A 29-year-old woman was treated with large loop excision of the transformation zone (LLETZ) for CIN 3. Histology confirmed clear margins. At her 6-month follow-up, the Pap smear shows atypical squamous cells of undetermined significance (ASCUS) and high-risk HPV testing is negative. What is the recommended next step in management?

• A Repeat colposcopy immediately
• B Repeat co-testing (cytology and HPV) at 12 months ✓
• C Proceed to cold knife conization
• D Perform an endometrial biopsy

Explanation

After excisional treatment for CIN 3 with clear margins, surveillance with co-testing at 12 months is standard. A negative high-risk HPV test is the single most important predictor of low recurrence risk. ASCUS with negative hrHPV in this surveillance context does not warrant immediate colposcopy or repeat excision. The ASCCP guidelines recommend co-testing at 12 months post-treatment, and if both are negative, return to routine screening. This avoids unnecessary procedures.

Reference: Williams Gynecology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.