. 2021 Jan 15;30(1):5–13. doi: 10.1089/jwh.2020.8918

Table 2.

Comparison of 2012 and 2019 Consensus Recommendations for Management of Common Abnormalities (ASCCP)

Current HPV result	Current Pap test result	Prior results	Management by 2012 guidelines	Management by 2019 guidelines
Negative	ASC-US	Unknown or HPV-negative^a	Repeat Pap plus HPV testing in 3 years	Repeat HPV test with or without concurrent Pap test in 3 years
Negative	LSIL	Unknown or HPV-negative^a	Repeat Pap plus HPV testing in 1 year preferred, colposcopy acceptable	Repeat HPV test with or without concurrent Pap test in 1 year
Negative	ASC-H	Noncontributory	Colposcopy	Colposcopy
Noncontributory	AGC	Noncontributory	Colposcopy	Colposcopy
Positive	NILM	Unknown or HPV-negative^a	Repeat Pap plus HPV testing in 1 year	Repeat HPV test with or without concurrent Pap test in 1 year
Positive	NILM	HPV-positive^b	Colposcopy	Colposcopy
Positive for genotype HPV16 and/or HPV18	NILM	Noncontributory	Colposcopy	Colposcopy
Positive for genotype HPV16 and/or HPV18	ASC-US or LSIL	Noncontributory	Not applicable, genotyping not recommended for ASCUS/LSIL in 2012	Colposcopy
Positive	ASC-US or LSIL	Unknown or HPV-positive	Colposcopy	Colposcopy
Positive	ASC-US or LSIL	Negative screening results with HPV testing or HPV plus Pap testing within past 5 years	Colposcopy	Repeat HPV test with or without concurrent Pap test in 1 year^c
Positive	ASC-US or LSIL	Colposcopy confirming the absence of high-grade lesion within the past year	Colposcopy	Repeat HPV test with or without concurrent Pap test in 1 year^c
Positive	ASC-H	Noncontributory	Colposcopy	Colposcopy or expedited treatment
Positive: untyped Positive: genotype other than HPV 16 Negative	HSIL	Noncontributory	Colposcopy or expedited treatment	Colposcopy or expedited treatment
Positive: genotype HPV16	HSIL	Noncontributory	Colposcopy or expedited treatment	Expedited treatment^d

Bold indicates difference between 2012 and 2019 guidelines.

^{^a}

Note colposcopy may be warranted for patients with a history of high-grade lesions (CIN2, CIN3, histologic or cytologic HSIL, ASC-H, AGC, AIS).

^{^b}

Prior Pap results do not modify the recommendation; colposcopy is always recommended for two consecutive HPV-positive tests.

^{^c}

Negative HPV test or cotest (HPV plus Pap test) results only reduce risk sufficiently to defer colposcopy if performed for screening purposes within the last 5 years. Colposcopy is still warranted if negative HPV test or cotest results occurred in the context of surveillance for a prior abnormal result.

^{^d}

Expedited treatment is preferred for nonpregnant patients aged 25 and older. Colposcopy with biopsy is an acceptable option if desired by patient after shared decision-making.

AGC, atypical glandular cells; ASC-H, atypical squamous cells cannot exclude HSIL; ASC-US, atypical squamous cells of undetermined significance; LSIL, low-grade squamous intraepithelial lesion; NILM, negative for intraepithelial lesion or malignancy; Pap, Papanicolaou.