Summary of recommendations

From Cancer Guidelines Wiki


This guideline contains evidence-based recommendations (EBR), consensus-based recommendations (CBR) and practice points (PP) as defined in Table B.4 NHMRC approved recommendation types and definitions.

Table B.5. Key to types of recommendations in these guidelines outlines the types of recommendations appearing in these guidelines.

This is a summary of the recommendations in these guidelines, numbered according to chapter to which they relate. Please note that some chapters do not have associated recommendations.

Recommendations

4. Unsatisfactory cervical screening results

Practice pointQuestion mark transparent.png

REC4.1: Attempt adequate repeat preparations for an unsatisfactory LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. test
In the case of unsatisfactory LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory., laboratories should ensure that adequate repeat preparations are attempted, after dealing with potentially remediable technical problems.

  • Clinical_question:Cervical cancer/Screening/Unsatisfactory cervical screening results#Practice_point_1
  • REC4.1: Attempt adequate repeat preparations for an unsatisfactory LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. test
    In the case of unsatisfactory LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory., laboratories should ensure that adequate repeat preparations are attempted, after dealing with potentially remediable technical problems.
  • Good practice point
Practice pointQuestion mark transparent.png

REC4.2: Report cellular abnormality for LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. specimens with abnormal cells
Any LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. specimen with abnormal cells should not be reported as ‘Unsatisfactory’. The identified cellular abnormality should be reported.

  • Clinical_question:Cervical cancer/Screening/Unsatisfactory cervical screening results#Practice_point_2
  • REC4.2: Report cellular abnormality for LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. specimens with abnormal cells
    Any LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. specimen with abnormal cells should not be reported as ‘Unsatisfactory’. The identified cellular abnormality should be reported.
  • Good practice point
Practice pointQuestion mark transparent.png

REC4.3: Recall women in 6−12 weeks if they have an unsatisfactory screening report
A woman with an unsatisfactory screening report should have a repeat sample collected in 6–12 weeks. If the reason for the unsatisfactory sample has been identified then this problem should be corrected if possible before the repeat sample is collected.

  • Clinical_question:Cervical cancer/Screening/Unsatisfactory cervical screening results#Practice_point_3
  • REC4.3: Recall women in 6−12 weeks if they have an unsatisfactory screening report
    A woman with an unsatisfactory screening report should have a repeat sample collected in 6–12 weeks. If the reason for the unsatisfactory sample has been identified then this problem should be corrected if possible before the repeat sample is collected.
  • Good practice point

6. Management of HPV test results

Oncogenic HPV types not detected

MSACThe Australian Medical Services Advisory Committee evidence-based recommendationQuestion mark transparent.png

REC6.1: Oncogenic HPV typesOncogenic HPV are HPV types considered capable of causing cancer. Types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68 are included in tests suitable for cervical screening. Some tests also detect type 66. not detected at routine screening
Women who have a screening HPV test in which oncogenic HPV types are not detected should rescreen in 5 years.

  • Clinical_question:Oncogenic HPV typesOncogenic HPV are HPV types considered capable of causing cancer. Types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68 are included in tests suitable for cervical screening. Some tests also detect type 66. not detected#Practice_point_1
  • REC6.1: Oncogenic HPV typesOncogenic HPV are HPV types considered capable of causing cancer. Types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68 are included in tests suitable for cervical screening. Some tests also detect type 66. not detected at routine screening
    Women who have a screening HPV test in which oncogenic HPV types are not detected should rescreen in 5 years.
  • Recommendation msac

Back to top

Oncogenic HPV types 16 and/or 18

MSACThe Australian Medical Services Advisory Committee evidence-based recommendationQuestion mark transparent.png

REC6.2: Women with a positive HPV (16/18) test result
Women with a positive oncogenic HPV (16/18)Women with a positive HPV test result of HPV types 16 and/or 18 detected using routine HPV testing in a pathology laboratory. test result should be referred directly for colposcopic assessment, which will be informed by the result of reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory..

  • Clinical_question:Oncogenic HPV typesOncogenic HPV are HPV types considered capable of causing cancer. Types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68 are included in tests suitable for cervical screening. Some tests also detect type 66. 16 and or 18#Practice_point_1
  • REC6.2: Women with a positive HPV (16/18) test result

Women with a positive oncogenic HPV (16/18)Women with a positive HPV test result of HPV types 16 and/or 18 detected using routine HPV testing in a pathology laboratory. test result should be referred directly for colposcopic assessment, which will be informed by the result of reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory..

  • Recommendation msac
Consensus-based recommendation*Question mark transparent.png

REC6.3: Referral to gynaecological oncologist for LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of invasive disease
Women who have a positive oncogenic HPV (16/18)Women with a positive HPV test result of HPV types 16 and/or 18 detected using routine HPV testing in a pathology laboratory. test result with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report of invasive cancer (squamous, glandular or other) should be referred to a gynaecological oncologist or gynaecological cancer centre for urgent evaluation, ideally within 2 weeks.

  • Clinical_question:Oncogenic HPV typesOncogenic HPV are HPV types considered capable of causing cancer. Types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68 are included in tests suitable for cervical screening. Some tests also detect type 66. 16 and or 18#Practice_point_2
  • REC6.3: Referral to gynaecological oncologist for LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of invasive disease
    Women who have a positive oncogenic HPV (16/18)Women with a positive HPV test result of HPV types 16 and/or 18 detected using routine HPV testing in a pathology laboratory. test result with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report of invasive cancer (squamous, glandular or other) should be referred to a gynaecological oncologist or gynaecological cancer centre for urgent evaluation, ideally within 2 weeks.
  • Consensus based recommendation star
Practice pointQuestion mark transparent.png

REC6.4: Referral of women with a positive HPV (16/18) test result and unsatisfactory LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory.
When reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. is unsatisfactory, but the woman requires colposcopic referral regardless of the LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. result (i.e. when HPV 16/18Only HPV types 16 and or 18 detected using routine HPV screening tests in laboratory. is detected), then the screening episode should be classified as ‘Higher risk for cervical cancer or precursors’. A cervical sample for LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. should be collected at the time of colposcopy (see Chapter 4. Unsatisfactory cervical screening results).

  • Clinical_question:Oncogenic HPV typesOncogenic HPV are HPV types considered capable of causing cancer. Types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68 are included in tests suitable for cervical screening. Some tests also detect type 66. 16 and or 18#Practice_point_3
  • REC6.4: Referral of women with a positive HPV (16/18) test result and unsatisfactory LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory.

When reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. is unsatisfactory, but the woman requires colposcopic referral regardless of the LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. result (i.e. when HPV 16/18Only HPV types 16 and or 18 detected using routine HPV screening tests in laboratory. is detected), then the screening episode should be classified as ‘Higher risk for cervical cancer or precursors’. A cervical sample for LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. should be collected at the time of colposcopy (see Chapter 4. Unsatisfactory cervical screening results).

  • Good practice point
Practice pointQuestion mark transparent.png

REC6.5: Referral of women with a positive HPV (16/18) test result and reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).
Women with a positive oncogenic HPV (16/18)Women with a positive HPV test result of HPV types 16 and/or 18 detected using routine HPV testing in a pathology laboratory. test result and reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). should be referred for colposcopic assessment at the earliest opportunity, ideally within 8 weeks.

  • Clinical_question:Oncogenic HPV typesOncogenic HPV are HPV types considered capable of causing cancer. Types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68 are included in tests suitable for cervical screening. Some tests also detect type 66. 16 and or 18#Practice_point_4
  • REC6.5: Referral of women with a positive HPV (16/18) test result and reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).

Women with a positive oncogenic HPV (16/18)Women with a positive HPV test result of HPV types 16 and/or 18 detected using routine HPV testing in a pathology laboratory. test result and reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). should be referred for colposcopic assessment at the earliest opportunity, ideally within 8 weeks.

  • Good practice point

Back to top

Oncogenic HPV types not 16/18

Evidence-based recommendationQuestion mark transparent.png Grade
REC6.6: Positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory.Women with a positive HPV test result of other oncogenic HPV types not including types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result at routine screening

Women with a positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result, with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report of negative or prediction of 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., should have a repeat HPV test in 12 months.

C
  • Clinical_question:Oncogenic HPV typesOncogenic HPV are HPV types considered capable of causing cancer. Types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68 are included in tests suitable for cervical screening. Some tests also detect type 66. not 16/18#Recommendation_1
  • REC6.6: Positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory.Women with a positive HPV test result of other oncogenic HPV types not including types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result at routine screening

Women with a positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result, with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report of negative or prediction of 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., should have a repeat HPV test in 12 months.

  • Recommendation
Practice pointQuestion mark transparent.png

REC6.7: Referral of women with a positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result and LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system., HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). or any glandular abnormality
Women with a positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result, with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). or any glandular abnormality, should be referred for colposcopic assessment at the earliest opportunity, ideally within 8 weeks.

  • Clinical_question:Oncogenic HPV typesOncogenic HPV are HPV types considered capable of causing cancer. Types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68 are included in tests suitable for cervical screening. Some tests also detect type 66. not 16/18#Practice_point_1
  • REC6.7: Referral of women with a positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result and LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system., HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). or any glandular abnormality
    Women with a positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result, with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). or any glandular abnormality, should be referred for colposcopic assessment at the earliest opportunity, ideally within 8 weeks.
  • Good practice point
Consensus-based recommendation*Question mark transparent.png

REC6.8: Referral to gynaecological oncologist for LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of invasive disease
Women who have a positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report of invasive cancer (squamous, glandular or other) should be referred to a gynaecological oncologist or gynaecological cancer centre for urgent evaluation, ideally within 2 weeks.

  • Clinical_question:Oncogenic HPV typesOncogenic HPV are HPV types considered capable of causing cancer. Types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68 are included in tests suitable for cervical screening. Some tests also detect type 66. not 16/18#Practice_point_2
  • REC6.8: Referral to gynaecological oncologist for LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of invasive disease
    Women who have a positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report of invasive cancer (squamous, glandular or other) should be referred to a gynaecological oncologist or gynaecological cancer centre for urgent evaluation, ideally within 2 weeks.
  • Consensus based recommendation star
Evidence-based recommendationQuestion mark transparent.png Grade
REC6.9: Management after repeat HPV test at 12 months, following initial positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result
At repeat HPV testing 12 months after a positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result with reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. negative 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.:
  • if a woman has a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result, reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. will be performed and she should be referred for colposcopic assessment
  • if oncogenic HPV is not detected, the woman should be advised to return to routine 5-yearly screening.
C
  • Clinical_question:Oncogenic HPV typesOncogenic HPV are HPV types considered capable of causing cancer. Types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68 are included in tests suitable for cervical screening. Some tests also detect type 66. not 16/18#Recommendation_2
  • REC6.9: Management after repeat HPV test at 12 months, following initial positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result
    At repeat HPV testing 12 months after a positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result with reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. negative 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.:
  • if a woman has a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result, reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. will be performed and she should be referred for colposcopic assessment
  • if oncogenic HPV is not detected, the woman should be advised to return to routine 5-yearly screening.
  • Recommendation

Back to top

Self-collected vaginal samples

MSACThe Australian Medical Services Advisory Committee evidence-based recommendationQuestion mark transparent.png

REC6.10: Oncogenic HPV typesOncogenic HPV are HPV types considered capable of causing cancer. Types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68 are included in tests suitable for cervical screening. Some tests also detect type 66. not detected in self-collected sample
Women who have undergone HPV testing on a self-collected sample and in whom oncogenic HPV is not detected should be invited to re-screen with a HPV test in 5 years and should be advised to have a clinician-collected sample.

  • Clinical_question:Self-collected vaginal samples#Practice_point_1
  • REC6.10: Oncogenic HPV typesOncogenic HPV are HPV types considered capable of causing cancer. Types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68 are included in tests suitable for cervical screening. Some tests also detect type 66. not detected in self-collected sample
    Women who have undergone HPV testing on a self-collected sample and in whom oncogenic HPV is not detected should be invited to re-screen with a HPV test in 5 years and should be advised to have a clinician-collected sample.
  • Recommendation msac
MSACThe Australian Medical Services Advisory Committee evidence-based recommendationQuestion mark transparent.png

REC6.11: Referral of women with positive oncogenic HPV (16/18)Women with a positive HPV test result of HPV types 16 and/or 18 detected using routine HPV testing in a pathology laboratory. test result (self-collected sample)
Women who have undergone HPV testing on a self-collected sample and have a positive oncogenic HPV (16/18)Women with a positive HPV test result of HPV types 16 and/or 18 detected using routine HPV testing in a pathology laboratory. test result should be referred directly for colposcopic assessment. A cervical sample for LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. should be obtained at the time of colposcopy and is not required prior to referral.

  • Clinical_question:Self-collected vaginal samples#Practice_point_2
  • REC6.11: Referral of women with positive oncogenic HPV (16/18)Women with a positive HPV test result of HPV types 16 and/or 18 detected using routine HPV testing in a pathology laboratory. test result (self-collected sample)

Women who have undergone HPV testing on a self-collected sample and have a positive oncogenic HPV (16/18)Women with a positive HPV test result of HPV types 16 and/or 18 detected using routine HPV testing in a pathology laboratory. test result should be referred directly for colposcopic assessment. A cervical sample for LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. should be obtained at the time of colposcopy and is not required prior to referral.

  • Recommendation msac
Consensus-based recommendationQuestion mark transparent.png

REC6.12: Women with a positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result (self-collected sample)
Women who have undergone HPV testing on a self-collected sample and who have a positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result should be advised to visit their GP or healthcare professional to obtain a cervical sample for LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory.:

  • If the LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. test result is negative 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., HPV testing should be repeated in 12 months, preferably by a healthcare professional.
  • If the LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. test result is pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). or any glandular abnormality the woman should be referred for colposcopy at the earliest opportunity, ideally within 8 weeks.
  • Clinical_question:Self-collected vaginal samples#Practice_point_3
  • REC6.12: Women with a positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result (self-collected sample)
    Women who have undergone HPV testing on a self-collected sample and who have a positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result should be advised to visit their GP or healthcare professional to obtain a cervical sample for LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory.:
  • If the LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. test result is negative 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., HPV testing should be repeated in 12 months, preferably by a healthcare professional.
  • If the LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. test result is pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). or any glandular abnormality the woman should be referred for colposcopy at the earliest opportunity, ideally within 8 weeks.
  • Consensus based recommendation
Consensus-based recommendationQuestion mark transparent.png

REC6.13: Management of 12 month repeat HPV test result after initial positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result on a self-collected sample
At 12-month repeat HPV testing:

  • Women in whom oncogenic HPV is not detected should return to routine 5 yearly screening, and should be advised to have a clinician-collected sample at that time.
  • Women with a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result should be referred for colposcopic assessment:
  • If the repeat HPV test was clinician-collected, reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. will be available to inform colposcopic assessment.
  • If the repeat HPV test was self-collected, a cervical sample for LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. should be obtained at the time of colposcopy.
  • Clinical_question:Self-collected vaginal samples#Practice_point_4
  • REC6.13: Management of 12 month repeat HPV test result after initial positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result on a self-collected sample
    At 12-month repeat HPV testing:
  • Women in whom oncogenic HPV is not detected should return to routine 5 yearly screening, and should be advised to have a clinician-collected sample at that time.
  • Women with a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result should be referred for colposcopic assessment:
  • If the repeat HPV test was clinician-collected, reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. will be available to inform colposcopic assessment.
  • If the repeat HPV test was self-collected, a cervical sample for LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. should be obtained at the time of colposcopy.
  • Consensus based recommendation
Practice pointQuestion mark transparent.png

REC6.14: Clinician-collected sample for follow-up HPV test after initial self-collected sample
When follow-up HPV testing is required after an initial positive oncogenic HPV test result, the sample should be collected by a clinician, if possible.

Women should be advised that a clinician-collected sample is preferred because it is more effective and reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. can be performed on the same sample, which avoids a further visit to collect a cervical sample for LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory..

If the woman declines the clinician-collected sample, she can have a self-collected sample and is eligible for reimbursement under the Medical Benefits Schedule.

  • Clinical_question:Self-collected vaginal samples#Practice_point_5
  • REC6.14: Clinician-collected sample for follow-up HPV test after initial self-collected sample
    When follow-up HPV testing is required after an initial positive oncogenic HPV test result, the sample should be collected by a clinician, if possible.

Women should be advised that a clinician-collected sample is preferred because it is more effective and reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. can be performed on the same sample, which avoids a further visit to collect a cervical sample for LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory..

If the woman declines the clinician-collected sample, she can have a self-collected sample and is eligible for reimbursement under the Medical Benefits Schedule.

  • Good practice point
Practice pointQuestion mark transparent.png

REC6.15: Clinician-collected sample after invitation to re-screen
Women who are invited to have a clinician-collected sample, and decline, will not be eligible for self-collection at that time.

Not eligible for reimbursement under the Medical Benefits Schedule unless they meet the eligibility criteria for self-collection (aged > 30 years, at least 2 years overdue for cervical screening test, or never been screened) as per NCSPNational Cervical Screening ProgramA joint program of the Australian, state and territory governments. It aims to reduce morbidity and mortality from cervical cancer, in a cost-effective manner through an organised approach to cervical screening. The program encourages women in the target population to have regular Pap smears. policy.

