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Cervical cancer screening

Preparation of cervical screening reports

GUIDELINE UPDATES - This guideline was last updated 7/1/2022

Preparation of cervical screening reports

Examples of cervical screening reports conforming to the requirements of the renewed NCSP are found in the Supplement. Sample reports.

Cervical screening result

Reported as low, intermediate or higher risk of significant cervical abnormality, or as unsatisfactory for evaluation, based on both the HPV test and (where indicated) reflex LBC (Table 3.2).

Table 3.2. Reporting of cervical screening result

Findings
Report
HPV test resultReflex LBC
Oncogenic HPV not detectedN/ALow risk for significant cervical abnormality
Oncogenic HPV (not 16/18)Negative or pLSIL/LSILIntermediate risk for significant cervical abnormality
HPV 16/18Any of the following:
Unsatisfactory
Negative
pLSIL/LSIL
pHSIL/HSIL+
Any glandular abnormality
Higher risk for significant cervical abnormality
Oncogenic HPV (not 16/18)pHSIL/HSIL+
Any glandular abnormality
Higher risk for significant cervical abnormality
Oncogenic HPV (any type) persisting at 12 month repeat following initial oncogenic HPV (not 16/18)

Any of the following:
Unsatisfactory
Negative
pLSIL/LSIL

pHSIL/HSIL+
Any glandular abnormality

Higher risk for significant cervical abnormality
Test not completed for technical reasonsN/AUnsatisfactory for evaluation
Oncogenic HPV (not 16/18)UnsatisfactoryUnsatisfactory for evaluation

LBC: liquid-based cytology
HSIL+: HSIL or higher-grade abnormality

Specimen type

  • Indicate sample medium.
  • Indicate method of collection:
    • practitioner-collected
    • Indicate that the specimen is cervical in origin.
    • self-collected.

Test result(s)

HPV test

  • Indicate the test method used.
  • Indicate the test result:
    • HPV 16/18 detected. (For test platforms that do not distinguish between HPV 18 and 45, use this category to report HPV 18/45.)
    • oncogenic HPV (not 16/18) detected. (For test platforms that separately identify 45,31,33 or other oncogenic types (not 16/18), include any such types in this category.)
    • oncogenic HPV not detected
    • unsatisfactory.

LBC results

  • Indicate method of analysis:
    • image assisted
    • manually screened.
  • Report the epithelial cell findings using AMBS terminology.
    • Include a statement on the presence or absence of an endocervical component.
    • Note the presence of organisms when identified:
      • Trichomonas vaginalis
      • fungal organisms morphologically consistent with Candida spp
      • shift in flora suggestive of bacterial vaginosis
      • bacteria morphologically consistent with Actinomyces spp
      • cellular changes consistent with herpes simplex virus.
  • Note the presence of other non-neoplastic findings when identified (optional):
    • reactive cellular changes associated with:
      • inflammation and repair
      • radiation
      • intrauterine contraceptive device
  • glandular cells after hysterectomy
  • atrophy.

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Recommendation

Concise management recommendations, as set out in these guidelines, should be included in the report. 

The recommendation must take account of the woman’s screening history as recorded with the National Cancer Screening Register (NCSP). 

The management recommendations should align with the cervical screening result as follows:

Cervical screening resultManagement recommendation’
Low risk of significant cervical abnormalityRescreen in 5 years
Intermediate risk of significant cervical abnormalityRepeat HPV test in 12 months
Higher risk of significant cervical abnormalityRefer for colposcopic assessment
UnsatisfactoryRetest in 6 weeks#

#In cases where the HPV test has been performed and reflex LBC is indicated but cannot be performed, the laboratory should not repeat the HPV test on receipt of the repeat sample, but should proceed directly to LBC and then issue a combined report taking account of both tests.

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Preparation of stand-alone LBC reports

LBC will be requested without an HPV test in the following circumstances:

  • at the time of colposcopy (when indicated)
  • where reflex LBC has been reported as ‘Unsatisfactory’ following the detection of oncogenic HPV (not 16/18)
  • following the detection of Oncogenic HPV (not 16/18) in a self-collected sample.

Reporting LBC at the time of colposcopy

LBC on samples taken at the time of colposcopy is not considered a screening test, but rather as part of the assessment process. Accordingly, an over-arching cervical screening report incorporating a risk statement is not required or appropriate in this setting.

  • Indicate sample medium.
  • Indicate method of analysis:
    • image assisted
    • manually screened.
  • Report the epithelial cell findings using AMBS terminology (2004).
  • Include a statement on the presence or absence of an endocervical component.
  • Note the presence of organisms when identified:
    • Trichomonas vaginalis
    • fungal organisms morphologically consistent with Candida spp
    • shift in flora suggestive of bacterial vaginosis
    • bacteria morphologically consistent with Actinomyces spp
    • cellular changes consistent with herpes simplex virus.
  • Note the presence of other non-neoplastic findings when identified (optional):
    • reactive cellular changes associated with:
      • inflammation and repair
      • radiation
      • intrauterine contraceptive device
    • glandular cells after hysterectomy
    • atrophy.
  • Document that the woman is under gynaecological management and therefore a recommendation is not provided.

Following Unsatisfactory LBC

Where a woman has a positive oncogenic HPV (not 16/18) test result and the reflex LBC was unsatisfactory, she should have a further cervical sample taken for LBC in 6 weeks. The repeat cervical sample should not be tested for HPV. The laboratory should undertake LBC and prepare a cervical screening report (see Preparation of cervical screening reports), combining the results of the original HPV test and the repeat LBC. It is anticipated that the support of the National Cancer Screening Register will be critical in this circumstance.

Following self-collection

Where a woman has a positive oncogenic HPV (not 16/18) test result on a self-collected sample she should have an LBC sample taken by her health care professional. The LBC specimen should not be tested for HPV. The laboratory should undertake LBC and prepare a cervical screening report (see Preparation of cervical screening reports), combining the results of the original HPV test result and the LBC. It is anticipated that the support of the National Cancer Screening Register will be critical in this circumstance.

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WEBSITE UPDATES - This website was last updated 7/1/2022

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