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.
NHSCSP Screening Protocol algorithm for HPV Triage and TOC
Early identification allows earlier referral and treatment
(i) The management of women with abnormal cytology at this second 12 month follow up test will mirror that at the first 12 month repeat test
(ii) Women referred back to colposcopy (at TOC following treatment for CIN) due to borderline, low-grade dyskaryosis or negative cytology,
who are HR-HPV positive, and who then have a satisfactory and negative colposcopy, can be recalled in 3 years.
(iii) Women who have been adequately treated (complete excision margins) for CGIN or SMILE will follow the management in this protocol algorithm. Women receiving annual surveillance tests following treatment for CGIN or SMILE in the past may also be tested in line with this policy at their next two tests. Women treated for cervical cancer are excluded from this management policy.
|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)||9||(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||colposcopy 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.)|
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.