result is:
    • Greater than or equal to ASCUS, refer to colposcopy.
    • Normal, repeat the cytology again in 6 months. If the result is:
      • Normal, return to routine screening in 3 years.
      • Greater than or equal to ASCUS, refer to colposcopy.

High-Grade Squamous Intraepithelial Lesion (HSIL)

Management / Follow-Up
Colposcopy

Squamous Carcinoma, Adenocarcinoma, Other Malignant Neoplasms

Management / Follow-Up
Colposcopy

Unsatisfactory for Evaluation

Management / Follow-Up
Repeat cytology in 3 months

Satisfactory for Evaluation, No Transformation Zone Present

Management / Follow-Up
Routine screening in 3 years;
no immediate recall required

Benign Endometrial Cells on Pap Tests

Management / Follow-Up
Pre-menopausal women who are asymptomatic require no action (continue to follow usual screening guidelines).

Post-menopausal women require investigations, including adequate endometrial tissue sampling.

Any woman with abnormal vaginal bleeding requires investigation, which should include adequate endometrial tissue sampling.

Screening/Surveillance in Primary Care After Discharge from Colposcopy

The colposcopy should provide specific and individualized screening recommendations when a woman is discharged from colposcopy:

  • Women eligible for discharge from colposcopy who have normal, ASCUS or LSIL cytology and a negative HPV test are at average risk and should be screened every three years.
  • Women eligible for discharge from colposcopy who have normal, ASCUS or LSIL cytology and a positive HPV test are at elevated risk and should have annual surveillance.
  • Women eligible for discharge from colposcopy, whose HPV status is not known, should be screened according to risk-based recommendations made by the colposcopist.

Re-referral to colposcopy should be based on screening results (cytology), as per current guidelines.

Screening/surveillance intervals after discharge from colposcopy
HPV status
Recommended interval
Negative 3 years
Positive Annual
Unknown Follow recommendations from colposcopist

Healthcare Provider Resources
icon for Cervical Screening appQR code for Cervical Screening app Free App – Guidelines at Your Fingertips!
These recommendations can be accessed in the Ontario Cervical Screening Program's free mobile app. Scan the QR code or search "Ontario Cancer Screening" in your app store to download.
Last modified: Thu, Jan 12, 2017
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