NHSCSP Management Guidelines

Written by Robert Storer Created on Updated on .

 

Updated from Achievable standards, Benchmarks for reporting, and Criteria for evaluating cervical cytopathology (3rd Edition) January 2013 for more information click the link below

NHSCSP 1

 

 

 

A: GUIDELINES FOR ACTION ON CYTOLOGY – SQUAMOUS ABNORMALITIES

 

REPORT              

ACTION

Inadequate

 

Repeat in 3 months

Third consecutive inadequate

 

Refer to colposcopy

Negative

Routine Recall/Early Repeat/ HPV TOC

Borderline nuclear changes Squamous

 

HPV Triage/ HPV TOC/ HPV Re-Triage

Low Grade Dyskaryosis 

 

HPV Triage/HPV TOC/ HPV Re-Triage

High Grade Dyskaryosis (Moderate/Severe)

 

Refer to colposcopy

High Grade Dyskaryosis (Severe)

?invasive

 

Urgent 2 week referral to colposcopy

 

B: GUIDELINES FOR ACTION ON CYTOLOGY - GLANDULAR ABNORMALITIES

 

REPORT

ACTION

Borderline changes in  Endocervical cells

 

HPV Triage/ HPV TOC or HPV Re-Triage

?Glandular neoplasia – Endocervical

 

Urgent 2 week referral to colposcopy

?Glandular neoplasia – Non cervical

Urgent 2 week referral to a Gynaecologist * NB Not part of laboratory “direct referral” process

 

C: GUIDELINES FOR ACTION ON CYTOLOGY POST HPV TESTING

 

REPORT

ACTION

Borderline/Low Grade Squamous or Endocervical HPV Triage HR-HPV Positive

 

Refer to colposcopy

Remain at colposcopy

Borderline/Low Grade Squamous or Endocervical HPV Triage HR-HPV Negative

 

Routine Recall (3 or 5 years)

Borderline/Low Grade Squamous or Endocervical HPV Re-Triage HR-HPV Positive

 

Refer to colposcopy

Remain at colposcopy

Borderline/Low Grade Squamous or Endocervical HPV Re-Triage HR-HPV Negative

 

3 year recall

Borderline/Low Grade Squamous or Endocervical HPV TOC HR-HPV Positive

 

Refer to colposcopy

Remain at colposcopy

Borderline/Low Grade Squamous or Endocervical HPV TOC HR-HPV Negative

 

3 year recall

Negative HPV TOC HR-HPV Positive

 

 

Refer to colposcopy

Remain at colposcopy

Negative HPV TOC HR-HPV Negative

 

 

3 year recall

CGIN Follow-up First Negative Cytology, Positive HR HPV TOC

 

 

Refer to Colp

Remain at Colp

CGIN Follow-up First Negative Cytology, Negative HR HPV TOC

 

 

Repeat 12/12

CGIN Follow-up Second Negative Cytology, Positive HR HPV TOC

 

 

Refer to Colp

Remain at Colp

CGIN Follow-up Second Negative Cytology, Negative HR HPV TOC

 

 

3 year recall

 

D:  GUIDELINES FOR CYTOLOGY FOLLOW UP (without HPV testing)

 

PREVIOUS SMEAR HISTORY

FOLLOW UP

 

BNC

Three negative smears, one at 6 months and two annual smears. If all negative return to routine screening.

 

Low grade dyskaryosis

 

Three negative smears, one at 6 months and two annual smears.  If all negative return to routine screening.

 

High Grade Dyskaryosis (Moderate or severe dysk) and severe ?invasive

Ten negative smears, one at 6 months and nine annual smears.  If all negative return to routine screening.

 

?glandular neoplasia of endocervical type

 

Follow up cytologically at 6 monthly intervals for 5 years and annually for the following 5 years.  Best practice guidelines suggest these samples should be taken in Colposcopy

   

 

 

 

 

 

 

 

 

         E:  GUIDELINES FOR CYTOLOGY FOLLOW-UP - UNTREATED CIN I

REPORT

FOLLOW UP

 

Negative – No HPV Test required

 

Repeat at 12 months.  If this is negative, no HPV test is required.  Return to routine 3- or 5-yearly recall.

