The 2008 ACOG (The American College of Obstetricians and Gynecologists ACOG) guidelines on the management of cervical cytology and histological abnormalities are presented. I. Level A evidence 1. Premenopausal women aged 21 or older with ASCUS (atypical squamous cells) found on cervical cytology: perform colposcopy or check for high-risk HPV or repeat TCT at 6 or 12 months. 2. Colposcopy is recommended for HPV-positive ASCUS, LSIL (low-grade lesions), and ASCUS at any age without excluding HSIL (high-grade lesions). 3.HPV positive ASCUS, LSIL, ASCUS without exclusion of HSIL, etc. colposcopy without finding CIN2 or CIN3, repeat TCT at 6 or 12 months or HPV at 12 months without treatment, repeat colposcopy if still ASCUS or HPV positive on recheck; two consecutive TCT or one HPV negative, then switch to routine screening. 4. For women aged 21 years or older with cytologic findings of HSIL, LEEP or colposcopy is feasible, along with removal of the endocervical canal for examination; for women with HSIL found during puberty or pregnancy, colposcopy is recommended instead of immediate excision. In non-pregnant women with HSIL, when colposcopy is unsatisfactory or any grade of CIN is found in the endocervical canal, diagnostic resection (LEEP or cold knife conization) is recommended. 5. After treatment for CIN2 and CIN3, HPV DNA is checked at 6-12 months or cytology and/or colposcopy every 6 months, and cytology is recommended for adolescent women. colposcopy is recommended in cases of HPV positivity or repeat cytological findings of ASCUS and above. If HPV negative or two consecutive negative cytologies, routine cytology every 12 months for at least 20 years. Level B evidence 1. Women aged 21 years and older with ASCUS and HPV negative or unknown HPV status and negative colposcopy may repeat TCT in 1 year; patients with ASUS, cytology every 6 months with a total of two negative tests may be referred to routine screening. 2. Women with cytologic ASCUS or LSIL during adolescence (before age 21), or with CIN1 due to ASCUS, LSIL, or AGC-NOS colposcopy histologic findings, may be retested every 12 months. Colposcopy is required at the first review for HSIL and above only, and colposcopy should be performed for ASCUS and above found during the 24-month review. HPV testing is not necessary in adolescent women, and a positive HPV result does not affect the choice of treatment. 3. When colposcopy is performed for ASCUS or LSIL in non-pregnant women, cervical canal sampling should be performed if no lesions are found or if colposcopy is unsatisfactory, and cervical canal sampling is also required for lesions found in the migratory zone. For all non-pregnant women with HSIL, colposcopy or cervical canal sampling is recommended, and microscopic canal scraping is not recommended for pregnant women. 4. Pregnant women with CIN1 do not require treatment but should be followed up. 5. Women 21 years of age or older with CIN1 that has persisted for at least 2 years may continue to be followed up or treated. When choosing treatment, if colposcopy is satisfactory, it can be removed or eliminated (physical therapy). If colposcopy is unsatisfactory, cervical canal is positive, or previously treated, excision is recommended. 6.Pregnant women with histologically confirmed CIN2 or CIN3 and infiltrating carcinoma is ruled out can be evaluated by cytology and colposcopy within 6 weeks postpartum. Unless infiltrating carcinoma is suspected, treatment is not recommended during pregnancy, and if infiltrating carcinoma is suspected, diagnostic excision is recommended. 7. If CIN2 or CIN3 is sampled from the incisional margin or cervical canal after diagnostic resection, cytology and endocervical canal sampling will be performed for evaluation 4-6 months after treatment. For persistent or recurrent CIN2 and CIN3, diagnostic resection can be repeated, and if re-excision is difficult, hysterectomy is feasible. 8. Non-pregnant women with a histologic diagnosis of CIN2 and CIN3 and satisfactory colposcopy may opt for excision or elimination (physical therapy). If colposcopy is not performed, CIN of any grade in the cervical canal, unsatisfactory colposcopy, recurrent CIN2 or CIN3, etc., the option of excision is recommended. 