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Follow-up Guidelines; Pap test results

Ontario interim recommendations for follow-up of Pap test results. These are minimum guidelines only. There may be clinical situations that require earlier follow-up / referral for colposcopy. Any repeat Pap test should not be performed earlier than three months.

The Pap test should not be used in the assessment of a visible cervical lesion. These patients require biopsy for accurate diagnosis.

Statement of Adequacy Recommendation
Within normal limits: Satisfactory for evaluation Continue with normal screening interval. 
Within normal limits: Satisfactory for evaluation but limited by: state reason If previous Pap tests have been normal, and satisfactory for evaluation, continue normal screening interval. If there is no previous Pap test or no test satisfactory for evaluation, the test should be repeated earlier than one year. 
Unsatisfactory for evaluation Repeat in three months
Diagnostic Category Recommendation
Benign cellular changes: Inflammation Culture and treatment, if appropriate Continue with normal screening interval 
Benign cellular changes: Non-specific If previous tests have been normal and satisfactory for evaluation, continue with normal screening interval.
Atypical squamous cells of undetermined significance (ASCUS)

Low-grade intraepithelial lesion (LSIL)
The minimum recommendation is to repeat at six-month intervals for up to two years. If a second diagnosis of ASCUS or LSIL occurs in a two-year period, colposcopy could be considered. If there is no evidence of cytological progression on repeat Pap tests, it is acceptable to follow the patient for up to two years, at which point all patients with persistent abnormalities should be referred for colposcopy.
It is noted that there will be clinical situations (e.g. poor compliance, previous abnormal Pap test) in which immediate colposcopy and biopsy is the recommended forms of investigation.
High -Grade  Squamous Intra-epithilial Lesion  (HSIL) Colposcopy
Squamous cell carcinoma Colposcopy
Endometrial cells cytologicallly benign in a post menopausal woman These findings shoud be interpreted in light of the clinical scenario.
Atypical glandular cells of  undetermined significance [AGUS]: favour  endometrial origin Suggest endometrial sampling
AGUS: favour reactive endocervical cells Repeat test in six months
AGUS: favour neoplastic endocervical cells  
AGUS: not otherwise specified
It is recognized that follow-up of pap tests recognized as AGUS may include sampling of the endocervical canal, in addition to colposcopy
Atypical glandular cells, consistent with adenocarcinoma in situ 
With cytological evidence of adenocarcinoma in situ, a diagnostic cone  biopsy should be performed.(ie, knife excision, not loop electrodiathermy excision procedure.-LEEP)
Malignant  cells present , consistent with adenocarcinoma Suggest further investigation
Malignant  cells present, NOS Suggest further investigation