  • Clinical_question:Self-collected vaginal samples#Practice_point_6
  • REC6.15: Clinician-collected sample after invitation to re-screen
    Women who are invited to have a clinician-collected sample, and decline, will not be eligible for self-collection at that time.

Not eligible for reimbursement under the Medical Benefits Schedule unless they meet the eligibility criteria for self-collection (aged > 30 years, at least 2 years overdue for cervical screening test, or never been screened) as per NCSPNational Cervical Screening ProgramA joint program of the Australian, state and territory governments. It aims to reduce morbidity and mortality from cervical cancer, in a cost-effective manner through an organised approach to cervical screening. The program encourages women in the target population to have regular Pap smears. policy.

  • Good practice point

Back to top

Women undergoing exit testing

MSACThe Australian Medical Services Advisory Committee evidence-based recommendationQuestion mark transparent.png

REC6.16: Women aged 70–74 years in whom oncogenic HPV is not detected (exit testing)
Women can be discharged from the NCSPNational Cervical Screening ProgramA joint program of the Australian, state and territory governments. It aims to reduce morbidity and mortality from cervical cancer, in a cost-effective manner through an organised approach to cervical screening. The program encourages women in the target population to have regular Pap smears. if they are aged 70–74 years and have a screening test at which oncogenic HPV is not detected.

  • Clinical_question:Women undergoing exit testing#Practice_point_1
  • REC6.16: Women aged 70–74 years in whom oncogenic HPV is not detected (exit testing)

Women can be discharged from the NCSPNational Cervical Screening ProgramA joint program of the Australian, state and territory governments. It aims to reduce morbidity and mortality from cervical cancer, in a cost-effective manner through an organised approach to cervical screening. The program encourages women in the target population to have regular Pap smears. if they are aged 70–74 years and have a screening test at which oncogenic HPV is not detected.

  • Recommendation msac
Consensus-based recommendationQuestion mark transparent.png

REC6.17: Referral of women aged 70–74 years with a positive oncogenic HPV test result (exit testing)
Women aged 70–74 who have a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result should be referred directly for colposcopic assessment, which should be informed by the result of reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory..

  • Clinical_question:Women undergoing exit testing#Practice_point_2
  • REC6.17: Referral of women aged 70–74 years with a positive oncogenic HPV test result (exit testing)

Women aged 70–74 who have a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result should be referred directly for colposcopic assessment, which should be informed by the result of reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory..

  • Consensus based recommendation

Back to top

Screening in women older than 75

NCSPNational Cervical Screening ProgramA joint program of the Australian, state and territory governments. It aims to reduce morbidity and mortality from cervical cancer, in a cost-effective manner through an organised approach to cervical screening. The program encourages women in the target population to have regular Pap smears. recommendationQuestion mark transparent.png

REC6.18: Women aged 75 years or older who request screening
Women who are 75 years or older who have never had a cervical screening test, or have not had one in the previous five years, may request a test and can be screened.

  • Clinical_question:Screening in women older than 75#Practice_point_1
  • REC6.18: Women aged 75 years or older who request screening
    Women who are 75 years or older who have never had a cervical screening test, or have not had one in the previous five years, may request a test and can be screened.
  • NCSPNational Cervical Screening ProgramA joint program of the Australian, state and territory governments. It aims to reduce morbidity and mortality from cervical cancer, in a cost-effective manner through an organised approach to cervical screening. The program encourages women in the target population to have regular Pap smears. recommendation

Back to top

7. ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities.

Colposcopy terminology

Practice pointQuestion mark transparent.png

REC7.1:New colposcopy terminology
The new terminology adopted by the IFCPCThe International Federation of Cervical Pathology and Colposcopy in 2011 should be incorporated into Australian practice.

  • Clinical_question:ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. terminology#Practice_point_1
  • REC7.1:New colposcopy terminology
    The new terminology adopted by the IFCPCThe International Federation of Cervical Pathology and Colposcopy in 2011 should be incorporated into Australian practice.
  • Good practice point

Back to top

History, examination and investigation

Practice pointQuestion mark transparent.png

REC7.2: ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. and acetic acid
Acetic acid should be applied for 2 minutes to allow sufficient time for aceto-white changes to become apparent. This is especially important when the lesion is low grade as it may take more time to become visible.

  • Clinical_question:History, examination and investigation#Practice_point_1
  • REC7.2: ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. and acetic acid
    Acetic acid should be applied for 2 minutes to allow sufficient time for aceto-white changes to become apparent. This is especially important when the lesion is low grade as it may take more time to become visible.
  • Good practice point
Practice pointQuestion mark transparent.png

REC7.3: ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. and VAINVaginal intra-epithelial neoplasia
When the LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report predicts a squamous abnormality and there is no colposcopically visible cervical lesion, careful colposcopic examination of the vagina should be performed to exclude VAINVaginal intra-epithelial neoplasia, using acetic acid and Lugol’s Iodine.

  • Clinical_question:History, examination and investigation#Practice_point_2
  • REC7.3: ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. and VAINVaginal intra-epithelial neoplasia
    When the LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report predicts a squamous abnormality and there is no colposcopically visible cervical lesion, careful colposcopic examination of the vagina should be performed to exclude VAINVaginal intra-epithelial neoplasia, using acetic acid and Lugol’s Iodine.
  • Good practice point
Practice pointQuestion mark transparent.png

REC7.4: Repeat LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. usually not necessary at time of colposcopy
It is not necessary to take a cervical sample for LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. at the time of colposcopy except in the following circumstances:

  • delay in attending for colposcopy > 3 months after referral LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory.
  • referral LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. is unsatisfactory
  • referral LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. is negative but lacks an endocervical component
  • prior LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. is not available because the HPV test was performed on a self-collected sample
  • the woman has developed symptoms suggestive of cervical cancer since undergoing her screening test.
  • Clinical_question:History, examination and investigation#Practice_point_3
  • REC7.4: Repeat LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. usually not necessary at time of colposcopy
    It is not necessary to take a cervical sample for LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. at the time of colposcopy except in the following circumstances:
  • delay in attending for colposcopy > 3 months after referral LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory.
  • referral LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. is unsatisfactory
  • referral LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. is negative but lacks an endocervical component
  • prior LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. is not available because the HPV test was performed on a self-collected sample
  • the woman has developed symptoms suggestive of cervical cancer since undergoing her screening test.
  • Good practice point
Consensus-based recommendation*Question mark transparent.png

REC7.5: BiopsyRemoval of tissue for medical examination. of high grade lesions
The cervix should be biopsied when the LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction is pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system. or HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). and the colposcopic appearance shows major change (see IFCPCThe International Federation of Cervical Pathology and Colposcopy definition above) and the abnormal TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. is visible (Type 1 or Type 2 TZType 2 TZ: the upper limit of the TZ is partly or wholly visible in the canal and is completely visible around 360 degrees).

  • Clinical_question:History, examination and investigation#Practice_point_4
  • REC7.5: BiopsyRemoval of tissue for medical examination. of high grade lesions
    The cervix should be biopsied when the LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction is pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system. or HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). and the colposcopic appearance shows major change (see IFCPCThe International Federation of Cervical Pathology and Colposcopy definition above) and the abnormal TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. is visible (Type 1 or Type 2 TZType 2 TZ: the upper limit of the TZ is partly or wholly visible in the canal and is completely visible around 360 degrees).
  • Consensus based recommendation star
Practice pointQuestion mark transparent.png

REC7.6: BiopsyRemoval of tissue for medical examination. visible lesion if suspicious for invasion when T3 TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. colposcopy
In some situations, when there is a visible high-grade lesion on the ectocervix but there is a T3 TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. (lesion extends into canal out of visual range), it may be reasonable to take a cervical biopsy of the visible lesion if there is any suspicion of superficially invasive or invasive carcinoma.

  • Clinical_question:History, examination and investigation#Practice_point_5
  • REC7.6: BiopsyRemoval of tissue for medical examination. visible lesion if suspicious for invasion when T3 TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. colposcopy
    In some situations, when there is a visible high-grade lesion on the ectocervix but there is a T3 TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. (lesion extends into canal out of visual range), it may be reasonable to take a cervical biopsy of the visible lesion if there is any suspicion of superficially invasive or invasive carcinoma.
  • Good practice point
Practice pointQuestion mark transparent.png

REC7.7: BiopsyRemoval of tissue for medical examination. of low-grade lesions is encouraged but not always necessary
Women with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of pLSILPossible LSIL in the Australian Modified Bethesda System is broadly equivalent to ASCUS in US Bethesda system. or 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 a colposcopic impression of low-grade disease or less may not always require a biopsy. However, biopsy is accepted practice for confirmation of the colposcopic impression and exclusion of high-grade disease, and should be encouraged, especially for less experienced colposcopists.

  • Clinical_question:History, examination and investigation#Practice_point_6
  • REC7.7: BiopsyRemoval of tissue for medical examination. of low-grade lesions is encouraged but not always necessary
    Women with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of pLSILPossible LSIL in the Australian Modified Bethesda System is broadly equivalent to ASCUS in US Bethesda system. or 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 a colposcopic impression of low-grade disease or less may not always require a biopsy. However, biopsy is accepted practice for confirmation of the colposcopic impression and exclusion of high-grade disease, and should be encouraged, especially for less experienced colposcopists.
  • Good practice point
Practice pointQuestion mark transparent.png

REC7.8: Upper genital tract imaging
Upper genital tract imaging should be considered in cases where no lower genital tract abnormality is detected at colposcopy after referral with abnormal glandular cytology (including atypical glandular cells or endocervical cells of undetermined significance). In some women, further investigation, such as endometrial sampling to exclude an endometrial origin for atypical glandular cells, may be required.

  • Clinical_question:History, examination and investigation#Practice_point_7
  • REC7.8: Upper genital tract imaging
    Upper genital tract imaging should be considered in cases where no lower genital tract abnormality is detected at colposcopy after referral with abnormal glandular cytology (including atypical glandular cells or endocervical cells of undetermined significance). In some women, further investigation, such as endometrial sampling to exclude an endometrial origin for atypical glandular cells, may be required.
  • Good practice point

Back to top

Treatment

Consensus-based recommendation*Question mark transparent.png

REC7.9: ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. prior to treatment
All women should have an adequate colposcopic assessment prior to treatment.

adequate: the cervix is clearly seen (IFCPC 2011 terminology)

  • Clinical_question:ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. and treatment#Practice_point_1
  • REC7.9: ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. prior to treatment
    All women should have an adequate colposcopic assessment prior to treatment.

adequate: the cervix is clearly seen (IFCPC 2011 terminology)

  • Consensus based recommendation star
Consensus-based recommendation*Question mark transparent.png

REC7.10: Histopathological confirmation prior to treatment
Treatment should be reserved for women with histologically confirmed HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2/3) or AISAdenocarcinoma in situ, except for women requiring diagnostic excisional biopsy.

  • Clinical_question:ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. and treatment#Practice_point_2
  • REC7.10: Histopathological confirmation prior to treatment
    Treatment should be reserved for women with histologically confirmed HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2/3) or AISAdenocarcinoma in situ, except for women requiring diagnostic excisional biopsy.
  • Consensus based recommendation star
Consensus-based recommendation*Question mark transparent.png

REC7.11: BiopsyRemoval of tissue for medical examination. prior to ablative treatment
Women should have a cervical biopsy prior to any ablative treatment.

  • Clinical_question:ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. and treatment#Practice_point_3
  • REC7.11: BiopsyRemoval of tissue for medical examination. prior to ablative treatment
    Women should have a cervical biopsy prior to any ablative treatment.
  • Consensus based recommendation star
Consensus-based recommendationQuestion mark transparent.png

REC7.12: Pathology review of discordant test results
For women who have had a colposcopy with significant discordance between the histopathology and the referral cytology, both specimens should be reviewed by a pathologist from at least one of the reporting laboratories who should then convey the results of the review to the colposcopist in order to inform the management plan.

  • Clinical_question:ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. and treatment#Practice_point_4
  • REC7.12: Pathology review of discordant test results
    For women who have had a colposcopy with significant discordance between the histopathology and the referral cytology, both specimens should be reviewed by a pathologist from at least one of the reporting laboratories who should then convey the results of the review to the colposcopist in order to inform the management plan.
  • Consensus based recommendation
Practice pointQuestion mark transparent.png

REC7.13: Tertiary referral may be necessary
In some clinical situations, the woman should be referred to a more experienced colposcopist, a gynaecological oncologist, tertiary colposcopy clinic or gynaecological cancer centre:

  • adenocarcinoma in situ
  • abnormalities in pregnancy
  • immune-deficient women
  • women with multifocal lower genital tract disease.
  • Clinical_question:ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. and treatment#Practice_point_5
  • REC7.13: Tertiary referral may be necessary
    In some clinical situations, the woman should be referred to a more experienced colposcopist, a gynaecological oncologist, tertiary colposcopy clinic or gynaecological cancer centre:
  • adenocarcinoma in situ
  • abnormalities in pregnancy
  • immune-deficient women
  • women with multifocal lower genital tract disease.
  • Good practice point
Practice pointQuestion mark transparent.png

REC7.14: Second opinion
When there is any concern about diagnosis or patient management, a second opinion should be sought and documented.

  • Clinical_question:ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. and treatment#Practice_point_6
  • REC7.14: Second opinion
    When there is any concern about diagnosis or patient management, a second opinion should be sought and documented.
  • Good practice point
Practice pointQuestion mark transparent.png

REC7.15: The role of multidisciplinary team review
It is not always practical for a colposcopist to access a multidisciplinary team review which is usually conducted in a tertiary referral centre. However, a multidisciplinary team review is particularly helpful when:

  • dealing with complex cases where there is discordance between histopathology and referral cytology (e.g. LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology)., with negative or 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. histology).
  • implementation of treatment is not urgent and therefore it is possible to take the required time to review the findings and optimise the management plan.
  • Clinical_question:ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. and treatment#Practice_point_7
  • REC7.15: The role of multidisciplinary team review
    It is not always practical for a colposcopist to access a multidisciplinary team review which is usually conducted in a tertiary referral centre. However, a multidisciplinary team review is particularly helpful when:
  • dealing with complex cases where there is discordance between histopathology and referral cytology (e.g. LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology)., with negative or 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. histology).
  • implementation of treatment is not urgent and therefore it is possible to take the required time to review the findings and optimise the management plan.
  • Good practice point
Practice pointQuestion mark transparent.png

REC7.16: ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. at time of treatment
All treatments should be performed under colposcopic vision, with the exception of cold-knife cone biopsy.

  • Clinical_question:ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. and treatment#Practice_point_8
  • REC7.16: ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. at time of treatment
    All treatments should be performed under colposcopic vision, with the exception of cold-knife cone biopsy.
  • Good practice point
Consensus-based recommendation*Question mark transparent.png

REC7.17: Criteria for ablative treatment
Ablative therapy should be reserved for women intending to have children, and when the following conditions have all been met:

  • TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. is completely visible (Type 1 or Type 2).
  • There is no evidence of invasive or glandular disease.
  • A biopsy has been performed prior to treatment.
  • HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2/3) has been histologically confirmed.
  • There is no significant discordance between the histopathology and referral cytology results.
  • Clinical_question:ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. and treatment#Practice_point_9
  • REC7.17: Criteria for ablative treatment
    Ablative therapy should be reserved for women intending to have children, and when the following conditions have all been met:
  • TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. is completely visible (Type 1 or Type 2).
  • There is no evidence of invasive or glandular disease.
  • A biopsy has been performed prior to treatment.
  • HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2/3) has been histologically confirmed.
  • There is no significant discordance between the histopathology and referral cytology results.
  • Consensus based recommendation star
Practice pointQuestion mark transparent.png

REC7.18: Depth of ablation
A Type 1 TZType 1 TZ: the whole TZ including all the upper limit is ectocervical with a HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2/3) lesion requires 6–8 mm (and not more than 10 mm) of cervical ablation to be adequately treated.

  • Clinical_question:ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. and treatment#Practice_point_10
  • REC7.18: Depth of ablation
    A Type 1 TZType 1 TZ: the whole TZ including all the upper limit is ectocervical with a HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2/3) lesion requires 6–8 mm (and not more than 10 mm) of cervical ablation to be adequately treated.
  • Good practice point
Consensus-based recommendation*Question mark transparent.png

REC7.19: Excision specimen quality and pathology
Excisional therapy should aim to remove the entire TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. with a pre-determined length of cervical tissue, ideally in one piece, with minimal distortion or artefact to the final histological specimen.

This is critical for management of suspected or histologically confirmed AISAdenocarcinoma in situ.

  • Clinical_question:ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. and treatment#Practice_point_11
  • REC7.19: Excision specimen quality and pathology
    Excisional therapy should aim to remove the entire TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. with a pre-determined length of cervical tissue, ideally in one piece, with minimal distortion or artefact to the final histological specimen.

