The 2012 guidelines detail the clinical management of women with negative cervical cytology who test positive for high-risk HPV and specify that only a few methods approved by the U.S. Food and Drug Administration (FDA) may be used for HPV testing in cervical cancer screening. The clinical management of pregnant women with abnormal cervical cytology differs from that of the general population due to pregnancy safety concerns. In addition, HPV infection is common in young women, but most of them clear HPV on their own within 1-2 years, and the incidence of cervical cancer in women under 25 years of age is very low, so the 2006 clinical management guidelines set up a special population group of adolescent women aged 20 years and younger, and their management is different from that of the general population; and the 2011 cervical cancer screening guidelines further recommend that screening for women aged 20 years and younger Therefore, the 2012 clinical management guidelines do not cover adolescent females aged 20 years and below, but newly include women aged 21-24 years as a special group of young people, whose corresponding clinical management is different from that of the general population. I. Clinical management of women with abnormal cervical cytology Negative cytology but lacking ECJTZ component 1. Women aged 21 to 29 years: routine screening is recommended, and HPV testing is not recommended. 2. Women 30 years of age and older: (1) HPV testing is preferred. Because some studies have shown that HPV detection rates are independent of the presence of EC/TZ components, HPV testing can help predict the risk of cervical lesions. negative HPV test results, then routine screening is recommended; if positive, then either cytology + HPV co-testing at 12 months or immediate HPV genotyping; if HPVl6 or 18 positive, colposcopy can be performed or repeat co-testing at 12 months if HPVl6 or 18 negative. (2) If HPV testing is not performed, repeat cytology at 3 years is optional. Cytology negative with HPV positive The 2012 guidelines recommend that the best screening approach for women aged 30 to 65 years is co-testing (cytology + HPV), so there will be a situation where cytology is negative and HPV is positive. These women, especially those positive for HPVl6 and 18, have a higher probability of later developing CIN III than those with a double negative co-test result. The 2012 guidelines for the clinical management of these women list two options: 1. Repeat co-testing at 12 months. If HPV remains positive or cytology is ASCUS or above, colposcopy is recommended; if double negative, repeat co-testing is recommended at 3 years. 2. Perform HPV genotyping immediately. Colposcopy is recommended if HPVl6 or 18 positive; repeat co-testing at 1 year is recommended if HPVl6 and 18 negative. The 2012 guidelines for the clinical management of women with ASCUS are as follows: 1. Optimal protocol: feedback HPV testing. If HPV testing is negative (either feedback testing or co-testing), repeat co-testing at 3 years is recommended. If HPV testing is positive, colposcopy is recommended. If no CIN is seen on colposcopy, repeat co-testing at 12 months. If co-testing is double negative, resume age-appropriate screening at 3 years. If all tests are negative at 3 years, routine screening may continue. 2. Optional option: No HPV testing and repeat cytology at 1 year. If repeat cytology is negative, resumption of cytologic screening at 3 years is recommended; if repeat cytology is ASCUS or above, colposcopy is recommended. 3. Women aged 2l to 24 years: the best option is to perform a separate cytology at 12 months. An optional option is feedback HPV testing, and repeat cytology at 12 months is recommended if the feedback test results are positive for high-risk HPV. Immediate colposcopy or repeat HPV testing is not recommended. If the feedback HPV test is high-risk type negative, resumption of routine 3-year interval cytologic screening is recommended. 4. Women 65 years of age and older: The management of ASCUS in postmenopausal women is essentially the same as in the general population. However, ASCUS with HPV negativity in women aged 65 years and older should not be discontinued but should continue to be monitored. Retesting at 1 year is recommended and the best option is co-testing, but cytology alone is also an option. LSIL 1. General population: colposcopy is recommended for those who have not been tested for HPV or are HPV positive. If the co-test results are cytologic LSIL and HPV negative, the best option is to repeat the co-test at 1 year, with the option of direct colposcopy. If the co-test result is non-double negative at 1 year, i.e. cytologic ASCUS (or above) and/or HPV positive, colposcopy is recommended; if the repeat co-test result is double negative at 1 year, repeat co-testing at 3 years is recommended, and if still double negative, routine screening is recommended. 