Diagnosis: Guidelines for clinical management of cervicovaginal Pap test result, “Atypical squamous cells, cannot exclude high grade intraepithelial lesion (ASC-H)”
• Currently, the recommended management of ASC-H is referral for colposcopy. If CIN2 or CIN3 is not detected, follow up with cervicalPap testing at 6 months and 12 months or follow-up human papillomavirus (HPV) testing at 12 months is an acceptable recommendation.
• Immediate loop electrocautery excision procedure (LEEP) is not the management for patients following a diagnosis of ASC-H, but it is one of the management choices following an unequivocal diagnosis of high grade squamous intraepithelial lesion (HSIL) on Pap testing; however, this does not apply to pregnant women or adolescents.
• High risk HPV testing is recommended when atypical squamous cells of undetermined significance (ASC-US) is detected on cervicovaginal Pap screening tests in women over the age of 20.
• Repeat pap smear after topical estrogen treatment sometimes is used when atrophic cells raise the concern of HSIL due to similar patterns shared by both. In this case, application of topical estrogen may produce sufficient maturation to allow definitive diagnosis on follow up cytology testing.
