A woman undergoes Pap smear which shows atypical squamous cells – cannot exclude high-grade lesion (ASC-H). According to current guidelines, what is the MOST appropriate next step?
- A Immediate colposcopy regardless of HPV status ✓
- B Repeat Pap smear in 12 months
- C HPV testing with reflex colposcopy if positive
- D Endocervical curettage alone
Correct answer: A. Immediate colposcopy regardless of HPV status
Explanation
ASC-H (atypical squamous cells – cannot exclude HSIL) carries a significantly higher risk of CIN 2–3 (~24–94% in various series) compared to ASC-US. Current ASCCP 2019 guidelines recommend immediate colposcopy (regardless of HPV co-test result) for ASC-H. The HPV reflex approach is appropriate only for ASC-US. For ASC-H, colposcopy with directed biopsy is mandatory because the risk of high-grade lesion is too high to manage with repeat cytology.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.