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Abnormal Pap Smear Cytology +/- Abnormal hrHPV Co-testing

LSIL

ASC-US

ASC-H

HSIL

SCC (clear evidence)

Atypical glandular cells

Endometrial cells

Reflex hrHPV testing

Repeat testing in 1 year (age 21-24) or co-testing in 3 years (age >24)

Colposcopy +/- biopsy

Mildly atypical cells in the lower 1/3 of cervix

Moderately atypical cells in the lower 2/3 of cervix

Severely atypical cells in more than the lower 2/3 of cervix

Mild dysplasia (CIN I)

Moderate dysplasia (CIN II)

Severe dysplasia (CIN III)

Repeat testing in 1 year

LEEP or conization

LEEP or conization

Squamous cell carcinoma

Surgical resection and/or chemotherapy (stage-dependent)

Endometrial sampling (if age >=35 or high risk)

CIN II or less

Non-diagnostic or evidence of AIS

Repeat Pap smear with hrHPV co-testing in 12 months

Conization

Adenocarcinoma in situ (AIS)

Adenocarcinoma

Surgical resection

Surgical resection

Endometrial sampling and endocervical curettage

Endometrial pathology

No endometrial pathology

See Abnormal Uterine Bleeding

Proceed based on diagnostic findings

Colposcopy with endocervical curettage

Colposcopy

aub-box: Abnormal uterine bleeding