    This is critical for management of suspected or histologically confirmed AISAdenocarcinoma in situ.
  • Consensus based recommendation star
Practice pointQuestion mark transparent.png

REC7.20: Excision specimen quality, pathology and very large ectocervical lesion
A very large ectocervical lesion may require removal in two pieces in order to remove the entire lesion. It is still important that the endocervical and stromal margins are suitable for pathological interpretation and that the specimens are accurately oriented and labelled.

  • Clinical_question:ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. and treatment#Practice_point_12
  • REC7.20: Excision specimen quality, pathology and very large ectocervical lesion
    A very large ectocervical lesion may require removal in two pieces in order to remove the entire lesion. It is still important that the endocervical and stromal margins are suitable for pathological interpretation and that the specimens are accurately oriented and labelled.
  • Good practice point
Practice pointQuestion mark transparent.png

REC7.21: Excisional techniques and surgical competency
Therapeutic colposcopists should use the excisional techniques with which they are comfortable and competent and that produce the best histological specimen.

  • Clinical_question:ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. and treatment#Practice_point_13
  • REC7.21: Excisional techniques and surgical competency
    Therapeutic colposcopists should use the excisional techniques with which they are comfortable and competent and that produce the best histological specimen.
  • Good practice point
Practice pointQuestion mark transparent.png

REC7.22: Cold-knife cone biopsy: setting
Cold-knife cone biopsy should be performed in an operating theatre, under general anaesthesia, by a gynaecological oncologist or gynaecologist competent in the technique.

  • Clinical_question:ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. and treatment#Practice_point_14
  • REC7.22: Cold-knife cone biopsy: setting
    Cold-knife cone biopsy should be performed in an operating theatre, under general anaesthesia, by a gynaecological oncologist or gynaecologist competent in the technique.
  • Good practice point
Practice pointQuestion mark transparent.png

REC7.23: Loop excisional biopsy technique (LEEPLoop electrical excision procedureLoop electrical excision procedure/LLETZLarge loop excision of the transformation zone)
A single pass of the loop (side to side or posterior to anterior) to produce a specimen in one piece is optimal.

  • Clinical_question:ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. and treatment#Practice_point_15
  • REC7.23: Loop excisional biopsy technique (LEEPLoop electrical excision procedureLoop electrical excision procedure/LLETZLarge loop excision of the transformation zone)
    A single pass of the loop (side to side or posterior to anterior) to produce a specimen in one piece is optimal.
  • Good practice point
Practice pointQuestion mark transparent.png

REC7.24: Loop ‘top-hat’ excisions should be avoided (LEEPLoop electrical excision procedureLoop electrical excision procedure/LLETZLarge loop excision of the transformation zone)
The ‘top-hat’ excision techniques using a wire loop, in which a second piece of endocervical tissue is removed after the first excision, is not an alternative to a properly performed single-piece Type 3 excisionType 3 excision (for Type 3 TZ) Equivalent to ‘cone biopsy’ and >15mm length, and should be avoided.

  • Clinical_question:ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. and treatment#Practice_point_16
  • REC7.24: Loop ‘top-hat’ excisions should be avoided (LEEPLoop electrical excision procedureLoop electrical excision procedure/LLETZLarge loop excision of the transformation zone)
    The ‘top-hat’ excision techniques using a wire loop, in which a second piece of endocervical tissue is removed after the first excision, is not an alternative to a properly performed single-piece Type 3 excisionType 3 excision (for Type 3 TZ) Equivalent to ‘cone biopsy’ and >15mm length, and should be avoided.
  • Good practice point
Practice pointQuestion mark transparent.png

REC7.25: Cold-knife cone biopsy and AISAdenocarcinoma in situ
Predicted or histologically confirmed AISAdenocarcinoma in situ should be treated by a Type 3 excisionType 3 excision (for Type 3 TZ) Equivalent to ‘cone biopsy’ and >15mm length (usually a cold-knife cone biopsy) performed in an operating theatre, under general anaesthesia, by a gynaecological oncologist or gynaecologist competent in the technique.

  • Clinical_question:ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. and treatment#Practice_point_17
  • REC7.25: Cold-knife cone biopsy and AISAdenocarcinoma in situ
    Predicted or histologically confirmed AISAdenocarcinoma in situ should be treated by a Type 3 excisionType 3 excision (for Type 3 TZ) Equivalent to ‘cone biopsy’ and >15mm length (usually a cold-knife cone biopsy) performed in an operating theatre, under general anaesthesia, by a gynaecological oncologist or gynaecologist competent in the technique.
  • Good practice point
Practice pointQuestion mark transparent.png

REC7.26: Role of repeat excision in management of SISCCASuperficially invasive squamous cell carcinoma (previously termed 'Micro-invasive carcinoma')
In the presence of a superficially invasive squamous carcinoma, if HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2/3) extends to any excision margin, a repeat excision (usually by cold-knife cone biopsy) is recommended.

  • Clinical_question:ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. and treatment#Practice_point_18
  • REC7.26: Role of repeat excision in management of SISCCASuperficially invasive squamous cell carcinoma (previously termed 'Micro-invasive carcinoma')
    In the presence of a superficially invasive squamous carcinoma, if HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2/3) extends to any excision margin, a repeat excision (usually by cold-knife cone biopsy) is recommended.
  • Good practice point
Practice pointQuestion mark transparent.png

REC7.27: Do not treat at first visit with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report of a low-grade lesion
Women who have a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of 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. should not be treated at the first visit.

  • Clinical_question:ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. and treatment#Practice_point_19
  • REC7.27: Do not treat at first visit with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report of a low-grade lesion
    Women who have a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of 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. should not be treated at the first visit.
  • Good practice point
Practice pointQuestion mark transparent.png

REC7.28: Excision required for recurrent disease after ablation
If there is recurrence of high-grade disease after previous ablation, treatment should be by excision.

  • Clinical_question:ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. and treatment#Practice_point_20
  • REC7.28: Excision required for recurrent disease after ablation
    If there is recurrence of high-grade disease after previous ablation, treatment should be by excision.
  • Good practice point
Practice pointQuestion mark transparent.png

REC7.29: Repeat excision not necessarily required for incomplete excision of high-grade lesions
Women who have incomplete excision of HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2/3) with positive endocervical or stromal margins do not necessarily require immediate repeat excision and could be offered test of cure (HPV and LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory.) surveillance, with the exception of:

  • women aged 50 years or over
  • women who may not be compliant with recommended follow-up
  • women in whom subsequent adequate colposcopy and follow-up cytology cannot be guaranteed.
  • Clinical_question:ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. and treatment#Practice_point_21
  • REC7.29: Repeat excision not necessarily required for incomplete excision of high-grade lesions
    Women who have incomplete excision of HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2/3) with positive endocervical or stromal margins do not necessarily require immediate repeat excision and could be offered test of cure (HPV and LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory.) surveillance, with the exception of:
  • women aged 50 years or over
  • women who may not be compliant with recommended follow-up
  • women in whom subsequent adequate colposcopy and follow-up cytology cannot be guaranteed.
  • Good practice point

Back to top

8. Management of discordant colposcopic impression, histopathology and referral LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction

Normal colposcopic findings following LBC prediction of LSIL or HSIL

Consensus-based recommendationQuestion mark transparent.png

REC8.1: Normal colposcopy following LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of negative 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.
For women with a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result, a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report of negative 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 normal colposcopy, the HPV test should be repeated in 12 months:

  • If HPV is not detected at 12 months, the woman should return to routine 5-yearly HPV screening.
  • If the woman has a positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result at 12 months and a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report of negative 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., the HPV test should be repeated in another 12 months.
  • If the woman has a positive oncogenic HPV ( any type) test at the 24 month HPV test, she should be referred directly for colposcopic assessment, which will be informed by the result of the reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory..
  • If the woman has a positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result at 12 months and a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). or any glandular abnormality, she should be referred for colposcopic assessment at the earliest opportunity, ideally within 8 weeks.
  • If the woman has a positive oncogenic HPV (16/18)Women with a positive HPV test result of HPV types 16 and/or 18 detected using routine HPV testing in a pathology laboratory. test result at 12 months, she should be referred directly for colposcopic assessment at the earliest opportunity, ideally within 8 weeks, and the reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. result will inform the colposcopy.
  • Clinical_question:Normal colposcopic findings following LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of 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. or HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).#Practice_point_1
  • REC8.1: Normal colposcopy following LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of negative 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.
    For women with a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result, a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report of negative 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 normal colposcopy, the HPV test should be repeated in 12 months:
  • If HPV is not detected at 12 months, the woman should return to routine 5-yearly HPV screening.
  • If the woman has a positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result at 12 months and a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report of negative 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., the HPV test should be repeated in another 12 months.
  • If the woman has a positive oncogenic HPV ( any type) test at the 24 month HPV test, she should be referred directly for colposcopic assessment, which will be informed by the result of the reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory..
  • If the woman has a positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result at 12 months and a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). or any glandular abnormality, she should be referred for colposcopic assessment at the earliest opportunity, ideally within 8 weeks.
  • If the woman has a positive oncogenic HPV (16/18)Women with a positive HPV test result of HPV types 16 and/or 18 detected using routine HPV testing in a pathology laboratory. test result at 12 months, she should be referred directly for colposcopic assessment at the earliest opportunity, ideally within 8 weeks, and the reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. result will inform the colposcopy.
  • Consensus based recommendation
Practice pointQuestion mark transparent.png

REC8.2: Normal colposcopy following LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).: cytopathology review
Cytopathology review is recommended to confirm HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). before proceeding to excisional treatment for women with a normal colposcopy after a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result and an initial LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology)..

  • Clinical_question:Normal colposcopic findings following LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of 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. or HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).#Practice_point_2
  • REC8.2: Normal colposcopy following LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).: cytopathology review
    Cytopathology review is recommended to confirm HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). before proceeding to excisional treatment for women with a normal colposcopy after a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result and an initial LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology)..
  • Good practice point
Practice pointQuestion mark transparent.png

REC8.3: Normal colposcopy following LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).: exclude VAINVaginal intra-epithelial neoplasia
When colposcopic impression is discordant with a referral LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology)., colposcopic examination of the vagina is indicated to exclude a vaginal intraepithelial neoplasia before diagnostic excisional treatment.

  • Clinical_question:Normal colposcopic findings following LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of 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. or HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).#Practice_point_3
  • REC8.3: Normal colposcopy following LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).: exclude VAINVaginal intra-epithelial neoplasia
    When colposcopic impression is discordant with a referral LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology)., colposcopic examination of the vagina is indicated to exclude a vaginal intraepithelial neoplasia before diagnostic excisional treatment.
  • Good practice point
Consensus-based recommendationQuestion mark transparent.png

REC8.4: Normal colposcopy following LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).: diagnostic excision of TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone.
For women who have a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result, normal colposcopy, and a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). on cytopathology review, diagnostic excision of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. should be performed.

  • Clinical_question:Normal colposcopic findings following LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of 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. or HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).#Practice_point_4
  • REC8.4: Normal colposcopy following LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).: diagnostic excision of TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone.
    For women who have a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result, normal colposcopy, and a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). on cytopathology review, diagnostic excision of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. should be performed.
  • Consensus based recommendation
Consensus-based recommendationQuestion mark transparent.png

REC8.5: Normal colposcopy following LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system.: consider diagnostic excision of TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone.
For women who have a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result, normal colposcopy, and a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system. on cytopathology review, diagnostic excision of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. should be considered, though observation is an option.

  • Clinical_question:Normal colposcopic findings following LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of 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. or HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).#Practice_point_5
  • REC8.5: Normal colposcopy following LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system.: consider diagnostic excision of TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone.
    For women who have a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result, normal colposcopy, and a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system. on cytopathology review, diagnostic excision of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. should be considered, though observation is an option.
  • Consensus based recommendation
Practice pointQuestion mark transparent.png

REC8.6: Normal colposcopy following LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system.: diagnostic excision or observation
Some women with a positive oncogenic HPV test result for whom diagnostic excision of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. is recommended due to a confirmed LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system. on cytopathology review, despite normal colposcopic findings, may be concerned about the possibility of having unnecessary treatment. The colposcopist may have similar concerns.
Women who opt to defer treatment, particularly younger women with concerns about fertility, can be offered observation:

  • A HPV test and colposcopy should be repeated at 6 months, and a diagnostic excisional procedure should be reconsidered based on the test results (HPV and reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory., if performed) obtained at that time.
  • If oncogenic HPV is not detected, and the colposcopic impression is unchanged, the HPV test should be repeated in 12 months and if oncogenic HPV is not detected, the woman can return to routine 5-yearly screening.
  • Clinical_question:Normal colposcopic findings following LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of 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. or HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).#Practice_point_6
  • REC8.6: Normal colposcopy following LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system.: diagnostic excision or observation

Some women with a positive oncogenic HPV test result for whom diagnostic excision of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. is recommended due to a confirmed LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system. on cytopathology review, despite normal colposcopic findings, may be concerned about the possibility of having unnecessary treatment. The colposcopist may have similar concerns.
Women who opt to defer treatment, particularly younger women with concerns about fertility, can be offered observation:

  • A HPV test and colposcopy should be repeated at 6 months, and a diagnostic excisional procedure should be reconsidered based on the test results (HPV and reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory., if performed) obtained at that time.
  • If oncogenic HPV is not detected, and the colposcopic impression is unchanged, the HPV test should be repeated in 12 months and if oncogenic HPV is not detected, the woman can return to routine 5-yearly screening.
  • Good practice point
Consensus-based recommendationQuestion mark transparent.png

REC8.7: Downgrading of discordant results
For women who have a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result, normal colposcopy, and a subsequent LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report of 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. or less on cytopathology review, management should be according to the reviewed cytological report (i.e. repeat HPV test in 12 months).

  • Clinical_question:Normal colposcopic findings following LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of 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. or HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).#Practice_point_7
  • REC8.7: Downgrading of discordant results
    For women who have a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result, normal colposcopy, and a subsequent LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report of 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. or less on cytopathology review, management should be according to the reviewed cytological report (i.e. repeat HPV test in 12 months).
  • Consensus based recommendation
Practice pointQuestion mark transparent.png

REC8.8: Colposcopist should manage discordant results
Women with discordant colposcopy and LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. results should have their management supervised by the colposcopist until both the colposcopist and the woman are satisfied with the proposed management plan.

  • Clinical_question:Normal colposcopic findings following LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of 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. or HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).#Practice_point_8
  • REC8.8: Colposcopist should manage discordant results
    Women with discordant colposcopy and LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. results should have their management supervised by the colposcopist until both the colposcopist and the woman are satisfied with the proposed management plan.
  • Good practice point

Back to top

Type 3 TZ (previously termed ‘unsatisfactory’) colposcopy following LBC prediction of LSIL or HSIL

Consensus-based recommendationQuestion mark transparent.png

REC8.9: Repeat HPV test after Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal colposcopy and referral LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. negative 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.
For women who have a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report of negative 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 colposcopy is reported as Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal, the HPV test should be repeated in 12 months:

  • If oncogenic HPV is not detected at 12 months, the HPV test should be repeated 12 months later.
  • If oncogenic HPV is not detected again at the second repeat HPV test, the woman should be advised to return to routine 5-yearly screening.
  • If the woman has a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result at 12 months, she should be referred directly for colposcopic assessment, with the LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report available to inform the assessment.


Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal indicates failure to visualise the upper limit of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone., or the entire TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. is within the endocervical canal. It corresponds to ‘unsatisfactory’ in previous terminology.

  • Clinical_question:Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal (unsatisfactory) colposcopy following LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of 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. or HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).#Practice_point_1
  • REC8.9: Repeat HPV test after Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal colposcopy and referral LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. negative 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.
    For women who have a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report of negative 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 colposcopy is reported as Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal, the HPV test should be repeated in 12 months:
  • If oncogenic HPV is not detected at 12 months, the HPV test should be repeated 12 months later.
  • If oncogenic HPV is not detected again at the second repeat HPV test, the woman should be advised to return to routine 5-yearly screening.
  • If the woman has a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result at 12 months, she should be referred directly for colposcopic assessment, with the LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report available to inform the assessment.


Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal indicates failure to visualise the upper limit of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone., or the entire TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. is within the endocervical canal. It corresponds to ‘unsatisfactory’ in previous terminology.

  • Consensus based recommendation
Practice pointQuestion mark transparent.png

REC8.10: Cytopathology review prior to observation for 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 at colposcopy
When observation is advised, cytopathology review is recommended to confirm the low-grade cytological abnormality.

  • If 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. is confirmed, observation is appropriate.
  • If pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). is indicated, then diagnostic excision of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. should be considered.
  • Clinical_question:Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal (unsatisfactory) colposcopy following LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of 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. or HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).#Practice_point_2
  • REC8.10: Cytopathology review prior to observation for 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 at colposcopy
    When observation is advised, cytopathology review is recommended to confirm the low-grade cytological abnormality.
  • If 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. is confirmed, observation is appropriate.
  • If pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). is indicated, then diagnostic excision of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. should be considered.
  • Good practice point
Practice pointQuestion mark transparent.png

REC8.11: Role of ECCEndocervical curettageThe removal of tissue from the endocervical canal of the cervix.The removal of tissue from the endocervical canal of the cervix in Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal colposcopy following LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of 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.
Despite a lack of evidence, endocervical curettage can be considered for women who have a positive oncogenic HPV test result (any type) with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report of persistent 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 colposcopy reported as Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal. A negative ECCEndocervical curettageThe removal of tissue from the endocervical canal of the cervix.The removal of tissue from the endocervical canal of the cervix may provide additional reassurance for a conservative (observational) approach.

Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal indicates failure to visualise the upper limit of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone., or the entire TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. is within the endocervical canal. It corresponds to ‘unsatisfactory’ in previous terminology.

  • Clinical_question:Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal (unsatisfactory) colposcopy following LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of 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. or HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).#Practice_point_3
  • REC8.11: Role of ECCEndocervical curettageThe removal of tissue from the endocervical canal of the cervix.The removal of tissue from the endocervical canal of the cervix in Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal colposcopy following LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of 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.
    Despite a lack of evidence, endocervical curettage can be considered for women who have a positive oncogenic HPV test result (any type) with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report of persistent 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 colposcopy reported as Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal. A negative ECCEndocervical curettageThe removal of tissue from the endocervical canal of the cervix.The removal of tissue from the endocervical canal of the cervix may provide additional reassurance for a conservative (observational) approach.



Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal indicates failure to visualise the upper limit of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone., or the entire TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. is within the endocervical canal. It corresponds to ‘unsatisfactory’ in previous terminology.

  • Good practice point
Consensus-based recommendationQuestion mark transparent.png

REC8.12: Diagnostic excision of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. should not be performed if there is no cytological or histological evidence of a high-grade lesion after Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal colposcopy
For asymptomatic women who have a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result, Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal colposcopy, and no cytological, colposcopic or histological evidence of a high-grade lesion, further diagnostic procedures (such as diagnostic excision of the transformation zone) should not routinely be performed.

Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal indicates failure to visualise the upper limit of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone., or the entire TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. is within the endocervical canal. It corresponds to ‘unsatisfactory’ in previous terminology.

  • Clinical_question:Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal (unsatisfactory) colposcopy following LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of 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. or HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).#Practice_point_4
  • REC8.12: Diagnostic excision of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. should not be performed if there is no cytological or histological evidence of a high-grade lesion after Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal colposcopy
    For asymptomatic women who have a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result, Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal colposcopy, and no cytological, colposcopic or histological evidence of a high-grade lesion, further diagnostic procedures (such as diagnostic excision of the transformation zone) should not routinely be performed.



Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal indicates failure to visualise the upper limit of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone., or the entire TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. is within the endocervical canal. It corresponds to ‘unsatisfactory’ in previous terminology.

  • Consensus based recommendation
Practice pointQuestion mark transparent.png

REC8.13: Role of diagnostic excision: exceptions to recommendation against diagnostic excision of TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. in the absence of high-grade cytology or histology
Diagnostic excision of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. can be offered to certain groups of women who have a positive oncogenic HPV test result, a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report of negative 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 colposcopy reported as Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal:

  • women who have completed childbearing
  • women who are anxious about cancer risk
  • women aged over 50 years
  • women who may not be compliant with recommended surveillance.


Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal indicates failure to visualise the upper limit of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone., or the entire TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. is within the endocervical canal. It corresponds to ‘unsatisfactory’ in previous terminology.

  • Clinical_question:Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal (unsatisfactory) colposcopy following LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of 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. or HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).#Practice_point_5
  • REC8.13: Role of diagnostic excision: exceptions to recommendation against diagnostic excision of TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. in the absence of high-grade cytology or histology
    Diagnostic excision of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. can be offered to certain groups of women who have a positive oncogenic HPV test result, a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report of negative 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 colposcopy reported as Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal:
  • women who have completed childbearing
  • women who are anxious about cancer risk
  • women aged over 50 years
  • women who may not be compliant with recommended surveillance.


Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal indicates failure to visualise the upper limit of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone., or the entire TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. is within the endocervical canal. It corresponds to ‘unsatisfactory’ in previous terminology.

  • Good practice point
Consensus-based recommendationQuestion mark transparent.png

REC8.14: Diagnostic excision: Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal colposcopy after LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).
For women who have a positive oncogenic HPV (any type) test result, a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). after cytopathology review, and Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal colposcopy, diagnostic excision of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. should be performed.

Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal indicates failure to visualise the upper limit of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone., or the entire TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. is within the endocervical canal. It corresponds to ‘unsatisfactory’ in previous terminology.

  • Clinical_question:Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal (unsatisfactory) colposcopy following LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of 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. or HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).#Practice_point_6
  • REC8.14: Diagnostic excision: Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal colposcopy after LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).
    For women who have a positive oncogenic HPV (any type) test result, a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). after cytopathology review, and Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal colposcopy, diagnostic excision of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. should be performed.



Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal indicates failure to visualise the upper limit of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone., or the entire TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. is within the endocervical canal. It corresponds to ‘unsatisfactory’ in previous terminology.

  • Consensus based recommendation
Practice pointQuestion mark transparent.png

REC8.15: Cytopathology review: Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal colposcopy following LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).
Cytopathology review should be considered to confirm a high-grade cytological abnormality before excision, after a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result and an initial LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology)., when there is a Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal colposcopy.

This is particularly important when the LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction is pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system. because pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system. has a lower PPVPositive predictive value for high-grade disease and the subsequent excision specimens show no evidence of cervical pathology in 45–55% of cases.

  • Clinical_question:Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal (unsatisfactory) colposcopy following LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of 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. or HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).#Practice_point_7
  • REC8.15: Cytopathology review: Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal colposcopy following LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).
    Cytopathology review should be considered to confirm a high-grade cytological abnormality before excision, after a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result and an initial LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology)., when there is a Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal colposcopy.



This is particularly important when the LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction is pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system. because pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system. has a lower PPVPositive predictive value for high-grade disease and the subsequent excision specimens show no evidence of cervical pathology in 45–55% of cases.

  • Good practice point
Practice pointQuestion mark transparent.png

REC8.16: Deferral of treatment following cytopathology review: Repeat HPV test and colposcopy in 6 months
Following cytopathology review, rarely the woman or the clinician wish to defer treatment. In this situation the woman should have a repeat HPV test and colposcopy in 6 months.

  • If HPV detectedWomen with a positive HPV test result of any oncogenic HPV types detected using HPV testing platforms in a pathology laboratory. (any type) and LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. 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., repeat HPV test in 12 months.
  • If HPV detectedWomen with a positive HPV test result of any oncogenic HPV types detected using HPV testing platforms in a pathology laboratory. (any type) and LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology)., the woman should have diagnostic Type 3 excisionType 3 excision (for Type 3 TZ) Equivalent to ‘cone biopsy’ and >15mm length of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone..
  • Clinical_question:Type 3 TZType 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal (unsatisfactory) colposcopy following LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of 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. or HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).#Practice_point_8
  • REC8.16: Deferral of treatment following cytopathology review: Repeat HPV test and colposcopy in 6 months
    Following cytopathology review, rarely the woman or the clinician wish to defer treatment. In this situation the woman should have a repeat HPV test and colposcopy in 6 months.


  • If HPV detectedWomen with a positive HPV test result of any oncogenic HPV types detected using HPV testing platforms in a pathology laboratory. (any type) and LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. 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., repeat HPV test in 12 months.
  • If HPV detectedWomen with a positive HPV test result of any oncogenic HPV types detected using HPV testing platforms in a pathology laboratory. (any type) and LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology)., the woman should have diagnostic Type 3 excisionType 3 excision (for Type 3 TZ) Equivalent to ‘cone biopsy’ and >15mm length of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone..
  • Good practice point

Back to top

9. Management of histologically confirmed low-grade squamous abnormalities

Consensus-based recommendationQuestion mark transparent.png

REC9.1: HPV test 12 months after histologically confirmed 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. (Less than or equal to CIN1mild dysplasia)
Women who have a positive oncogenic HPV (any type) test result with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report of either negative 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 histologically confirmed Less than or equal to CIN1mild dysplasia on biopsy, should have a repeat HPV test 12 months later:

  • If oncogenic HPV is not detected at the repeat HPV test, the woman should return to routine 5 yearly screening.
  • If the repeat test is positive for oncogenic HPV (not 16/18) and the LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report is negative 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., the woman should have a further repeat HPV test in 12 months.
  • If the second follow-up HPV test is negative the woman should return to routine 5-yearly screening.
  • If the second follow-up test is HPV positiveWomen with a positive HPV test result of any oncogenic HPV types detected using HPV testing platforms in a pathology laboratory., the woman should be referred for colposcopic assessment informed by reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory..
  • If the repeat test is positive for oncogenic HPV (not 16/18) and the LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report is pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology)., the woman should be referred for colposcopic assessment.
  • If the repeat test is positive for oncogenic HPV (16/18), the woman should be referred for colposcopic assessment informed by the reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory..
  • Clinical_question:Management of histologically confirmed low-grade squamous abnormalities#Practice_point_1
  • REC9.1: HPV test 12 months after histologically confirmed 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. (Less than or equal to CIN1mild dysplasia)
    Women who have a positive oncogenic HPV (any type) test result with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report of either negative 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 histologically confirmed Less than or equal to CIN1mild dysplasia on biopsy, should have a repeat HPV test 12 months later:
  • If oncogenic HPV is not detected at the repeat HPV test, the woman should return to routine 5 yearly screening.
  • If the repeat test is positive for oncogenic HPV (not 16/18) and the LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report is negative 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., the woman should have a further repeat HPV test in 12 months.
  • If the second follow-up HPV test is negative the woman should return to routine 5-yearly screening.
  • If the second follow-up test is HPV positiveWomen with a positive HPV test result of any oncogenic HPV types detected using HPV testing platforms in a pathology laboratory., the woman should be referred for colposcopic assessment informed by reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory..
  • If the repeat test is positive for oncogenic HPV (not 16/18) and the LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report is pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology)., the woman should be referred for colposcopic assessment.
  • If the repeat test is positive for oncogenic HPV (16/18), the woman should be referred for colposcopic assessment informed by the reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory..
  • Consensus based recommendation
Consensus-based recommendationQuestion mark transparent.png

REC9.2: 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. (Less than or equal to CIN1mild dysplasia) should not be treated
Women who have a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report of negative 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., who have undergone colposcopy and have a histologically confirmed 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. (Less than or equal to CIN1mild dysplasia), should not be treated, because these lesions are considered to be an expression of a productive HPV infection.

  • Clinical_question:Management of histologically confirmed low-grade squamous abnormalities#Practice_point_2
  • REC9.2: 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. (Less than or equal to CIN1mild dysplasia) should not be treated
    Women who have a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report of negative 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., who have undergone colposcopy and have a histologically confirmed 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. (Less than or equal to CIN1mild dysplasia), should not be treated, because these lesions are considered to be an expression of a productive HPV infection.
  • Consensus based recommendation
Consensus-based recommendationQuestion mark transparent.png

REC9.3: Diagnostic excision when HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). confirmed on cytopathology review
Women who have a positive oncogenic HPV test result (any type) with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report of HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (confirmed after cytopathology review), and who have undergone colposcopy and have a histologically confirmed 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. (Less than or equal to CIN1mild dysplasia), should be offered diagnostic excision of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone..

  • Clinical_question:Management of histologically confirmed low-grade squamous abnormalities#Practice_point_3
  • REC9.3: Diagnostic excision when HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). confirmed on cytopathology review
    Women who have a positive oncogenic HPV test result (any type) with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report of HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (confirmed after cytopathology review), and who have undergone colposcopy and have a histologically confirmed 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. (Less than or equal to CIN1mild dysplasia), should be offered diagnostic excision of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone..
  • Consensus based recommendation
Consensus-based recommendationQuestion mark transparent.png

REC9.4: Option for observation following cytological prediction of pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system.
Women who have a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system. (confirmed after cytopathology review), and who have undergone colposcopy and have a histologically confirmed 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. (Less than or equal to CIN1mild dysplasia), could be offered diagnostic excision of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone..
If the colposcopist considers a period of observation is preferable to treatment, or the woman with these findings wishes to defer diagnostic excision, she can be offered observation with a HPV test and colposcopy at 6–12 months:

  • If oncogenic HPV is not detected at the repeat test, the HPV test should be repeated again in 12 months.
  • If the second follow-up test is negative, the woman should return to routine 5-yearly screening.
  • If the woman has a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result at the repeat test, her reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report is negative 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 her colposcopic impression is normal or 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., the HPV test should be repeated annually.
  • When oncogenic HPV is not detected at two consecutive annual tests, the woman can return to 5-yearly screening.
  • If the woman has a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result at the repeat test, and her LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction is pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). or any glandular abnormality, she should have a diagnostic excision of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone..
  • Clinical_question:Management of histologically confirmed low-grade squamous abnormalities#Practice_point_4
  • REC9.4: Option for observation following cytological prediction of pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system.
    Women who have a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system. (confirmed after cytopathology review), and who have undergone colposcopy and have a histologically confirmed 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. (Less than or equal to CIN1mild dysplasia), could be offered diagnostic excision of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone..


If the colposcopist considers a period of observation is preferable to treatment, or the woman with these findings wishes to defer diagnostic excision, she can be offered observation with a HPV test and colposcopy at 6–12 months:

  • If oncogenic HPV is not detected at the repeat test, the HPV test should be repeated again in 12 months.
  • If the second follow-up test is negative, the woman should return to routine 5-yearly screening.
  • If the woman has a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result at the repeat test, her reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report is negative 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 her colposcopic impression is normal or 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., the HPV test should be repeated annually.
  • When oncogenic HPV is not detected at two consecutive annual tests, the woman can return to 5-yearly screening.
  • If the woman has a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result at the repeat test, and her LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction is pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). or any glandular abnormality, she should have a diagnostic excision of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone..
  • Consensus based recommendation
Practice pointQuestion mark transparent.png

REC9.5: Criteria for observation following cytological prediction of pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system.
Women should not be offered observation unless the colposcopic assessment meets all the following conditions:

  • ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. is adequate.
  • TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. is completely visualised (Type 1 or 2 TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone.^).
  • 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. (Less than or equal to CIN1mild dysplasia) has been confirmed on histopathological review.


^IFCPCThe International Federation of Cervical Pathology and Colposcopy: International Federation of Cervical Pathology and ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. 2011

  • Clinical_question:Management of histologically confirmed low-grade squamous abnormalities#Practice_point_5
  • REC9.5: Criteria for observation following cytological prediction of pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system.
    Women should not be offered observation unless the colposcopic assessment meets all the following conditions:
  • ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. is adequate.
  • TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. is completely visualised (Type 1 or 2 TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone.^).
  • 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. (Less than or equal to CIN1mild dysplasia) has been confirmed on histopathological review.


^IFCPCThe International Federation of Cervical Pathology and Colposcopy: International Federation of Cervical Pathology and ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. 2011

  • Good practice point
Practice pointQuestion mark transparent.png

REC9.6: Cytology review essential when test results are discordant
For women who have a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result with a histologically confirmed 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. (Less than or equal to CIN1mild dysplasia) after LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology)., both the cytology and the histopathology should be reviewed by a pathologist from at least one of the reporting laboratories, who should then convey the results of the review to the colposcopist in order to inform the management plan.

  • Clinical_question:Management of histologically confirmed low-grade squamous abnormalities#Practice_point_6
  • REC9.6: Cytology review essential when test results are discordant
    For women who have a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result with a histologically confirmed 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. (Less than or equal to CIN1mild dysplasia) after LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology)., both the cytology and the histopathology should be reviewed by a pathologist from at least one of the reporting laboratories, who should then convey the results of the review to the colposcopist in order to inform the management plan.
  • Good practice point

Back to top

10. Management of histologically confirmed high-grade squamous abnormalities

Diagnosis of high-grade squamous abnormalities

Consensus-based recommendation*Question mark transparent.png

REC10.1: Histological diagnosis prior to treatment
For women who have a visible lesion at colposcopy, histological confirmation of HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). is recommended before undertaking definitive treatment.

  • Clinical_question:Diagnosis of high-grade squamous abnormalities#Practice_point_1
  • REC10.1: Histological diagnosis prior to treatment
    For women who have a visible lesion at colposcopy, histological confirmation of HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). is recommended before undertaking definitive treatment.
  • Consensus based recommendation star

Back to top

Treatment of high-grade squamous abnormalities

Consensus-based recommendation*Question mark transparent.png

REC10.2: Treatment for HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2)
Women with a histological diagnosis of HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2) should be treated in order to reduce the risk of developing invasive cervical carcinoma.

  • Clinical_question:Treatment of high-grade squamous abnormalities#Practice_point_1
  • REC10.2: Treatment for HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2)
    Women with a histological diagnosis of HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2) should be treated in order to reduce the risk of developing invasive cervical carcinoma.
  • Consensus based recommendation star
Practice pointQuestion mark transparent.png

REC10.3: p16 should be used to clarify diagnosis of HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2)
The use of p16 immunohistochemistry is recommended to stratify the management of HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2) into immediate treatment or a period of observation.

