Table 3.
Benchmark of quality indicators among countries or regions.
| BSCCP | ASCCP | EFC (EU) | NCSP (NZ) | AEPCC (ESP) |
|---|---|---|---|---|
| Notification of results | ||||
| ·Within 4 weeks (QI≥90%) ·Within 8 weeks (QI: 100%) |
·HSIL: Within 4 weeks ·Suspicion of invasive cancer: Within 2 weeks (60%≤QI ≤ 90%) |
·Varies by country (not specified) | ·Within 30 working days (QI≥95%) | ·Within 8 weeks (QI≥90%) |
| Interval from cytology to colposcopy | ||||
| ·HSIL+ or AGC: within 2 weeks (QI≥93%) ·Others: within 6 weeks (QI≥99%) |
·HSIL: within 4 weeks ·Suspected invasive cancer: within 2 weeks (60%≤QI ≤ 90%) |
·Varies by country (not specified) | ·Suspected invasive cancer: within 10 working days ·HSIL or AGC: within 20 business days ·LSIL (including persistent hrHPV-positive): within 26 weeks ·Persistent hrHPV-positive after HSIL treatment (within 3 years): within 4–12 weeks (QI≥95%) |
·NILM with hrHPV positivity: within 16 weeks ·ASC-US (hrHPV-positive) or LSIL: within 8 weeks ·ASC-H, HSIL, or AGC: within 4 weeks ·AIS or suspected invasive cancer: within 2 weeks (QI≥80%) |
| Documentation of findings | ||||
| ·Reason for referral, hrHPV and cytology findings, TZ type, colposcopic findings of the cervix (including SCJ visibility and cervical visualization), presence of extension into the vaginal wall or endocervical canal, lesion location, colposcopic impression, biopsy site (recommended) (QI: Not numerically specified ) |
·Visibility of SCJ (QI≥90%) ·Presence of acetowhite epithelium (QI ≥90%) ·Colposcopic impression (QI ≥80%) ·Cervical visibility (QI ≥70%) ·Lesion visibility (QI ≥70%) ·Lesion location (QI: 0–100%) |
·Documentation of TZ type in colposcopic assessment (QI: 100%) | ·Accurate documentation of colposcopic findings (including SCJ visibility) at initial and subsequent assessments (QI: 100%) | ·Documentation of lesion characteristics (type, location, visibility) (QI ≥90%) ·Documentation of colposcopic impression (QI ≥90%) |
| Time to treatment intervention | ||||
| ·See and treat (without biopsy) is permitted ·HSIL: within 4 weeks (QI ≥90%), within 8 weeks (QI = 100%) |
·See and treat is permitted for high-risk patients aged ≥25 years * ·For patients under 25, follow-up every 6 months is also acceptable (QI: Not specified) * At least 2 of the followings: HSIL cytology, HPV 16 and/or HPV 18 positive, high-grade colposcopy impression |
·Not determined | ·CIN2/3: within 8 weeks (QI≥90%) |
·HSIL/CIN3: within 8 weeks (QI: Not specified) |
| Treatment | ||||
| ·Excision: single intact specimen (not fragmented) (QI ≥80%) ·Target excision length:TZ1: >7 mm (but <10 mm in reproductive age) TZ2: 10–15 mm, TZ3: 15–25 mm (QI >95%) ·Pathological appropriateness of excised specimen (QI ≥90%) ·Histological treatment failure within 12 months ≤5% (QI ≤5%) |
Not specified | ·Colposcopy prior to treatment for screening abnormalities (QI = 100%) ·Negative endocervical margin in excised specimen (QI >80%) ·Documentation of SCJ (QI = 100%) ·Excisional specimens should confirm CIN2 or worse (QI>85%) |
·Outpatient LLETZ under local anesthesia (QI ≥80%) ·Women who undergo ablative therapy should have histologic assessment confirming appropriateness (QI = 100%) |
·Excision: single intact specimen (not fragmented) (QI ≥80%) ·Excision performed under colposcopic guidance (QI ≥90%) ·Outpatient treatment (QI ≥70%) ·Major hemorrhagic complications requiring treatment (QI <5%) ·Hospitalization due to complications (QI <2%) ·Excision confirms HSIL/CIN2+ (QI ≥70%), no lesion present (QI ≤15%), Overall margin positivity (QI ≤20%), Endocervical margin positivity (QI ≤15%) |
| Post-treatment follow-up | ||||
| ·HSIL/CIN2–3: hrHPV testing at 6 months post-treatment → If negative: return to 3-yearly screening (QI = 100%) → If positive: reflex cytology + colposcopy (QI = 100%) |
After the initial HPV-based test at 6 months, annual HPV or cotesting is preferred until 3 consecutive negative tests have been obtained. | ·Follow-up for up to 20 years after CIN treatment ·hrHPV testing at 6 months (alone or with cytology) ·Repeat cytology and hrHPV at defined intervals, recommend colposcopy if abnormal (QI not specified) |
·Women treated for CIN2/3 should receive cytology and colposcopy within 9 months (QI ≥90%) | ·Residual or recurrent HSIL at 6 months post-treatment (QI ≤ 10%) ·Residual or recurrent HSIL at 24 months post-treatment (QI ≤ 5%) |
| Management of non-attenders | ||||
| · New patients requiring treatment (QI<10%) ·Missed follow-up appointments (non-attenders) (QI<15%) |
·No guideline or QI specified | ·Determined individually by each country (no unified QI) | ·No-show rate for initial appointments and follow-up (QI<15%) | ·No guideline or QI specified |
BSCCP, British Society for Colposcopy and Cervical Pathology; ASCCP, American Society for Colposcopy and Cervical Pathology; EFC, European Federation of Colposcopy; NCSP(NZ), National Cervical Screening Program (New Zealand); AEPCC, Asociación Española de Patología Cervical y Colposcopia.