9. For women with AGC (atypical glandular cells) and AIS (adenocarcinoma in situ), colposcopy and endocervical sampling and HPV DNA testing are recommended. For women 35 years and older or younger than 35 years but suspected of possible tumor in the cervical canal (e.g., unexplained vaginal bleeding, atypical endocytosis, etc.), endometrial sampling is recommended and colposcopy can be performed at the first examination. Endometrial and cervical canal sampling is not recommended in women during pregnancy. 10. Women with atypical cervical duct, endometrial or glandular cells without histological findings of CIN or glandular carcinoma should be retested for cytology and HPV at 6 months if HPV-positive or at 12 months if HPV-negative. If high-risk HPV or ASCUS and above are found during the review, colposcopy is performed. If all negative, refer to routine screening. 11, Patients with AGC predisposed to tumor or adenocarcinoma in situ, unless invasive carcinoma has been identified, are recommended for diagnostic resection, requiring a complete specimen and cut margins, along with cervical canal sampling, unless in pregnancy. 12.Hysterectomy is not recommended for the initial treatment of CIN. 13, Diagnostic resection or elimination is not recommended for initial management of ASCUS and LSIL. C. Level C evidence 1. In women 21 years and older with HSIL without histologic findings of CIN2 or CIN3, there are three options: diagnostic resection; review cytology, histology and colposcopy results and manage accordingly; if colposcopy is satisfactory and cervical canal sampling is negative, cytology and colposcopy can be reviewed every 6 months for a total of 1 year, and at 6 or 12 months with repeat cytologic findings of HSIL Diagnostic excision is recommended. Two consecutive negative cases will be referred for routine screening. 2. Adolescent females with HSIL, satisfactory colposcopy, negative cervical canal sampling, and no CIN2 or CIN3 on colposcopic biopsy are advised to repeat cytology and colposcopy every 6 months for a total of 2 years. Biopsy is recommended if cytology HSIL or colposcopy with high-grade lesions is found to persist for 1 year. If HSIL persists for 24 months without finding CIN2 or CIN3, or if colposcopy is unsatisfactory, diagnostic excision is recommended. Two consecutive negative cytologies are referred to routine screening. 3. Histologic diagnosis of CIN2, CIN3-NOS in adolescent females with satisfactory colposcopy, treatment or cytology and colposcopy review every 6 months for a total of 24 months. If CIN2, observation is recommended. If CIN3 and colposcopy is unsatisfactory, diagnostic excision is recommended. If the colposcopic lesion is poorly behaved or cytology HSIL, colposcopy high grade lesion persists for 1 year, repeat biopsy is recommended, two consecutive negative cytology and normal colposcopic performance, refer to routine screening, if it is CIN3 or CIN2 persists for 24 months, treatment is recommended. 4. Non-pregnant women with HSIL or AGC-NOS and colposcopic histological confirmation of CIN1 have three options: diagnostic excision; review cytology, histology, colposcopic findings and treat accordingly; if colposcopy is satisfactory and cervical canal sampling is negative, review cytology and colposcopy every 6 months for at least 1 year, repeat with HSIL at 6 and 12 months, diagnostic excision is recommended. Two consecutive negative cases are converted to routine screening. 5.Women aged 21 years and above with atypical cervical canal cells, endothelial cells, non-specific glandular cells are recommended to have HPV DNA examination at colposcopy. Histology does not reveal CIN, adenomatous changes, while HPV DNA status is not known, after colposcopy it is recommended to repeat cytology every 6 months and turn to routine screening with 4 consecutive negative results. 6. Cervical biopsy diagnosed as AIS (adenocarcinoma in situ) requires diagnostic excision to exclude invasive carcinoma, cold knife conization is recommended because it preserves the complete specimen and fully evaluates the cut edge. After conization, hysterectomy is recommended for those who have completed childbirth. For those with fertility requirements, conservative treatment is possible if the incisional margin and cervical canal sampling are negative. For those who want to be treated conservatively, if the margins are positive or if the cervical canal sample contains CIN or AIS, repeat resection is recommended with repeat cytology, colposcopy, and HPV DNA every 6 months. long-term follow-up is recommended for all patients with AIS.