From HPV genotype to risk stratification & management

A positive HPV test requires further investigation, and the 2019 American Society for Colposcopy and Cervical Pathology (ASCCP) cervical cancer management guidelines recommend a personalized
risk-based management.¹

All positive HPV primary tests, regardless of genotype, should have a cytology test (Pap test) performed to inform the next steps of patient management.¹

Possible results of a Pap test²

Normal

NILM

no cancer cells or other abnormal cells

Abnormal

LSIL

mildly abnormal changes in the cervical cells; usually caused by an HPV infection that often goes away on its own

HSIL

more serious changes in the cervix than LSIL; more likely than LSIL to be linked to precancer and cancer

ASC-H

changes in the cervical cells have been found that raise concern for the presence of HSIL

AGC

changes in the glandular cells (found in the uterus and in the cervix) that raise concern for the presence of precancer or cancer

Uncertain

ASC-US

changes in the cervical cells; almost always a sign of an HPV infection

The 2019 ASCCP cervical cancer management guidelines consider HPV natural history, HPV-prevalence changes based on vaccination, cervical carcinogenesis and new screening and triage tests.¹

The guidelines move away from a “test results-based algorithm” where follow-up is based on HPV test and cytology result alone. They move towards “risk-based management” where current test results, past test results, and age are used to calculate risk and follow-up is based on risk-thresholds.¹

Previous ASCCP guidelines¹

Test results-based algorithms

Colposcopy is recommended for patients with HPV-positive atypical squamous cells of undetermined significance (ASC-US) or low-grade, low-grade squamous intraepithelial lesion (LSIL)

2019 ASCCP guidelines¹

Risk-based guidelines

Colposcopy is recommended for any combination of history and current test results yielding a 4% or greater probability of finding CIN3+

ACOG, American College of Obstetricians and Gynecologists; AGC, atypical glandular cells; ASCCP, American Society for Colposcopy and Cervical Pathology; ASC-H, atypical squamous cells, cannot exclude HSIL; ASC-US, atypical squamous cells of undetermined significance; CC, cervical cancer; CIN, cervical intraepithelial neoplasia; HPV, human papillomavirus; hr, high-risk; HSIL, high-grade squamous intraepithelial lesion; LSIL, low-grade squamous intraepithelial lesion; NILM, negative for intraepithelial lesion or malignancy; Pap test, Papanicolaou test

1. Perkins RB et al. J Low Genit Tract Dis. 2020;24(2):102-131
2. Abnormal Cervical Cancer Screening Test Results. ACOG. 2021. Accessed 8 Nov 2021.