  • Clinical_question:Treatment of high-grade squamous abnormalities#Practice_point_2
  • REC10.3: p16 should be used to clarify diagnosis of HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2)
    The use of p16 immunohistochemistry is recommended to stratify the management of HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2) into immediate treatment or a period of observation.
  • Good practice point
Practice pointQuestion mark transparent.png

REC10.4: HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2) and observation
In some circumstances, it may be acceptable to offer a period of observation (generally 6–12 months) to women who have a histological diagnosis of HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2), and this would usually be supervised by an experienced colposcopist or at a tertiary centre. Observation may be considered for:

  • women who have not completed childbearing
  • women with discordant histology and LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of 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.
  • women with focal minor changes on colposcopy and HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2) on histology
  • women recently treated for HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2).
  • Clinical_question:Treatment of high-grade squamous abnormalities#Practice_point_3
  • REC10.4: HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2) and observation
    In some circumstances, it may be acceptable to offer a period of observation (generally 6–12 months) to women who have a histological diagnosis of HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2), and this would usually be supervised by an experienced colposcopist or at a tertiary centre. Observation may be considered for:
  • women who have not completed childbearing
  • women with discordant histology and LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of 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.
  • women with focal minor changes on colposcopy and HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2) on histology
  • women recently treated for HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2).
  • Good practice point
Consensus-based recommendation*Question mark transparent.png

REC10.5: Treatment of HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN3)
Women with a histological diagnosis of HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN3) should be treated in order to reduce the risk of developing invasive cervical carcinoma.

  • Clinical_question:Treatment of high-grade squamous abnormalities#Practice_point_4
  • REC10.5: Treatment of HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN3)
    Women with a histological diagnosis of HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN3) should be treated in order to reduce the risk of developing invasive cervical carcinoma.
  • Consensus based recommendation star
Consensus-based recommendation*Question mark transparent.png

REC10.6: Referral of women with invasive disease
A woman with a histologically confirmed diagnosis of invasive or superficially invasive (squamous cell carcinoma) should be referred to a gynaecological oncologist or a gynaecological cancer centre for multidisciplinary team review.

  • Clinical_question:Treatment of high-grade squamous abnormalities#Practice_point_5
  • REC10.6: Referral of women with invasive disease
    A woman with a histologically confirmed diagnosis of invasive or superficially invasive (squamous cell carcinoma) should be referred to a gynaecological oncologist or a gynaecological cancer centre for multidisciplinary team review.
  • Consensus based recommendation star

Back to top

Test of Cure after treatment for HSIL (CIN2 3)

Consensus-based recommendationQuestion mark transparent.png

REC10.7: Test of Cure after treatment for HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2/3)
A woman who has been treated for HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2/3) should have a co-testHPV test and LBC both requested and performed on a cervical sample. performed at 12 months after treatment, and annually thereafter, until she receives a negative co-testHPV test and LBC both requested and performed on a cervical sample. on two consecutive occasions, when she can return to routine 5 yearly screening.

Co-testingHPV test and LBC both requested and performed on a cervical sample. can be performed by the woman’s usual healthcare professional.

  • Clinical_question:Test of Cure after treatment for HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2 3)#Practice_point_1
  • REC10.7: Test of Cure after treatment for HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2/3)
    A woman who has been treated for HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2/3) should have a co-testHPV test and LBC both requested and performed on a cervical sample. performed at 12 months after treatment, and annually thereafter, until she receives a negative co-testHPV test and LBC both requested and performed on a cervical sample. on two consecutive occasions, when she can return to routine 5 yearly screening.



Co-testingHPV test and LBC both requested and performed on a cervical sample. can be performed by the woman’s usual healthcare professional.

  • Consensus based recommendation
Consensus-based recommendationQuestion mark transparent.png

REC10.8: Abnormal Test of Cure results: positive oncogenic HPV (16/18)Women with a positive HPV test result of HPV types 16 and/or 18 detected using routine HPV testing in a pathology laboratory. test result
If, at any time post treatment, the woman has a positive oncogenic HPV (16/18)Women with a positive HPV test result of HPV types 16 and/or 18 detected using routine HPV testing in a pathology laboratory. test result, she should be referred for colposcopic assessment (regardless of the reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. result).

  • Clinical_question:Test of Cure after treatment for HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2 3)#Practice_point_2
  • REC10.8: Abnormal Test of Cure results: positive oncogenic HPV (16/18)Women with a positive HPV test result of HPV types 16 and/or 18 detected using routine HPV testing in a pathology laboratory. test result
    If, at any time post treatment, the woman has a positive oncogenic HPV (16/18)Women with a positive HPV test result of HPV types 16 and/or 18 detected using routine HPV testing in a pathology laboratory. test result, she should be referred for colposcopic assessment (regardless of the reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. result).
  • Consensus based recommendation
Consensus-based recommendation*Question mark transparent.png

REC10.9: Abnormal Test of Cure results: LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). or glandular abnormality
If, at any time during Test of Cure, the woman has a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). or any glandular abnormality, irrespective of HPV status, she should be referred for colposcopic assessment.

  • Clinical_question:Test of Cure after treatment for HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2 3)#Practice_point_3
  • REC10.9: Abnormal Test of Cure results: LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). or glandular abnormality
    If, at any time during Test of Cure, the woman has a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). or any glandular abnormality, irrespective of HPV status, she should be referred for colposcopic assessment.
  • Consensus based recommendation star
Consensus-based recommendationQuestion mark transparent.png

REC10.10: Abnormal Test of Cure results: positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result
If, at any time post-treatment, the woman has a positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result and a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report of negative or prediction of 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., she should continue to have annual co-testingHPV test and LBC both requested and performed on a cervical sample. until the she has a negative co-testHPV test and LBC both requested and performed on a cervical sample. on two consecutive occasions, when she can return to routine 5-yearly screening.

  • Clinical_question:Test of Cure after treatment for HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2 3)#Practice_point_4
  • REC10.10: Abnormal Test of Cure results: positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result
    If, at any time post-treatment, the woman has a positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result and a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report of negative or prediction of 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., she should continue to have annual co-testingHPV test and LBC both requested and performed on a cervical sample. until the she has a negative co-testHPV test and LBC both requested and performed on a cervical sample. on two consecutive occasions, when she can return to routine 5-yearly screening.
  • Consensus based recommendation
Practice pointQuestion mark transparent.png

REC10.11: Fluctuating Test of Cure results: positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result and/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.
Some women may experience fluctuating results with a positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result and/or LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of 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.. These women do not need colposcopic review but, if the woman is anxious, a colposcopic assessment may be appropriate to provide reassurance.

  • Clinical_question:Test of Cure after treatment for HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2 3)#Practice_point_5
  • REC10.11: Fluctuating Test of Cure results: positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result and/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.
    Some women may experience fluctuating results with a positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result and/or LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of 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.. These women do not need colposcopic review but, if the woman is anxious, a colposcopic assessment may be appropriate to provide reassurance.
  • Good practice point
Practice pointQuestion mark transparent.png

REC10.12: ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. is not necessary at the initial post-treatment visit
A post-treatment colposcopic assessment at 4–6 months has been the usual practice under pre-renewal NCSPNational Cervical Screening ProgramA joint program of the Australian, state and territory governments. It aims to reduce morbidity and mortality from cervical cancer, in a cost-effective manner through an organised approach to cervical screening. The program encourages women in the target population to have regular Pap smears. guidelines. This practice is not evidence-based, but may provide reassurance to both the patient and clinician regarding the visual appearance of the cervix and allows for the discussion of any other relevant issues (bleeding, fertility, related symptoms etc.) following treatment.

The post-treatment review should:

  • include speculum examination of the vagina and cervix (but colposcopy is not considered necessary)
  • not involve HPV testing or LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory..

Subsequent post-treatment Test of Cure surveillance should be performed by the woman’s GP or health professional, who should follow the recommendations for the management of any abnormal test results.

  • Clinical_question:Test of Cure after treatment for HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2 3)#Practice_point_6
  • REC10.12: ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. is not necessary at the initial post-treatment visit
    A post-treatment colposcopic assessment at 4–6 months has been the usual practice under pre-renewal NCSPNational Cervical Screening ProgramA joint program of the Australian, state and territory governments. It aims to reduce morbidity and mortality from cervical cancer, in a cost-effective manner through an organised approach to cervical screening. The program encourages women in the target population to have regular Pap smears. guidelines. This practice is not evidence-based, but may provide reassurance to both the patient and clinician regarding the visual appearance of the cervix and allows for the discussion of any other relevant issues (bleeding, fertility, related symptoms etc.) following treatment.

The post-treatment review should:

  • include speculum examination of the vagina and cervix (but colposcopy is not considered necessary)
  • not involve HPV testing or LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory..

Subsequent post-treatment Test of Cure surveillance should be performed by the woman’s GP or health professional, who should follow the recommendations for the management of any abnormal test results.

  • Good practice point

Back to top

11. Management of glandular abnormalities

Investigation of cytological glandular abnormalities

Consensus-based recommendation*Question mark transparent.png

REC11.1: ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. referral for atypical glandular/endocervical cells
Women who have a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report of atypical glandular/endocervical cells of undetermined significance should be referred to a gynaecologist with expertise in the colposcopic evaluation of suspected malignancies or a gynaecological oncologist.

  • Clinical_question:Investigation of cytological glandular abnormalities#Practice_point_1
  • REC11.1: ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. referral for atypical glandular/endocervical cells
    Women who have a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report of atypical glandular/endocervical cells of undetermined significance should be referred to a gynaecologist with expertise in the colposcopic evaluation of suspected malignancies or a gynaecological oncologist.
  • Consensus based recommendation star
Consensus-based recommendation*Question mark transparent.png

REC11.2: Follow-up after normal colposcopy and LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of atypical glandular/endocervical cells
Women who have a positive oncogenic HPV test result (any type) with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of atypical glandular/endocervical cells of undetermined significance and normal colposcopy can be offered repeat co-testingHPV test and LBC both requested and performed on a cervical sample. (HPV and LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory.) at 6–12 months:

  • If the follow-up co-testHPV test and LBC both requested and performed on a cervical sample. is negative, co-testingHPV test and LBC both requested and performed on a cervical sample. should be repeated annually until the woman has two consecutive negative co-tests, after which she can return to 5-yearly screening.
  • If there is either a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result or an abnormal LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. (any report other than negative), the woman should be referred for colposcopic assessment, and diagnostic excision of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. should be considered.
  • Clinical_question:Investigation of cytological glandular abnormalities#Practice_point_2
  • REC11.2: Follow-up after normal colposcopy and LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of atypical glandular/endocervical cells
    Women who have a positive oncogenic HPV test result (any type) with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of atypical glandular/endocervical cells of undetermined significance and normal colposcopy can be offered repeat co-testingHPV test and LBC both requested and performed on a cervical sample. (HPV and LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory.) at 6–12 months:
  • If the follow-up co-testHPV test and LBC both requested and performed on a cervical sample. is negative, co-testingHPV test and LBC both requested and performed on a cervical sample. should be repeated annually until the woman has two consecutive negative co-tests, after which she can return to 5-yearly screening.
  • If there is either a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result or an abnormal LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. (any report other than negative), the woman should be referred for colposcopic assessment, and diagnostic excision of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. should be considered.
  • Consensus based recommendation star
Practice pointQuestion mark transparent.png

REC11.3: Exclusion of upper genital tract disease before diagnostic excision
For women who have a positive oncogenic HPV test result (any type) and who have atypical glandular/endocervical cells of undetermined significance on cytology, investigation of the upper genital tract (endometrium, fallopian tube or ovary) using endometrial sampling and/or pelvic ultrasound should be considered, before diagnostic excision of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. is performed or the woman is advised to return for colposcopy and further tests in 6–12 months, in these groups of women:

  • women aged over 45 years
  • women aged over 35 years with a BMI greater than 30
  • women diagnosed with polycystic ovarian syndrome
  • women with abnormal vaginal bleeding.
  • Clinical_question:Investigation of cytological glandular abnormalities#Practice_point_3
  • REC11.3: Exclusion of upper genital tract disease before diagnostic excision
    For women who have a positive oncogenic HPV test result (any type) and who have atypical glandular/endocervical cells of undetermined significance on cytology, investigation of the upper genital tract (endometrium, fallopian tube or ovary) using endometrial sampling and/or pelvic ultrasound should be considered, before diagnostic excision of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. is performed or the woman is advised to return for colposcopy and further tests in 6–12 months, in these groups of women:
  • women aged over 45 years
  • women aged over 35 years with a BMI greater than 30
  • women diagnosed with polycystic ovarian syndrome
  • women with abnormal vaginal bleeding.
  • Good practice point
Practice pointQuestion mark transparent.png

REC11.4: Role of immediate diagnostic excision of TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. versus observation
Immediate diagnostic excision of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. can be considered for women with atypical glandular/endocervical cells of undetermined significance if they prefer not to take a conservative observational approach. This might apply to:

  • women aged over 45 years
  • women who have completed childbearing
  • women who are particularly anxious about their cancer risk.
  • Clinical_question:Investigation of cytological glandular abnormalities#Practice_point_4
  • REC11.4: Role of immediate diagnostic excision of TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. versus observation
    Immediate diagnostic excision of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. can be considered for women with atypical glandular/endocervical cells of undetermined significance if they prefer not to take a conservative observational approach. This might apply to:
  • women aged over 45 years
  • women who have completed childbearing
  • women who are particularly anxious about their cancer risk.
  • Good practice point
Consensus-based recommendationQuestion mark transparent.png

REC11.5: ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. for possible high-grade glandular lesions
Women who have a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of possible high-grade glandular lesion should be referred to a gynaecologist with expertise in the colposcopic evaluation of suspected malignancies or a gynaecological oncologist.

Diagnostic excision of the endocervical TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. should be performed in most cases.

  • Clinical_question:Investigation of cytological glandular abnormalities#Practice_point_5
  • REC11.5: ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. for possible high-grade glandular lesions

Women who have a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of possible high-grade glandular lesion should be referred to a gynaecologist with expertise in the colposcopic evaluation of suspected malignancies or a gynaecological oncologist.

Diagnostic excision of the endocervical TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. should be performed in most cases.

  • Consensus based recommendation
Practice pointQuestion mark transparent.png

REC11.6: Women who decline treatment for possible high-grade glandular lesions
Women with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of possible high-grade glandular lesion who decline the recommended excision should be offered surveillance with co-testingHPV test and LBC both requested and performed on a cervical sample. (HPV and LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory.) and colposcopy in 6 months.

  • If in 6 months the woman has a positive result, she should be encouraged to have a diagnostic excision of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone..
  • It is important that the woman understands the potential risk of underlying disease (21.5% risk of AISAdenocarcinoma in situ and 5.5% risk of invasive cancer).
  • Clinical_question:Investigation of cytological glandular abnormalities#Practice_point_6
  • REC11.6: Women who decline treatment for possible high-grade glandular lesions
    Women with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of possible high-grade glandular lesion who decline the recommended excision should be offered surveillance with co-testingHPV test and LBC both requested and performed on a cervical sample. (HPV and LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory.) and colposcopy in 6 months.
  • If in 6 months the woman has a positive result, she should be encouraged to have a diagnostic excision of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone..
  • It is important that the woman understands the potential risk of underlying disease (21.5% risk of AISAdenocarcinoma in situ and 5.5% risk of invasive cancer).
  • Good practice point
Consensus-based recommendation*Question mark transparent.png

REC11.7: ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. referral for AISAdenocarcinoma in situ
Women with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of AISAdenocarcinoma in situ should be referred to a gynaecologist with expertise in the colposcopic evaluation of suspected malignancies or to a gynaecological oncologist.

Diagnostic excision of the endocervical TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. should be performed.

  • Clinical_question:Investigation of cytological glandular abnormalities#Practice_point_7
  • REC11.7: ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. referral for AISAdenocarcinoma in situ
    Women with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of AISAdenocarcinoma in situ should be referred to a gynaecologist with expertise in the colposcopic evaluation of suspected malignancies or to a gynaecological oncologist.

Diagnostic excision of the endocervical TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. should be performed.

  • Consensus based recommendation star
Consensus-based recommendation*Question mark transparent.png

REC11.8: Referral to gynaecological oncologist for LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of invasive disease
Women who have a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of invasive adenocarcinoma should be referred to a gynaecological oncologist or a gynaecological oncology centre for urgent evaluation, ideally within 2 weeks.

  • Clinical_question:Investigation of cytological glandular abnormalities#Practice_point_8
  • REC11.8: Referral to gynaecological oncologist for LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of invasive disease
    Women who have a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of invasive adenocarcinoma should be referred to a gynaecological oncologist or a gynaecological oncology centre for urgent evaluation, ideally within 2 weeks.
  • Consensus based recommendation star
Consensus-based recommendation*Question mark transparent.png

REC11.9: Specimen for histological assessment of glandular abnormalities
When diagnostic excision of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. is performed in the investigation of glandular abnormalities, the method chosen should ensure that a single, intact specimen with interpretable margins is obtained for histological assessment.

