How are abnormal cervical screening results managed (the screening-to-colposcopy pathway)?

In HPV primary screening: HPV-negative -> routine recall; HPV-positive with normal cytology -> repeat HPV in ~12 months; HPV-positive with abnormal cytology -> colposcopy.

At colposcopy, the cervix is examined with acetic acid/iodine; abnormal areas are biopsied, and high-grade disease (CIN2/3) is treated (usually LLETZ). Treated women have test-of-cure follow-up.

Clinical relevance. Knowing the screening-to-colposcopy pathway (HPV/cytology triage, colposcopy/biopsy, treat CIN2/3, test of cure) underpins cervical cancer prevention.

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Management of abnormal cervical screening results

The screening-to-colposcopy pathway triages women to diagnosis and treatment.

HPV primary screening results

• HPV-negative -> routine recall.
• HPV-positive, normal (negative) cytology -> repeat HPV test in ~12 months (persistent HPV -> colposcopy).
• HPV-positive with abnormal cytology -> refer to colposcopy.

Colposcopy

• The cervix is examined under magnification with acetic acid (acetowhite changes) and iodine (Schiller test).
• Suspicious/abnormal areas are biopsied for histological diagnosis (CIN grade).

Treatment of CIN

• CIN1 - often observed (frequently regresses).
• CIN2/3 (high-grade) - treated, usually by LLETZ (excision) or ablation.

Follow-up

• Test of cure - an HPV test after treatment (HPV-negative -> return to routine recall) to confirm successful treatment.