Current HPV | Current cytology | Past results | Management | |
HPV 16/18 | 16 | HSIL | N/A* | Treatment preferred; colposcopy acceptable |
16 | ASC-H | N/A | Treatment or colposcopy | |
16 | NILM, ASC-US, LSIL, AGC, or no cytology | N/A | Colposcopy¶ with collection of cytology if not already done | |
18 | HSIL | N/A | Treatment or colposcopy | |
18 | NILM, ASCUS, LSIL, ASC-H, AGC, or no cytology | N/A | Colposcopy¶ with collection of cytology if not already done | |
HPV 45, 33/58, 31, 52/35/39/68, 51 Untyped or "other" types when 16 and 18 are not present | 45, 33/58, 31, 52/35/39/68, 51 | HSIL, ASC-H, AGC | N/A | Colposcopy¶Δ |
45, 33/58, 31, 52/35/39/68, 51 | ASC-US or LSIL | N/A | Colposcopy | |
Untyped/other | ASC-US or LSIL | Documented HPV negative screen in past 5 years or colposcopy <CIN2◊ in past year | Repeat HPV test in 1 year | |
Untyped/other | ASC-US or LSIL | Any history other than above | Colposcopy | |
45, 33/58, 31, 52/35/39/68, 51, or untyped/other | NILM | Normal§ or colposcopy <CIN2 within past year | Repeat HPV test in 1 year | |
45, 33/58, 31, 52/35/39/68, 51, or untyped/other | N/A | HPV+ without colposcopy (ie, current test is second consecutive HPV+) | Colposcopy | |
HPV 59/56/66 | 59/56/66 | ASC-H, AGC, or HSIL¥ | N/A | Colposcopy¶ |
59/56/66 | NILM, ASC-US, LSIL or no cytology¥ | Normal or colposcopy <CIN2 within past 1 year | Repeat HPV test in 1 year | |
59/56/66 | N/A | HPV+ without colposcopy (ie, current test is second consecutive HPV+) | Colposcopy |
AGC: atypical glandular cells; ASC-H: atypical squamous cells, cannot exclude high-grade intraepithelial lesion; ASC-US: atypical squamous cells of undetermined significance; HPV: human papillomavirus; HSIL: high-grade squamous intraepithelial lesion; LSIL: low-grade squamous intraepithelial lesion; N/A: not applicable; NILM: negative for intraepithelial lesion or malignancy.
* Test result, if obtained, would not affect management.
¶ Endometrial biopsy recommended for an AGC result if risk factors for endometrial cancer are present (eg, age 35 years or older, obesity, irregular bleeding, anovulation) or if atypical endometrial cells are present.
Δ Colposcopy or treatment is acceptable for results of untyped HPV with ASC-H or HSIL cytology.
◊ Cervical intraepithelial neoplasia grade 2 or less severe.
§ Normal screening history per patient or documented in medical record.
¥ Cytology triage is not recommended for primary HPV screening with results positive for HPV59/56/66; this guideline may be used if cytology results are obtained.