  • Clinical_question:Investigation of cytological glandular abnormalities#Practice_point_9
  • REC11.9: Specimen for histological assessment of glandular abnormalities
    When diagnostic excision of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. is performed in the investigation of glandular abnormalities, the method chosen should ensure that a single, intact specimen with interpretable margins is obtained for histological assessment.
  • Consensus based recommendation star
Practice pointQuestion mark transparent.png

REC11.10: Cold-knife cone biopsy is the ‘gold standard’ for glandular abnormalities’
Cold-knife cone biopsy should be considered the ‘gold standard’ for the diagnostic assessment of glandular lesions. However, a diathermy excisional procedure may be appropriate in some circumstances and could provide an appropriate surgical specimen when performed by a gynaecologist with appropriate training, experience and expertise.

  • Clinical_question:Investigation of cytological glandular abnormalities#Practice_point_10
  • REC11.10: Cold-knife cone biopsy is the ‘gold standard’ for glandular abnormalities’
    Cold-knife cone biopsy should be considered the ‘gold standard’ for the diagnostic assessment of glandular lesions. However, a diathermy excisional procedure may be appropriate in some circumstances and could provide an appropriate surgical specimen when performed by a gynaecologist with appropriate training, experience and expertise.
  • Good practice point
Practice pointQuestion mark transparent.png

REC11.11: Size of cone biopsy
The depth and extent of the cone biopsy should be tailored to the woman's age and fertility requirements. A Type 3 Excision of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. is usually required.

  • Clinical_question:Investigation of cytological glandular abnormalities#Practice_point_11
  • REC11.11: Size of cone biopsy
    The depth and extent of the cone biopsy should be tailored to the woman's age and fertility requirements. A Type 3 Excision of the TZTransformation zoneThis region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone. is usually required.
  • Good practice point
Practice pointQuestion mark transparent.png

REC11.12: Cone biopsy excision margins and multifocal AISAdenocarcinoma in situ
Multifocal disease has been reported in 13–17% of cases of AISAdenocarcinoma in situ, though the majority of lesions are unifocal. If the margin is close but apparently excised (less than 5 mm), close surveillance by Test of Cure, as recommended in these guidelines, is considered appropriate. In this situation further excision is not considered necessary.

  • Clinical_question:Investigation of cytological glandular abnormalities#Practice_point_12
  • REC11.12: Cone biopsy excision margins and multifocal AISAdenocarcinoma in situ
    Multifocal disease has been reported in 13–17% of cases of AISAdenocarcinoma in situ, though the majority of lesions are unifocal. If the margin is close but apparently excised (less than 5 mm), close surveillance by Test of Cure, as recommended in these guidelines, is considered appropriate. In this situation further excision is not considered necessary.
  • Good practice point

Back to top

Follow-up after excisional treatment for AIS

Consensus-based recommendation*Question mark transparent.png

REC11.13: Follow-up of completely excised AISAdenocarcinoma in situ
Women with histologically confirmed AISAdenocarcinoma in situ who have undergone complete excision with clear margins should have annual co-testingHPV test and LBC both requested and performed on a cervical sample. indefinitely.

If any abnormal result is obtained on follow-up co-testingHPV test and LBC both requested and performed on a cervical sample., the woman should be referred for colposcopic assessment.

Until sufficient data become available to support cessation of testing.

  • Clinical_question:Follow-up after excisional treatment for AISAdenocarcinoma in situ#Practice_point_1
  • REC11.13: Follow-up of completely excised AISAdenocarcinoma in situ
    Women with histologically confirmed AISAdenocarcinoma in situ who have undergone complete excision with clear margins should have annual co-testingHPV test and LBC both requested and performed on a cervical sample. indefinitely.

If any abnormal result is obtained on follow-up co-testingHPV test and LBC both requested and performed on a cervical sample., the woman should be referred for colposcopic assessment.

Until sufficient data become available to support cessation of testing.

  • Consensus based recommendation star
Consensus-based recommendation*Question mark transparent.png

REC11.14: Repeat excision for incompletely excised AISAdenocarcinoma in situ
If AISAdenocarcinoma in situ is incompletely excised (positive endocervical margin and/or deep stromal margin, not ectocervical margin) or if the margins cannot be assessed, further excision to obtain clear margins should be performed.

  • Clinical_question:Follow-up after excisional treatment for AISAdenocarcinoma in situ#Practice_point_2
  • REC11.14: Repeat excision for incompletely excised AISAdenocarcinoma in situ
    If AISAdenocarcinoma in situ is incompletely excised (positive endocervical margin and/or deep stromal margin, not ectocervical margin) or if the margins cannot be assessed, further excision to obtain clear margins should be performed.
  • Consensus based recommendation star
Consensus-based recommendationQuestion mark transparent.png

REC11.15: Role of hysterectomy in AISAdenocarcinoma in situ
In women who have been treated for AISAdenocarcinoma in situ by excision, with clear margins, there is no evidence to support completion hysterectomy. In this situation, hysterectomy is not recommended.

  • Clinical_question:Follow-up after excisional treatment for AISAdenocarcinoma in situ#Practice_point_3
  • REC11.15: Role of hysterectomy in AISAdenocarcinoma in situ
    In women who have been treated for AISAdenocarcinoma in situ by excision, with clear margins, there is no evidence to support completion hysterectomy. In this situation, hysterectomy is not recommended.
  • Consensus based recommendation

Back to top

12. Screening in Aboriginal and Torres Strait Islander women

Consensus-based recommendationQuestion mark transparent.png

REC12.1: Cervical Screening for Aboriginal and Torres Strait Islander women
Aboriginal and Torres Strait Islander women should be invited and encouraged to participate in the NCSPNational Cervical Screening ProgramA joint program of the Australian, state and territory governments. It aims to reduce morbidity and mortality from cervical cancer, in a cost-effective manner through an organised approach to cervical screening. The program encourages women in the target population to have regular Pap smears. and have a 5-yearly HPV test, as recommended for all Australian women.

  • Clinical_question:HPV screening strategies for Aboriginal and Torres Strait Islander women#Practice_point_1
  • REC12.1: Cervical Screening for Aboriginal and Torres Strait Islander women
    Aboriginal and Torres Strait Islander women should be invited and encouraged to participate in the NCSPNational Cervical Screening ProgramA joint program of the Australian, state and territory governments. It aims to reduce morbidity and mortality from cervical cancer, in a cost-effective manner through an organised approach to cervical screening. The program encourages women in the target population to have regular Pap smears. and have a 5-yearly HPV test, as recommended for all Australian women.
  • Consensus based recommendation
Practice pointQuestion mark transparent.png

REC12.2: Invitations to screen for Aboriginal and Torres Strait Islander women
Specific efforts should be made to maximise delivery of invitations to Aboriginal and Torres Strait Islander women.

  • Clinical_question:HPV screening strategies for Aboriginal and Torres Strait Islander women#Practice_point_2
  • REC12.2: Invitations to screen for Aboriginal and Torres Strait Islander women
    Specific efforts should be made to maximise delivery of invitations to Aboriginal and Torres Strait Islander women.
  • Good practice point
Practice pointQuestion mark transparent.png

REC12.3: Cervical screening services for Aboriginal and Torres Strait Islander women
Specific efforts should be made to provide screening, diagnostic and treatment services that are accessible and culturally appropriate to Aboriginal and Torres Strait Islander women.

  • Clinical_question:HPV screening strategies for Aboriginal and Torres Strait Islander women#Practice_point_3
  • REC12.3: Cervical screening services for Aboriginal and Torres Strait Islander women
    Specific efforts should be made to provide screening, diagnostic and treatment services that are accessible and culturally appropriate to Aboriginal and Torres Strait Islander women.
  • Good practice point
Practice pointQuestion mark transparent.png

REC12.4: Data collection and recording Aboriginal and Torres Strait Islander status
Healthcare professionals should ask all women whether they identify as Aboriginal or Torres Strait Islander, and a woman’s Aboriginal and Torres Strait Islander status should be recorded on the pathology request form in accordance with the ABS classification and standards.

  • Clinical_question:HPV screening strategies for Aboriginal and Torres Strait Islander women#Practice_point_4
  • REC12.4: Data collection and recording Aboriginal and Torres Strait Islander status
    Healthcare professionals should ask all women whether they identify as Aboriginal or Torres Strait Islander, and a woman’s Aboriginal and Torres Strait Islander status should be recorded on the pathology request form in accordance with the ABS classification and standards.
  • Good practice point

Back to top

13. Screening after total hysterectomy

Consensus-based recommendation*Question mark transparent.png

REC13.1: Total hysterectomy for benign disease
Women with a normal cervical screening history, who have undergone hysterectomy for benign disease (e.g. menorrhagia, uterine fibroids or utero-vaginal prolapse), and have no cervical pathology at the time of hysterectomy, do not require further screening or follow up.

  • Clinical_question:Screening after total hysterectomy#Practice_point_1
  • REC13.1: Total hysterectomy for benign disease
    Women with a normal cervical screening history, who have undergone hysterectomy for benign disease (e.g. menorrhagia, uterine fibroids or utero-vaginal prolapse), and have no cervical pathology at the time of hysterectomy, do not require further screening or follow up.
  • Consensus based recommendation star
Consensus-based recommendation*Question mark transparent.png

REC13.2: Total hysterectomy after completed Test of Cure
Women who have had a total hysterectomy with no evidence of cervical pathology, have previously been successfully treated for histologically confirmed HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). and have completed Test of Cure, do not require further follow-up. These women should be considered as having the same risk for vaginal neoplasia as the general population who have never had histologically confirmed HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). and have a total hysterectomy.

If unexpected 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. or HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). is identified in the cervix at the time of hysterectomy, then these women require follow-up with an annual co-testHPV test and LBC both requested and performed on a cervical sample. on a specimen from the vaginal vault until they have a negative co-testHPV test and LBC both requested and performed on a cervical sample. on two consecutive occasions.

  • Clinical_question:Screening after total hysterectomy#Practice_point_2
  • REC13.2: Total hysterectomy after completed Test of Cure

Women who have had a total hysterectomy with no evidence of cervical pathology, have previously been successfully treated for histologically confirmed HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). and have completed Test of Cure, do not require further follow-up. These women should be considered as having the same risk for vaginal neoplasia as the general population who have never had histologically confirmed HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). and have a total hysterectomy.

If unexpected 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. or HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). is identified in the cervix at the time of hysterectomy, then these women require follow-up with an annual co-testHPV test and LBC both requested and performed on a cervical sample. on a specimen from the vaginal vault until they have a negative co-testHPV test and LBC both requested and performed on a cervical sample. on two consecutive occasions.

  • Consensus based recommendation star
Consensus-based recommendationQuestion mark transparent.png

REC13.3: Total hysterectomy after adenocarcinoma in situ (AISAdenocarcinoma in situ)
Women who have had a total hysterectomy, have been treated for AISAdenocarcinoma in situ, and are under surveillance, should have a co-testHPV test and LBC both requested and performed on a cervical sample. on a specimen from the vaginal vault at 12 months and annually thereafter, indefinitely.

Women who have a total hysterectomy, as completion therapy or following incomplete excision of AISAdenocarcinoma in situ at cold-knife cone biopsy or diathermy excision, should have a co-testHPV test and LBC both requested and performed on a cervical sample. on a specimen from the vaginal vault at 12 months and annually thereafter, indefinitely.

Until sufficient data become available to support cessation of testing

  • Clinical_question:Screening after total hysterectomy#Practice_point_3
  • REC13.3: Total hysterectomy after adenocarcinoma in situ (AISAdenocarcinoma in situ)
    Women who have had a total hysterectomy, have been treated for AISAdenocarcinoma in situ, and are under surveillance, should have a co-testHPV test and LBC both requested and performed on a cervical sample. on a specimen from the vaginal vault at 12 months and annually thereafter, indefinitely.

Women who have a total hysterectomy, as completion therapy or following incomplete excision of AISAdenocarcinoma in situ at cold-knife cone biopsy or diathermy excision, should have a co-testHPV test and LBC both requested and performed on a cervical sample. on a specimen from the vaginal vault at 12 months and annually thereafter, indefinitely.

Until sufficient data become available to support cessation of testing

  • Consensus based recommendation
Consensus-based recommendation*Question mark transparent.png

REC13.4: Total hysterectomy for treatment of high-grade CIN in the presence of benign gynaecological disease
Women who have had a total hysterectomy as definitive treatment for histologically confirmed HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). in the presence of benign gynaecological disease, irrespective of cervical margins, should have a co-testHPV test and LBC both requested and performed on a cervical sample. on a specimen from the vaginal vault at 12 months after treatment and annually thereafter until the woman has tested negative by both tests on two consecutive occasions.

After two annual consecutive negative co-tests, the woman can be advised that no further testing is required.

  • Clinical_question:Screening after total hysterectomy#Practice_point_4
  • REC13.4: Total hysterectomy for treatment of high-grade CIN in the presence of benign gynaecological disease

Women who have had a total hysterectomy as definitive treatment for histologically confirmed HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). in the presence of benign gynaecological disease, irrespective of cervical margins, should have a co-testHPV test and LBC both requested and performed on a cervical sample. on a specimen from the vaginal vault at 12 months after treatment and annually thereafter until the woman has tested negative by both tests on two consecutive occasions.

After two annual consecutive negative co-tests, the woman can be advised that no further testing is required.

  • Consensus based recommendation star
Consensus-based recommendation*Question mark transparent.png

REC13.5: Total hysterectomy after histologically confirmed HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). without Test of Cure
Women who have been treated for histologically confirmed HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology)., are under surveillance or have returned to routine screening without Test of Cure, and have had a total hysterectomy with no evidence of cervical pathology, should have a co-testHPV test and LBC both requested and performed on a cervical sample. on a specimen from the vaginal vault at 12 months and annually until the woman has tested negative on two consecutive occasions.

After two annual consecutive negative co-tests, the woman can be advised that no further testing is required.

  • Clinical_question:Screening after total hysterectomy#Practice_point_5
  • REC13.5: Total hysterectomy after histologically confirmed HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). without Test of Cure

Women who have been treated for histologically confirmed HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology)., are under surveillance or have returned to routine screening without Test of Cure, and have had a total hysterectomy with no evidence of cervical pathology, should have a co-testHPV test and LBC both requested and performed on a cervical sample. on a specimen from the vaginal vault at 12 months and annually until the woman has tested negative on two consecutive occasions.

After two annual consecutive negative co-tests, the woman can be advised that no further testing is required.

  • Consensus based recommendation star
Consensus-based recommendation*Question mark transparent.png

REC13.6: Total hysterectomy and no screening history
Women who have had a total hysterectomy with no evidence of cervical pathology, and whose cervical screening history is not available, should have a HPV test on a specimen from the vaginal vault at 12 months and annually thereafter until they have a negative HPV test on two consecutive occasions.

After two annual consecutive negative HPV tests, women can be advised that no further testing is required.

  • Clinical_question:Screening after total hysterectomy#Practice_point_6
  • REC13.6: Total hysterectomy and no screening history

Women who have had a total hysterectomy with no evidence of cervical pathology, and whose cervical screening history is not available, should have a HPV test on a specimen from the vaginal vault at 12 months and annually thereafter until they have a negative HPV test on two consecutive occasions.

After two annual consecutive negative HPV tests, women can be advised that no further testing is required.

  • Consensus based recommendation star
Practice pointQuestion mark transparent.png

REC13.7: ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. referral for any positive co-testHPV test and LBC both requested and performed on a cervical sample. result following total hysterectomy
Women who have had a total hysterectomy and are under surveillance with co-testingHPV test and LBC both requested and performed on a cervical sample., and have a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result and/or any cytological abnormality, should be referred for colposcopic assessment.

  • Clinical_question:Screening after total hysterectomy#Practice_point_7
  • REC13.7: ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. referral for any positive co-testHPV test and LBC both requested and performed on a cervical sample. result following total hysterectomy

Women who have had a total hysterectomy and are under surveillance with co-testingHPV test and LBC both requested and performed on a cervical sample., and have a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result and/or any cytological abnormality, should be referred for colposcopic assessment.

  • Good practice point
Practice pointQuestion mark transparent.png

REC13.8: Vaginal bleeding following total hysterectomy
Women who have vaginal bleeding following total hysterectomy should be assessed by their GP or gynaecologist, regardless of the results of any surveillance tests.

Vaginal bleeding is quite common in the early weeks following hysterectomy and, where appropriate, should be investigated by the treating gynaecologist.

  • Clinical_question:Screening after total hysterectomy#Practice_point_8
  • REC13.8: Vaginal bleeding following total hysterectomy

Women who have vaginal bleeding following total hysterectomy should be assessed by their GP or gynaecologist, regardless of the results of any surveillance tests.

Vaginal bleeding is quite common in the early weeks following hysterectomy and, where appropriate, should be investigated by the treating gynaecologist.

  • Good practice point
Practice pointQuestion mark transparent.png

REC13.9: Total hysterectomy after genital tract cancer
Women who have been treated for cervical or endometrial cancer are at risk of recurrent cancer in the vaginal vault. These women should be under ongoing surveillance from a gynaecological oncologist. Therefore, they will be guided by their specialist regarding appropriate surveillance and this is outside the scope of these guidelines.

