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Recommended management of women

NHSCSP triage and test of cure protocol1

NHSCSP protocol for triage and test of cure - established the role of HPV testing in the assessment of women with borderline or low-grade dyskaryosis (mild dyskaryosis) LBC results. In England implementation of the protocol started in 2011.

  • HPV DNA triage testing for high-risk (oncogenic) types of HPV is the method chosen for managing women aged 25 years and older with borderline or mild dyskaryosis, query high-grade or borderline endocervical cells, cytology results.
  • Women resident in England but initially screened in Wales or Scotland (screening starting at 20 years of age) and who are reinvited automatically for cervical screening by the NHAIS (Exeter System) system at 21 to 24 years of age, are not eligible for HPV triage in England before age 25.
  • HPV Triage demonstrated a 70% and 87% reduction in repeat cervical screening results for borderline and mild precancerous changes, respectively.2


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Provisional Result codes    Action codes  
Ø * ?glandular neoplasia (non cervical)   A routine recall
G * ?glandular neoplasia (non cervical) (HPV tested)   Rm early repeat in 'm' months
1 inadequate   S suspend from recall
2 negative (not HPV tested)   Infection codes   
N        negative (HPV tested)    Ø (zero) HPV negative 
3 low grade dyskaryosis (not HPV tested)   (nine) HPV positive
M low grade dyskaryosis (HPV tested)   U HPV result inadequate/unreliable 
4            high grade dyskaryosis (severe)   Miscellaneous  
5 high grade dyskaryosis? invasive squamous carcinoma   NTDD  Next Test Due Date  
6 ? glandular neoplasia of endocervical type      
7 high grade dyskaryosis (moderate)   BLUE indicates codes used on NHAIS in format 
8 borderline change in squamous cells (not HPV tested)    Cytology result – HPV infection code – Action code  
B borderline change in squamous cells (HPV tested)     RED indicates manual action required to reset NTDD
9 borderline change in endocervical cells     5Star.jpgcolposcopy referral without HPV test  
E borderline change in endocervical cells (HPV tested)      
       
* non-cervical neoplasia treated as negative for CSP management (2) Used to denote both categories of negative result (negative and ?glandular neoplasia (non cervical)) or both categories of borderline result (borderline change in squamous cells and borderline change in endocervical cells.)
  • Acronyms:

References:

1. HPV Triage and Test of Cure Implementation Guide, NHS Cancer Screening Programmes; HPV TRIAGE AND TEST OF CURE: IMPLEMENTATION GUIDANCE, NHSCSP Good Practice Guide No3, July 2011.

2. Moss S, Gray A, Legood R, et al. Effect of testing for human papilloma virus as a triage during screening for cervical cancer: observational before and after study. BMJ 2006;332:83-85.