Implementation guide: primary HPV screening

Appendix 2: cervical screening colposcopy management

recommendations

Colposcopy Examination

Inadequate Adequate

No CIN on biopsy, Abnormal biopsy CIN1+

no biopsy or no or colposcopic
colposcopic impression of CIN1 (no
impression of CIN biopsy)

Index hrHPV
positive cytology Index hrHPV Index hrHPV Index hrHPV
≤low grade* positive/cytology positive/cytology positive/cytology
≥high grade or ≤low grade* ≥high grade or
borderline borderline
(endocervical) (endocervical)

Repeat colposcopy in Recall in 36 months Manage according to

12 months ‘abnormal colposcopy
LLETZ Discussion at MDT examination’
within 2 months (see below)

Inadequate
consider LLETZ
patient choice

*excludes borderline change in endocervical cells

Implementation guide: primary HPV screening

Colposcopy Examination

Abnormal

CIN1 on biopsy or colposcopic ≥CIN2 CGIN*

impression

Treatment Treatment

Recall in 12 months Recall in 6 months Recall in 6 months

hrHPV hrHPV hrHPV hrHPV hrHPV hrHPV

negative positive negative positive negative positive

Recall in 36 Cytology Cytology Recall in 36 Cytology Recall in 12 Cytology negative or Cytology abnormal
months negative abnormal months negative, months inadequate Refer to colposcopy
Recall in 12 Refer to inadequate Refer to colposcopy If normal colposcopy
months colposcopy or abnormal If normal colposcopy - and/or no re-excision
Refer to Recall in 12 months Complete 10 year
colposcopy follow up

hrHPV hrHPV
negative positive hrHPV hrHPV
negative positive

Recall in 36 Cytology Cytology

months negative abnormal Recall in 36 Cytology negative or Cytology abnormal
Recall in 36 Refer to months inadeqaute Refer to colposcopy
months colposcopy Refer to colposcopy If normal colposcopy
If normal colposcopy - and/or no re-excision
Recall in 12 months Complete 10 year
*Women who have been adequately treated (complete excision margins)
follow up
for CGIN or SMILE