  • Clinical_question:Screening after total hysterectomy#Practice_point_9
  • REC13.9: Total hysterectomy after genital tract cancer
    Women who have been treated for cervical or endometrial cancer are at risk of recurrent cancer in the vaginal vault. These women should be under ongoing surveillance from a gynaecological oncologist. Therefore, they will be guided by their specialist regarding appropriate surveillance and this is outside the scope of these guidelines.
  • Good practice point
Practice pointQuestion mark transparent.png

REC13.10: Subtotal hysterectomy
Women who have undergone subtotal hysterectomy (the cervix is not removed) should be invited to have 5-yearly HPV testing in accordance with the recommendation for the general population. Any detected abnormality should be managed according to these guidelines.

  • Clinical_question:Screening after total hysterectomy#Practice_point_10
  • REC13.10: Subtotal hysterectomy
    Women who have undergone subtotal hysterectomy (the cervix is not removed) should be invited to have 5-yearly HPV testing in accordance with the recommendation for the general population. Any detected abnormality should be managed according to these guidelines.
  • Good practice point

Back to top

14. Screening in pregnancy

Consensus-based recommendationQuestion mark transparent.png

REC14.1: Positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory.Women with a positive HPV test result of other oncogenic HPV types not including types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result with LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. negative 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. in pregnancy
Pregnant women who have a positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report of negative or prediction of 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. should have a repeat HPV test in 12 months.

  • Clinical_question:Screening in pregnancy#Practice_point_1
  • REC14.1: Positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory.Women with a positive HPV test result of other oncogenic HPV types not including types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result with LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. negative 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. in pregnancy
    Pregnant women who have a positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. report of negative or prediction of 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. should have a repeat HPV test in 12 months.
  • Consensus based recommendation
Consensus-based recommendationQuestion mark transparent.png

REC14.2: Positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory.Women with a positive HPV test result of other oncogenic HPV types not including types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result with LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). or any glandular abnormality in pregnancy
Pregnant women who have a positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). or any glandular abnormality should be referred for early colposcopic assessment.

When practical and not deferred until the postpartum period.

  • Clinical_question:Screening in pregnancy#Practice_point_2
  • REC14.2: Positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory.Women with a positive HPV test result of other oncogenic HPV types not including types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result with LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). or any glandular abnormality in pregnancy
    Pregnant women who have a positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result with a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). or any glandular abnormality should be referred for early colposcopic assessment.

    When practical and not deferred until the postpartum period.
  • Consensus based recommendation
Consensus-based recommendationQuestion mark transparent.png

REC14.3: Positive HPV (16/18) test result in pregnancy
Pregnant women who have a positive oncogenic HPV (16/18)Women with a positive HPV test result of HPV types 16 and/or 18 detected using routine HPV testing in a pathology laboratory. test result should be referred for early colposcopic assessment regardless of their LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. test result.

When practical and not deferred until the postpartum period.

  • Clinical_question:Screening in pregnancy#Practice_point_3
  • REC14.3: Positive HPV (16/18) test result in pregnancy
    Pregnant women who have a positive oncogenic HPV (16/18)Women with a positive HPV test result of HPV types 16 and/or 18 detected using routine HPV testing in a pathology laboratory. test result should be referred for early colposcopic assessment regardless of their LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. test result.

    When practical and not deferred until the postpartum period.
  • Consensus based recommendation
Consensus-based recommendation*Question mark transparent.png

REC14.4: Referral of pregnant women with invasive disease
Pregnant women should be referred and seen within 2 weeks by a gynaecological oncologist/gynaecological cancer centre for multidisciplinary team review and management in the following situations:

  • LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of invasive disease
  • colposcopic impression of invasive or superficially invasive squamous cell carcinoma of the cervix
  • histologically confirmed diagnosis of invasive or superficially invasive squamous cell carcinoma of the cervix.
  • Clinical_question:Screening in pregnancy#Practice_point_4
  • REC14.4: Referral of pregnant women with invasive disease
    Pregnant women should be referred and seen within 2 weeks by a gynaecological oncologist/gynaecological cancer centre for multidisciplinary team review and management in the following situations:
  • LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of invasive disease
  • colposcopic impression of invasive or superficially invasive squamous cell carcinoma of the cervix
  • histologically confirmed diagnosis of invasive or superficially invasive squamous cell carcinoma of the cervix.
  • Consensus based recommendation star
Consensus-based recommendation*Question mark transparent.png

REC14.5: ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. during pregnancy
The aim of colposcopy in pregnant women is to exclude the presence of invasive cancer and to reassure them that their pregnancy will not be affected by the presence of an abnormal cervical screening test result.

  • Clinical_question:Screening in pregnancy#Practice_point_5
  • REC14.5: ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. during pregnancy
    The aim of colposcopy in pregnant women is to exclude the presence of invasive cancer and to reassure them that their pregnancy will not be affected by the presence of an abnormal cervical screening test result.
  • Consensus based recommendation star
Practice pointQuestion mark transparent.png

REC14.6: ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. during pregnancy
ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. during pregnancy should be undertaken by a colposcopist experienced in assessing women during pregnancy.

  • Clinical_question:Screening in pregnancy#Practice_point_6
  • REC14.6: ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. during pregnancy
    ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. during pregnancy should be undertaken by a colposcopist experienced in assessing women during pregnancy.
  • Good practice point
Consensus-based recommendation*Question mark transparent.png

REC14.7: Cervical biopsy in pregnancy is usually unnecessary
BiopsyRemoval of tissue for medical examination. of the cervix is usually unnecessary in pregnancy, unless invasive disease is suspected on colposcopy or reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. predicts invasive disease.

  • Clinical_question:Screening in pregnancy#Practice_point_7
  • REC14.7: Cervical biopsy in pregnancy is usually unnecessary
    BiopsyRemoval of tissue for medical examination. of the cervix is usually unnecessary in pregnancy, unless invasive disease is suspected on colposcopy or reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. predicts invasive disease.
  • Consensus based recommendation star
Consensus-based recommendation*Question mark transparent.png

REC14.8: Defer treatment until after pregnancy
Definitive treatment of a suspected high-grade lesion, except invasive cancer, may be safely deferred until after the pregnancy.

  • Clinical_question:Screening in pregnancy#Practice_point_8
  • REC14.8: Defer treatment until after pregnancy
    Definitive treatment of a suspected high-grade lesion, except invasive cancer, may be safely deferred until after the pregnancy.
  • Consensus based recommendation star
Practice pointQuestion mark transparent.png

REC14.9: Follow-up assessment after pregnancy
If postpartum follow-up assessment (colposcopy and/or HPV test and reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. if necessary) is required, it should be done no less than 6 weeks after delivery and preferably at 3 months. This interval is optimal to reduce the risk of reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. interpretation difficulties or unsatisfactory reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory..

The cervical sample (for HPV test and reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. if necessary) could be collected at the time of postpartum check or at the time of the colposcopic assessment.

  • Clinical_question:Screening in pregnancy#Practice_point_9
  • REC14.9: Follow-up assessment after pregnancy
    If postpartum follow-up assessment (colposcopy and/or HPV test and reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. if necessary) is required, it should be done no less than 6 weeks after delivery and preferably at 3 months. This interval is optimal to reduce the risk of reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. interpretation difficulties or unsatisfactory reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory..

The cervical sample (for HPV test and reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. if necessary) could be collected at the time of postpartum check or at the time of the colposcopic assessment.

  • Good practice point
Practice pointQuestion mark transparent.png

REC14.10: Vaginal oestrogen prior to postpartum colposcopy
For women who are breastfeeding, the use of intra-vaginal oestrogen cream or pessary prior to colposcopy may improve visualisation of the cervix and the quality of any cervical sample for LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory..

Daily for two weeks and cease approximately 3 days before colposcopy.

  • Clinical_question:Screening in pregnancy#Practice_point_10
  • REC14.10: Vaginal oestrogen prior to postpartum colposcopy
    For women who are breastfeeding, the use of intra-vaginal oestrogen cream or pessary prior to colposcopy may improve visualisation of the cervix and the quality of any cervical sample for LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory..



Daily for two weeks and cease approximately 3 days before colposcopy.

  • Good practice point
Practice pointQuestion mark transparent.png

REC14.11: Cervical screening in pregnancy
Routine antenatal and postpartum care should include a review of the woman’s cervical screening history. Women who are due or overdue for screening should be screened.

  • Clinical_question:Screening in pregnancy#Practice_point_11
  • REC14.11: Cervical screening in pregnancy
    Routine antenatal and postpartum care should include a review of the woman’s cervical screening history. Women who are due or overdue for screening should be screened.
  • Good practice point
Practice pointQuestion mark transparent.png

REC14.12: Cervical screening in pregnancy
A woman can be safely screened at any time during pregnancy, provided that the correct sampling equipment is used. A cytobrush or combi-brush should not be inserted into the cervical canal because of the risk of associated bleeding, which may distress women.

  • Clinical_question:Screening in pregnancy#Practice_point_12
  • REC14.12: Cervical screening in pregnancy
    A woman can be safely screened at any time during pregnancy, provided that the correct sampling equipment is used. A cytobrush or combi-brush should not be inserted into the cervical canal because of the risk of associated bleeding, which may distress women.
  • Good practice point
Practice pointQuestion mark transparent.png

REC14.13: Self-collection in pregnancy
Self-collection for HPV testing is not recommended in pregnancy.

  • Clinical_question:Screening in pregnancy#Practice_point_13
  • REC14.13: Self-collection in pregnancy
    Self-collection for HPV testing is not recommended in pregnancy.
  • Good practice point

Back to top

15. Screening in women who experienced early sexual intercourse or have been victims of sexual abuse

MSACThe Australian Medical Services Advisory Committee evidence-based recommendationQuestion mark transparent.png

REC15.1: Routine cervical screening is not recommended in young women
Routine cervical screening is not recommended in women under the age of 25 years.

  • Clinical_question:Women experienced early sexual activity or victims of abuse#Practice_point_1
  • REC15.1: Routine cervical screening is not recommended in young women
    Routine cervical screening is not recommended in women under the age of 25 years.
  • Recommendation msac
Consensus-based recommendationQuestion mark transparent.png

REC15.2: Early sexual activity and cervical screening in young women
For women who experienced first sexual activity at a young age (<14 years) and who had not received the HPV vaccine before sexual debut, a single HPV test between 20 and 24 years of age could be considered on an individual basis.

  • Clinical_question:Women experienced early sexual activity or victims of abuse#Practice_point_2
  • REC15.2: Early sexual activity and cervical screening in young women
    For women who experienced first sexual activity at a young age (<14 years) and who had not received the HPV vaccine before sexual debut, a single HPV test between 20 and 24 years of age could be considered on an individual basis.
  • Consensus based recommendation
Consensus-based recommendationQuestion mark transparent.png

REC15.3: Women with abnormal vaginal bleeding
Women at any age who have signs or symptoms suggestive of cervical cancer or its precursors, should have a co-testHPV test and LBC both requested and performed on a cervical sample. and be referred for appropriate investigation to exclude genital tract malignancy.

Co-testingHPV test and LBC both requested and performed on a cervical sample. (HPV and LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory.) is recommended as the presence of blood has the potential to adversely affect the sensitivity of any of the available tests.

  • Clinical_question:Women experienced early sexual activity or victims of abuse#Practice_point_3
  • REC15.3: Women with abnormal vaginal bleeding
    Women at any age who have signs or symptoms suggestive of cervical cancer or its precursors, should have a co-testHPV test and LBC both requested and performed on a cervical sample. and be referred for appropriate investigation to exclude genital tract malignancy.



Co-testingHPV test and LBC both requested and performed on a cervical sample. (HPV and LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory.) is recommended as the presence of blood has the potential to adversely affect the sensitivity of any of the available tests.

  • Consensus based recommendation

Back to top

16. Screening in immune-deficient women

Consensus-based recommendationQuestion mark transparent.png

REC16.1: Immune-deficient women in whom oncogenic HPV is not detected
Immune-deficient women who have a HPV test in which oncogenic HPV types are not detected should be screened every 3 years with a HPV test.

  • Clinical_question:Screening in immune-deficient women#Practice_point_1
  • REC16.1: Immune-deficient women in whom oncogenic HPV is not detected
    Immune-deficient women who have a HPV test in which oncogenic HPV types are not detected should be screened every 3 years with a HPV test.
  • Consensus based recommendation
Consensus-based recommendationQuestion mark transparent.png

REC16.2: ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. referral: positive oncogenic HPV test result (any type) in immune-deficient women
Women who are immune-deficient and have a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result should be referred for colposcopic assessment informed by the reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory..

  • Clinical_question:Screening in immune-deficient women#Practice_point_2
  • REC16.2: ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. referral: positive oncogenic HPV test result (any type) in immune-deficient women
    Women who are immune-deficient and have a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result should be referred for colposcopic assessment informed by the reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory..
  • Consensus based recommendation
Consensus-based recommendation*Question mark transparent.png

REC16.3: ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. assessment and treatment in immune-deficient women
Assessment and treatment of immune-deficient women with screen-detected abnormalities should be by an experienced colposcopist or in a tertiary centre.

  • Clinical_question:Screening in immune-deficient women#Practice_point_3
  • REC16.3: ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. assessment and treatment in immune-deficient women
    Assessment and treatment of immune-deficient women with screen-detected abnormalities should be by an experienced colposcopist or in a tertiary centre.
  • Consensus based recommendation star
Consensus-based recommendation*Question mark transparent.png

REC16.4: ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. of whole lower genital tract in immune-deficient women
The entire lower anogenital tract should be assessed, as the same risk factors apply for cervical, vaginal, vulval, perianal and anal lesions.

  • Clinical_question:Screening in immune-deficient women#Practice_point_4
  • REC16.4: ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. of whole lower genital tract in immune-deficient women
    The entire lower anogenital tract should be assessed, as the same risk factors apply for cervical, vaginal, vulval, perianal and anal lesions.
  • Consensus based recommendation star
Consensus-based recommendation*Question mark transparent.png

REC16.5: Treatment in immune-deficient women
When treatment of the cervix is considered necessary in immune-deficient women, it should be by excisional methods.

  • Clinical_question:Screening in immune-deficient women#Practice_point_5
  • REC16.5: Treatment in immune-deficient women
    When treatment of the cervix is considered necessary in immune-deficient women, it should be by excisional methods.
  • Consensus based recommendation star
Practice pointQuestion mark transparent.png

REC16.6: Histological abnormalities of the cervix in immune-deficient women
Women with histologically confirmed abnormalities should be managed according to the same guidelines as women who are not immune-deficient.

  • Clinical_question:Screening in immune-deficient women#Practice_point_6
  • REC16.6: Histological abnormalities of the cervix in immune-deficient women
    Women with histologically confirmed abnormalities should be managed according to the same guidelines as women who are not immune-deficient.
  • Good practice point
Practice pointQuestion mark transparent.png

REC16.7: Test of Cure for treated immune-deficient women
Women who are immune-deficient and treated for HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2/3) should have follow-up with Test of Cure as recommended in these guidelines. Women who complete Test of Cure should return to routine 3-yearly screening with a HPV test.

  • Clinical_question:Screening in immune-deficient women#Practice_point_7
  • REC16.7: Test of Cure for treated immune-deficient women
    Women who are immune-deficient and treated for HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2/3) should have follow-up with Test of Cure as recommended in these guidelines. Women who complete Test of Cure should return to routine 3-yearly screening with a HPV test.
  • Good practice point
Practice pointQuestion mark transparent.png

REC16.8: Screening before solid organ transplantation
Women aged between 25 and 74 years should have a review of cervical screening history when they are added to the organ transplant waiting list and while they remain on the waiting list, to confirm they are up to date with recommended screening for the general population. Women who are overdue for screening, or become due while on the waiting list ,should be screened with a HPV test so that any abnormalities can be investigated or treated as necessary prior to transplantation and commencement of immunosuppressive therapy.

  • Clinical_question:Screening in immune-deficient women#Practice_point_8
  • REC16.8: Screening before solid organ transplantation
    Women aged between 25 and 74 years should have a review of cervical screening history when they are added to the organ transplant waiting list and while they remain on the waiting list, to confirm they are up to date with recommended screening for the general population.

Women who are overdue for screening, or become due while on the waiting list ,should be screened with a HPV test so that any abnormalities can be investigated or treated as necessary prior to transplantation and commencement of immunosuppressive therapy.

  • Good practice point
Practice pointQuestion mark transparent.png

REC16.9: Screening women with a new diagnosis of HIV
Women aged between 25 and 74 years who have a new diagnosis of HIV should have a review of their cervical screening history to ensure they are up to date with screening in line with the recommended 3-yearly interval for this group.

