Discussion: Management of discordant colposcopic impression, histopathology and referral LBC prediction

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Unresolved issues

There is currently insufficient high-level evidence to guide the management of discrepancies between cytological findings and colposcopic impression in women who have positive oncogenic HPV test results, or who have pLSILPossible LSIL in the Australian Modified Bethesda System is broadly equivalent to ASCUS in US Bethesda system./LSILLow-grade squamous intraepithelial lesionThe low-grade squamous intraepithelial lesion (LSIL) category is the morphological correlate of productive viral infection. It is to be used when the scientist/pathologist observes changes that would have been described as ‘HPV effect’ or ‘CIN 1’ in the previous Australian terminology and represents part of the previous ‘low-grade squamous epithelial abnormality’ category. and Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal colposcopy. These consensus-based recommendations and practice points are considered conservative and offer a safe approach, but this may require review as future research results become available.

Future research priorities

To determine optimal management, evidence is needed from:

  • prospective audits of management strategies of large cohorts of women who have positive oncogenic HPV test results with discordant cytology and colposcopic findings
  • randomised controlled trials or longitudinal studies comparing management strategies for women with a positive oncogenic HPV test result, who have normal cytology or pLSILPossible LSIL in the Australian Modified Bethesda System is broadly equivalent to ASCUS in US Bethesda system./LSILLow-grade squamous intraepithelial lesionThe low-grade squamous intraepithelial lesion (LSIL) category is the morphological correlate of productive viral infection. It is to be used when the scientist/pathologist observes changes that would have been described as ‘HPV effect’ or ‘CIN 1’ in the previous Australian terminology and represents part of the previous ‘low-grade squamous epithelial abnormality’ category., and Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal colposcopy.

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