I. Background: ASCUS Pap (Now ASC-US or ASC-H)

  1. ASCUS Pap now divided into 2 categories
    1. Atypical Squamous Cells, Cannot exclude HSIL (ASC-H)
      1. Higher risk - requires Colposcopy
      2. Accounts for 10% of ASCUS cases
    2. Atypical Squamous Cells undetermined signif. (ASC-US)
      1. Can be managed below (as per prior ASCUS guideline)
      2. Accounts for 90% of ASCUS cases
  2. ASCUS Pap should be followed closely
    1. ASCUS most common abnormality before HGSIL or Cervical Cancer
    2. Kinney (1998) Obstet Gynecol 91:973-6

II. Management: Initial ASC-US Pap Smear (choose 1 option)

  1. Options for ASC-US (All ASC-H require Colposcopy)
    1. Option 1: Send liquid pap on for HPV DNA Test
      1. HPV positive for low risk type: Pap Smear in 1 year
      2. HPV posiitve for high risk type: Colposcopy
    2. Option 2: Repeat Pap Smear in 6 months
      1. Abnormal: Colposcopy
      2. Normal: Repeat pap in 6 months
        1. Pap Smear abnormal: Colposcopy
        2. Pap Smear normal: Pap Smear annually
    3. Option 3: Colposcopy
      1. See Colposcopy Protocol
  2. Special Circumstances
    1. Pregnancy
      1. Manage the same as non-pregnant patients
    2. Post-Menopausal
      1. Option 1: Colposcopy
      2. Option 2: HPV DNA Testing
      3. Option 3: Trial of intravaginal Estrogen
        1. Use if signs of atrophy and no contraindication
        2. Repeat Pap Smear one week after Estrogen done
          1. Normal: Pap Smear in 4-6 months, then yearly
          2. ASCUS or CIN: Colposcopy

III. Management: Colposcopy evaluation of ASCUS

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Ontology: Atypical squamous cells of uncertain significance (C0521184)

Definition (NCI) Abnormal cells from the outer walls of the cervix (the lower, narrow end of the uterus). Abnormal squamous cells (thin, flat cells that look like fish scales) are found in a low number of Pap smears (a procedure used to detect cervical cancer) and may indicate infection with the human papillomavirus (HPV) or another infectious agent. The risk of developing cervical cancer is very low for patients with ASCUS without HPV infection.
Concepts Cell (T025)
SnomedCT 39035006
English Atypical squamous cells of uncertain significance, ascu, ascus, atypical squamous cells of uncertain significance, ASCUS, Atypical squamous cells of undetermined significance (morphologic abnormality), Atypical squamous cells of undetermined significance, Atypical Squamous Cell of Uncertain Significance, Atypical Squamous Cell of Undetermined Significance, ASC-US, atypical squamous cells of undetermined significance
Dutch ASC-US, atypische plaveiselcellen van ongekend belang
French Cellules épidermoïdes atypiques de signification indéterminée (ASCUS), Cellules épidermoïdes atypiques de signification non précisée
German atypische Plattenepithelzellen von ungeklärter Bedeutung, ASC-US
Italian Cellule squamose atipiche di significato indeterminato (ASCUS), Cellule squamose atipiche di significato indeterminato
Portuguese ASC-US, Células escamosas atípicas de significado indeterminado
Spanish ASC-US, Células escamosas atípicas de significado indeterminado, alteraciones de células pavimentosas de significación indeterminada (ASCUS), células escamosas atípicas de significación indeterminada (ASCUS) (anomalía morfológica), células escamosas atípicas de significación indeterminada (ASCUS)
Japanese 意義不明異型扁平上皮細胞, イギフメイイケイヘンペイジョウヒサイボウ
Czech ASC-US, Atypické skvamózní buňky neurčitého významu
Hungarian Meghatározatlan jellegű atypusos squamosus sejtek, ASC-US