  • Clinical_question:Screening in immune-deficient women#Practice_point_9
  • REC16.9: Screening women with a new diagnosis of HIV
    Women aged between 25 and 74 years who have a new diagnosis of HIV should have a review of their cervical screening history to ensure they are up to date with screening in line with the recommended 3-yearly interval for this group.
  • Good practice point
Practice pointQuestion mark transparent.png

REC16.10: Other groups that may require special consideration
The groups listed below could be considered for screening every 3 years with a HPV test in accordance with the recommendation for HIV-positive women and solid organ transplant recipients:

  • women with congenital (primary) immune deficiency
  • women who are being treated with immunosuppressant therapy for autoimmune disease (e.g. inflammatory bowel disease, systemic lupus erythematosus, rheumatoid arthritis, neuromyelitis optica, sarcoidosis)
  • allogenic bone marrow transplant recipients treated for graft versus host disease.
  • Clinical_question:Screening in immune-deficient women#Practice_point_10
  • REC16.10: Other groups that may require special consideration
    The groups listed below could be considered for screening every 3 years with a HPV test in accordance with the recommendation for HIV-positive women and solid organ transplant recipients:
  • women with congenital (primary) immune deficiency
  • women who are being treated with immunosuppressant therapy for autoimmune disease (e.g. inflammatory bowel disease, systemic lupus erythematosus, rheumatoid arthritis, neuromyelitis optica, sarcoidosis)
  • allogenic bone marrow transplant recipients treated for graft versus host disease.
  • Good practice point
Practice pointQuestion mark transparent.png

REC16.11: Regular screening for immune-deficient women
Women who are immune deficient should be educated regarding the increased risk from HPV infection and encouraged to attend for regular screening.

  • Clinical_question:Screening in immune-deficient women#Practice_point_11
  • REC16.11: Regular screening for immune-deficient women
    Women who are immune deficient should be educated regarding the increased risk from HPV infection and encouraged to attend for regular screening.
  • Good practice point
Practice pointQuestion mark transparent.png

REC16.12: Young women with long term immune deficiency
For young women who are sexually active and who have been immune deficient for more than 5 years, a single HPV test between 20 and 24 years of age could be considered on an individual basis (regardless of HPV vaccination status).

  • Clinical_question:Screening in immune-deficient women#Practice_point_12
  • REC16.12: Young women with long term immune deficiency
    For young women who are sexually active and who have been immune deficient for more than 5 years, a single HPV test between 20 and 24 years of age could be considered on an individual basis (regardless of HPV vaccination status).
  • Good practice point
Practice pointQuestion mark transparent.png

REC16.13: Guidance for immune-deficient women and their healthcare professionals
It is important that immune-deficient women and their healthcare professionals are guided by a clinical immunology specialist when using these guidelines.

  • Clinical_question:Screening in immune-deficient women#Practice_point_13
  • REC16.13: Guidance for immune-deficient women and their healthcare professionals
    It is important that immune-deficient women and their healthcare professionals are guided by a clinical immunology specialist when using these guidelines.
  • Good practice point

Back to top

17. Screening in DES-exposed women

Consensus-based recommendationQuestion mark transparent.png

REC17.1: Screening in DESDiethylstilbestrol-exposed women
Women exposed to DESDiethylstilbestrol in utero should be offered an annual co-testHPV test and LBC both requested and performed on a cervical sample. and colposcopic examination of both the cervix and vagina indefinitely.

  • Clinical_question:DESDiethylstilbestrol-exposed women#Practice_point_1
  • REC17.1: Screening in DESDiethylstilbestrol-exposed women


Women exposed to DESDiethylstilbestrol in utero should be offered an annual co-testHPV test and LBC both requested and performed on a cervical sample. and colposcopic examination of both the cervix and vagina indefinitely.

  • Consensus based recommendation
Consensus-based recommendation*Question mark transparent.png

REC17.2: ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. referral for abnormalities in DESDiethylstilbestrol-exposed women
Women exposed to DESDiethylstilbestrol in utero who have a screen-detected abnormality should be managed by an experienced colposcopist.

  • Clinical_question:DESDiethylstilbestrol-exposed women#Practice_point_2
  • REC17.2: ColposcopyThe examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities. referral for abnormalities in DESDiethylstilbestrol-exposed women


Women exposed to DESDiethylstilbestrol in utero who have a screen-detected abnormality should be managed by an experienced colposcopist.

  • Consensus based recommendation star
Practice pointQuestion mark transparent.png

REC17.3: Daughters of women exposed to DESDiethylstilbestrol
These women should be screened in accordance with the NCSPNational Cervical Screening ProgramA joint program of the Australian, state and territory governments. It aims to reduce morbidity and mortality from cervical cancer, in a cost-effective manner through an organised approach to cervical screening. The program encourages women in the target population to have regular Pap smears. policy (5-yearly HPV testing). Evidence of an adverse effect on the daughters of women exposed to DESDiethylstilbestrol in utero has not been found.

However, if these women have concerns, testing similar to that recommended for their DESDiethylstilbestrol-exposed mothers could be considered on an individual basis. Self-collection for HPV testing is not recommended.

  • Clinical_question:DESDiethylstilbestrol-exposed women#Practice_point_3
  • REC17.3: Daughters of women exposed to DESDiethylstilbestrol
    These women should be screened in accordance with the NCSPNational Cervical Screening ProgramA joint program of the Australian, state and territory governments. It aims to reduce morbidity and mortality from cervical cancer, in a cost-effective manner through an organised approach to cervical screening. The program encourages women in the target population to have regular Pap smears. policy (5-yearly HPV testing). Evidence of an adverse effect on the daughters of women exposed to DESDiethylstilbestrol in utero has not been found.

However, if these women have concerns, testing similar to that recommended for their DESDiethylstilbestrol-exposed mothers could be considered on an individual basis. Self-collection for HPV testing is not recommended.

  • Good practice point

Back to top

18. Investigation of abnormal vaginal bleeding

Consensus-based recommendationQuestion mark transparent.png

REC18.1: Women with abnormal vaginal bleeding
Women at any age who have signs or symptoms suggestive of cervical cancer should have a co-testHPV test and LBC both requested and performed on a cervical sample., and referral for appropriate investigation to exclude genital tract malignancy should be considered.

  • Clinical_question:Investigation of abnormal vaginal bleeding#Practice_point_1
  • REC18.1: Women with abnormal vaginal bleeding
    Women at any age who have signs or symptoms suggestive of cervical cancer should have a co-testHPV test and LBC both requested and performed on a cervical sample., and referral for appropriate investigation to exclude genital tract malignancy should be considered.
  • Consensus based recommendation
Consensus-based recommendationQuestion mark transparent.png

REC18.2: Abnormal vaginal bleeding and testing for HPV and LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory.
When women present with abnormal vaginal bleeding, appropriate investigations, which may include a cervical sample for a co-testHPV test and LBC both requested and performed on a cervical sample., should be performed and not delayed due to the presence of blood.

The woman’s recent cervical screening history should also be considered.

  • Clinical_question:Investigation of abnormal vaginal bleeding#Practice_point_2
  • REC18.2: Abnormal vaginal bleeding and testing for HPV and LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory.
    When women present with abnormal vaginal bleeding, appropriate investigations, which may include a cervical sample for a co-testHPV test and LBC both requested and performed on a cervical sample., should be performed and not delayed due to the presence of blood.



The woman’s recent cervical screening history should also be considered.

  • Consensus based recommendation
Consensus-based recommendationQuestion mark transparent.png

REC18.3: Postcoital bleeding in pre-menopausal women
Pre-menopausal women who have a single episode of postcoital bleeding and a clinically normal cervix do not need to be referred for colposcopy if oncogenic HPV is not detected and LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. is negative.

If postcoital bleeding recurs or persists despite a negative co-testHPV test and LBC both requested and performed on a cervical sample. women should be referred to a gynaecologist for appropriate assessment, including colposcopy, to exclude genital tract malignancy.

  • Clinical_question:Investigation of abnormal vaginal bleeding#Practice_point_3
  • REC18.3: Postcoital bleeding in pre-menopausal women
    Pre-menopausal women who have a single episode of postcoital bleeding and a clinically normal cervix do not need to be referred for colposcopy if oncogenic HPV is not detected and LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. is negative.



If postcoital bleeding recurs or persists despite a negative co-testHPV test and LBC both requested and performed on a cervical sample. women should be referred to a gynaecologist for appropriate assessment, including colposcopy, to exclude genital tract malignancy.

  • Consensus based recommendation
Practice pointQuestion mark transparent.png

REC18.4: Postcoital bleeding and sexually transmitted infections
Sexually transmitted infections, including Chlamydia infection, should be considered and, when appropriate, excluded in all women presenting with postcoital bleeding. It is necessary to obtain a sexual health history and perform appropriate tests and investigations.

  • Clinical_question:Investigation of abnormal vaginal bleeding#Practice_point_4
  • REC18.4: Postcoital bleeding and sexually transmitted infections
    Sexually transmitted infections, including Chlamydia infection, should be considered and, when appropriate, excluded in all women presenting with postcoital bleeding. It is necessary to obtain a sexual health history and perform appropriate tests and investigations.
  • Good practice point
Consensus-based recommendation*Question mark transparent.png

REC18.5: Symptomatic women with LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of cervical cancer
Women with symptoms and a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of invasive cervical cancer should be referred to a gynaecological oncologist or gynaecological cancer centre for assessment.

  • Clinical_question:Investigation of abnormal vaginal bleeding#Practice_point_5
  • REC18.5: Symptomatic women with LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of cervical cancer
    Women with symptoms and a LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. prediction of invasive cervical cancer should be referred to a gynaecological oncologist or gynaecological cancer centre for assessment.
  • Consensus based recommendation star
Consensus-based recommendationQuestion mark transparent.png

REC18.6: Women with intermenstrual bleeding may require specialist referral
Women with persistent and/or unexplained intermenstrual bleeding require appropriate investigation and should be referred for specialist gynaecological assessment, regardless of any test results.

  • Clinical_question:Investigation of abnormal vaginal bleeding#Practice_point_6
  • REC18.6: Women with intermenstrual bleeding may require specialist referral
    Women with persistent and/or unexplained intermenstrual bleeding require appropriate investigation and should be referred for specialist gynaecological assessment, regardless of any test results.
  • Consensus based recommendation
Consensus-based recommendationQuestion mark transparent.png

REC18.7: Postmenopausal women with vaginal bleeding require specialist referral
Postmenopausal women with any vaginal bleeding, including postcoital bleeding, should be referred for a specialist gynaecological assessment, to exclude genital tract malignancy.

  • Clinical_question:Investigation of abnormal vaginal bleeding#Practice_point_7
  • REC18.7: Postmenopausal women with vaginal bleeding require specialist referral
    Postmenopausal women with any vaginal bleeding, including postcoital bleeding, should be referred for a specialist gynaecological assessment, to exclude genital tract malignancy.
  • Consensus based recommendation

Back to top

20. Transition to the renewed National Cervical Screening Program

Practice pointQuestion mark transparent.png

REC20.1: HPV test replaces the Pap test

All Pap tests are replaced by HPV testing.

Conventional Pap tests are no longer used.

Reflex LBCReflex liquid-based cytologyA test performed on a liquid-based cytology sample when there is a positive oncogenic HPV test result. Reflex LBC may allow for the triage of women along different pathways, negative, LSIL and HSIL, glandular. For women who have HPV16 and/or 18, and who are being referred directly to colposcopy, the reflex LBC result would inform the colposcopic assessment. will be performed on any sample with a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result.

Co-testingHPV test and LBC both requested and performed on a cervical sample. (HPV and LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory.) to be performed only as recommended in these guidelines, in the follow-up of screen-detected abnormalities or the investigation of abnormal vaginal bleeding.

  • Clinical_question:Transition to the renewed National Cervical Screening Program#Practice_point_1
  • REC20.1: HPV test replaces the Pap test

All Pap tests are replaced by HPV testing.

Conventional Pap tests are no longer used.

Reflex LBCReflex liquid-based cytologyA test performed on a liquid-based cytology sample when there is a positive oncogenic HPV test result. Reflex LBC may allow for the triage of women along different pathways, negative, LSIL and HSIL, glandular. For women who have HPV16 and/or 18, and who are being referred directly to colposcopy, the reflex LBC result would inform the colposcopic assessment. will be performed on any sample with a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result.

Co-testingHPV test and LBC both requested and performed on a cervical sample. (HPV and LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory.) to be performed only as recommended in these guidelines, in the follow-up of screen-detected abnormalities or the investigation of abnormal vaginal bleeding.

  • Good practice point
Practice pointQuestion mark transparent.png

REC20.2: HPV testing for women in follow-up after 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.
Women who are in follow-up for 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. cytology in the previous program (pre-renewal NCSPNational Cervical Screening ProgramA joint program of the Australian, state and territory governments. It aims to reduce morbidity and mortality from cervical cancer, in a cost-effective manner through an organised approach to cervical screening. The program encourages women in the target population to have regular Pap smears.) should have a HPV test at their next scheduled follow-up appointment.

  • Women with a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result should be referred for colposcopic assessment informed by reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory..
  • If oncogenic HPV is not detected, the woman can return to 5-yearly screening.
  • Clinical_question:Transition to the renewed National Cervical Screening Program#Practice_point_2
  • REC20.2: HPV testing for women in follow-up after 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.
    Women who are in follow-up for 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. cytology in the previous program (pre-renewal NCSPNational Cervical Screening ProgramA joint program of the Australian, state and territory governments. It aims to reduce morbidity and mortality from cervical cancer, in a cost-effective manner through an organised approach to cervical screening. The program encourages women in the target population to have regular Pap smears.) should have a HPV test at their next scheduled follow-up appointment.


  • Women with a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result should be referred for colposcopic assessment informed by reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory..
  • If oncogenic HPV is not detected, the woman can return to 5-yearly screening.
  • Good practice point
Practice pointQuestion mark transparent.png

REC20.3: Colposcopic management of a prior screen-detected abnormality should continue
Women who have been referred for colposcopic assessment following any cytological abnormality in the pre-renewal NCSPNational Cervical Screening ProgramA joint program of the Australian, state and territory governments. It aims to reduce morbidity and mortality from cervical cancer, in a cost-effective manner through an organised approach to cervical screening. The program encourages women in the target population to have regular Pap smears. should continue their colposcopic management according to these guidelines.

  • Clinical_question:Transition to the renewed National Cervical Screening Program#Practice_point_3
  • REC20.3: Colposcopic management of a prior screen-detected abnormality should continue
    Women who have been referred for colposcopic assessment following any cytological abnormality in the pre-renewal NCSPNational Cervical Screening ProgramA joint program of the Australian, state and territory governments. It aims to reduce morbidity and mortality from cervical cancer, in a cost-effective manner through an organised approach to cervical screening. The program encourages women in the target population to have regular Pap smears. should continue their colposcopic management according to these guidelines.
  • Good practice point
Practice pointQuestion mark transparent.png

REC20.4: Prior treatment and Test of Cure
Women who have been treated for HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2/3) in the pre-renewal NCSPNational Cervical Screening ProgramA joint program of the Australian, state and territory governments. It aims to reduce morbidity and mortality from cervical cancer, in a cost-effective manner through an organised approach to cervical screening. The program encourages women in the target population to have regular Pap smears. and are undergoing, or have not yet commenced Test of Cure, should start or continue Test of Cure in accordance with these guidelines.

Women should have an annual co-testHPV test and LBC both requested and performed on a cervical sample. (HPV and LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory.) performed at 12 months after treatment, and annually thereafter, until both tests are negative on two consecutive occasions, when they can return to routine 5-yearly screening.

  • Clinical_question:Transition to the renewed National Cervical Screening Program#Practice_point_4
  • REC20.4: Prior treatment and Test of Cure
    Women who have been treated for HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2/3) in the pre-renewal NCSPNational Cervical Screening ProgramA joint program of the Australian, state and territory governments. It aims to reduce morbidity and mortality from cervical cancer, in a cost-effective manner through an organised approach to cervical screening. The program encourages women in the target population to have regular Pap smears. and are undergoing, or have not yet commenced Test of Cure, should start or continue Test of Cure in accordance with these guidelines.



Women should have an annual co-testHPV test and LBC both requested and performed on a cervical sample. (HPV and LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory.) performed at 12 months after treatment, and annually thereafter, until both tests are negative on two consecutive occasions, when they can return to routine 5-yearly screening.

  • Good practice point
Practice pointQuestion mark transparent.png

REC20.5: Prior treatment for AISAdenocarcinoma in situ
Women who have been treated for AISAdenocarcinoma in situ in the pre-renewal NCSPNational Cervical Screening ProgramA joint program of the Australian, state and territory governments. It aims to reduce morbidity and mortality from cervical cancer, in a cost-effective manner through an organised approach to cervical screening. The program encourages women in the target population to have regular Pap smears., and are undergoing or have not yet commenced surveillance, should have annual co-testingHPV test and LBC both requested and performed on a cervical sample. (HPV and LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory.) indefinitely.

Until sufficient data become available that may support a policy decision that cessation of testing is appropriate.

  • Clinical_question:Transition to the renewed National Cervical Screening Program#Practice_point_5
  • REC20.5: Prior treatment for AISAdenocarcinoma in situ

Women who have been treated for AISAdenocarcinoma in situ in the pre-renewal NCSPNational Cervical Screening ProgramA joint program of the Australian, state and territory governments. It aims to reduce morbidity and mortality from cervical cancer, in a cost-effective manner through an organised approach to cervical screening. The program encourages women in the target population to have regular Pap smears., and are undergoing or have not yet commenced surveillance, should have annual co-testingHPV test and LBC both requested and performed on a cervical sample. (HPV and LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory.) indefinitely.

Until sufficient data become available that may support a policy decision that cessation of testing is appropriate.

  • Good practice point

Back to top