Pap Smear Interpretation: Bethesda Classification, HPV Co-Testing, and the ASCCP Management Guidelines
Pap Smear Interpretation: Bethesda Classification, HPV Co-Testing, and the ASCCP Management Guidelines ASC-US with negative HPV? Routine screening. AGC? Colposcopy, endocervical curettage, and possibly endometrial biopsy. Know the difference. Cervical cancer screening has evolved dramatically, yet the interpretation of results and management algorithms remain a source of confusion for many providers. The shift from cytology-only screening to HPV co-testing and primary HPV screening has changed when and how we act on results. This post walks through the Bethesda classification system, the current screening strategies, and the 2019 ASCCP risk-based management consensus guidelines. Current Screening Strategies Age Group Preferred Strategy Acceptable Alternatives Interval <21 years No screening (regardless of sexual activity or HPV vaccination status) None N/A 21–24 years Cytology (Pap) alone No HPV testing in this age group (too many transient infections) Every 3 years 25–65 year...