2. Women aged 21 to 24 years (including pregnant women in the same age group): Clinical data indicate that women aged 21 to 24 years with LSIL have a lower risk of CIN III than older women, so cytologic review at the 12-month interval is recommended for women with LSIL in this age group, and colposcopy is not recommended. Further colposcopy is recommended only if the cytology review at 12 months is atypical squamous epithelial cells not excluding highly diseased (ASC-H) or HSIL. Colposcopy is also recommended if the cytologic review is ASCUS or higher at month 24. If 2 consecutive retests are negative, return to routine screening is recommended. 3. Pregnant women (excluding those aged 2l to 24 years): The best management of pregnant women with cytologic LSIL is colposcopy, with the option of colposcopy at 6 weeks postpartum; cervical canal scratching (ECC) is not indicated. For pregnant women with no suspicious CIN II or above lesions on cytology, histology or colposcopy, postpartum follow-up is recommended, and colposcopy or cytology should not be performed again during pregnancy. 4. Postmenopausal women: The rate of high-risk HPV positivity in postmenopausal women with LSIL is lower than that in younger women with LSIL, so the clinical management is different. For the clinical management of postmenopausal women with LSIL, the 2012 guidelines are similar to the 2006 guidelines, with three options for management: (1) HPV testing; (2) repeat cytology at 6 and 12 months; and (3) direct colposcopy. Repeat cytology at 12 months is recommended if the HPV test is negative or if no CIN is seen colposcopically. Further colposcopy is recommended if HPV test is positive or repeat cytology is ASCUS and above. If 2 consecutive repeat cytologies are negative, return to routine screening is recommended. The results of the ASC-H ALTS study showed an HPV positivity rate of 85% in women with ASC-H. KPNC recently reported an HPV positivity rate of 71% in women with ASC-H and 5-year follow-up results of CIN II and above lesions in 38% of the HPV-positive group compared with 9% of the HPV-negative group. the risk of cervical cancer in women with ASC-H is 2%. the 2001, 2006, and 2012 versions are available. The clinical management protocol for ASC-H is essentially the same in all 3 versions of the ASCCP guidelines from 2001, 2006, and 2012, i.e. colposcopy should be performed in women with ASC-H regardless of HPV results, and feedback HPV testing is not recommended. However, the fact that feedback HPV testing is routinely selected for women with ASC-H in many hospitals in the United States, the authors believe that feedback HPV testing is necessary for women with ASC-H and that colposcopy may not be required for some HPV-negative patients. HSIL 1. General population: The 2012 guidelines have similar options for the general population management of HSIL as the older guidelines, with colposcopy regardless of their HPV results. The other 1 option available is direct cervical loop electrosurgery (LEEP). Repeat cytology or feedback HPV testing is not advisable. If colposcopy reveals CIN II and above lesions, they are treated according to the appropriate treatment plan. 2. Women aged 21-24 years: For this younger group of women with HSIL, colposcopy is recommended and LEEP should not be performed immediately. if colposcopy reveals CIN II and above lesions then follow the treatment regimen for CIN in younger women as outlined in the 2012 guidelines. If colposcopic biopsy does not reveal CIN lI and above, follow-up can be performed with colposcopy and cytology at 6-month intervals until 24 months. Biopsy is recommended during the observation period if colposcopic changes resemble high-grade lesions or if cytology is HSIL for 1 year. Diagnostic cervical conization or LEEP is recommended if cytologic HSIL persists for 24 months but histologic biopsy does not reveal CIN II or higher lesions, and if colposcopy is unsatisfactory or reveals CIN II or CIN III or unclassifiable CIN lesions, diagnostic cervical conization or LEEP is recommended. If two consecutive negative cytologies and no evidence of high-grade lesions on colposcopy, routine screening may be resumed. Atypical glandular cells The diagnosis of adenocarcinoma in situ (AIS), atypical glandular cells (AGC) or benign glandular cells in the uterine cervix is poorly reproducible, with the majority of women with AGC having benign lesions (including polyps and septic changes) at follow-up, but high-grade lesions are seen in 10% to 20%. In addition, most cytologic AGC-associated lesions were squamous epithelial lesions, and cervical AIS or invasive adenocarcinoma accounted for 1-4% of AGC. The authors concluded that feedback HPV testing in women with AGC is useful for risk assessment of cervical adenocarcinoma or AIS, and that the probability of developing cervical adenocarcinoma or AIS in HPV-negative individuals is very low. HPV testing is not helpful in identifying the risk of developing endometrial adenocarcinoma.