 

BNC/ LG HR-HPV test inadequate/ unreliable

 

Repeat cytology at 3 months

 

BNC/ LG HR-HPV detected

 

Refer for Colposcopic Assessment

 

BNC/ LG HR-HPV not detected

 

Recall in 3 years

 

High Grade dyskaryosis, ? invasive or ? endocervical dyskaryosis

 

Refer for Colposcopic Assessment

                                                                                             

F:  GUIDELINES FOR FOLLOW-UP POST TREATMENT FOR CIN (Without/ prior HPV testing)

HISTOLOGICAL GRADING

FOLLOW UP

 

CIN 1

Repeat cytology in 6 months.  If negative annual cytology follow up for two years.  Unless high-grade on referral cytology when follow-up protocol will be decided at Colposcopy MDT.

 

CIN 2 and 3

Repeat cytology in 6 months.  If negative annual smears for 9 years in Primary Care.

CGIN

Follow up at 6 monthly intervals for 5 years in Colposcopy with cervix broom and endocervical brush (1 vial). If all negative return to Primary Care for 5yr annual  cytology follow up.

Cervical cancer

Follow up as per MDT recommendation

 

G:  GUIDELINES FOR CYTOLOGY FOLLOW-UP POST TREATMENT FOR CIN

(with TEST OF CURE  HPV testing)

 

HISTOLOGICAL GRADING

FOLLOW UP

CIN 1, CIN 2 and CIN 3

Follow up cytology is negative, borderline or low grade

HR-HPV TOC  inadequate/ unreliable

 

Repeat cytology at 3 months

CIN 1, CIN 2 and CIN 3

Follow up cytology is negative, borderline or low grade

HR-HPV TOC  negative

 

Repeat cytology in 36 months. If negative then return to routine recall.

CIN 1, CIN 2 and CIN 3

Follow up cytology is negative, borderline or low grade

HR-HPV TOC  positive

 

Re-refer for Colposcopic assessment.

CIN 1, CIN 2 and CIN 3

Follow up cytology is high grade (moderate/ severe) ? invasive or ? endocervical CGIN

 

Re-refer for Colposcopic assessment.

Cervical cancer- no HPV Test of Cure required

 

Follow up as per MDT recommendation

 

NB. Any high grade dyskaryosis reported during a non-routine follow-up period requires referral back to colposcopy. Three consecutive inadequate smears must be referred to colposcopy.

 

 

 

 

 

 

 

H:  GUIDELINES FOR CYTOLOGY FOLLOW-UP POST TREATMENT FOR CGIN/ SMILE

(with TEST OF CURE  HPV testing)

 

Follow-up cytology is negative.  HR-HPV TOC  inadequate/ unreliable.

 

Repeat cytology and TOC at 3 months

 

Follow-up cytology is negative.  HR-HPV TOC  negative.

 

Repeat cytology in 12 months with HR HPV TOC.  If negative for both, recall in 3 years.  If negative again return to routine recall.  

If either repeat sample is cytologicaly abnormal, complete 10-year cytology follow- up as per section F above.

If either HR HPV TOC is positive, re-refer for colposcopic assessment.

 

Follow-up cytology is abnormal.

 

Complete 10-year cytology follow- up as per section F above.

 

 

I: GUIDELINES FOR FOLLOW-UP POST HYSTERECTOMY WITH PREVIOUS ABNORMAL CYTOLOGY – CERVIX REMOVED

 

HISTOLOGICAL GRADING

FOLLOW UP

 

No CIN/CGIN or cervical cancer detected

 

x1 follow up vault cytology at 6 months post treatment

 

CIN/ CGIN or cervical cancer detected. Excision complete.

 

x2 follow up vault cytology at 6 and 18 months post treatment

 

CIN/ CGIN or cervical cancer detected. Excision incomplete.

 

Follow up vault cytology at 6 months and then as per NHSCSP guidelines detailed in section F above.

 

NB: Vaginal vault samples are not part of the NHS Cervical Screening Programme. Women requiring vaginal vault cytology follow up should remain in the colposcopy clinic for follow up. Vaginal vault samples taken following total hysterectomy for benign conditions or non-cervical cancers are unnecessary and will be rejected as they are not part of the NHSCSP.  In the event of an abnormal screening history within the last 10 years, the consultant should arrange for a colposcopic examination of the vault at 6 months post hysterectomy, when a cytology sample can be taken if indicated.

 

J:  GUIDELINES FOR FOLLOW-UP POST SUB-TOTAL HYSTERECTOMY WITH PREVIOUS ABNORMAL CYTOLOGY – CERVIX NOT REMOVED (without HPV testing)

Proceed as per guidance in section F: GUIDELINES FOR FOLLOW-UP POST TREATMENT OF CIN(Without/prior HPV testing).  In the event that no abnormality is detected, refer to section D above or follow MDT decision.