What should I do if I report HSIL on cervical cytology?

  Management of cervical cytologic and histologic abnormalities according to ACOG clinical guidelines.  The low likelihood of cancer in adolescents and the long window for detecting persistent high-grade precancerous lesions make immediate excision inappropriate.  Colposcopic biopsy of visible lesions is the recommended primary treatment option .  If the colposcopic findings are satisfactory, the cervical canal is negative and no lesions are found, or the biopsy is suggestive of CIN1 or no tumor, a series of cervical smears and colposcopies at 6-month intervals for 2 years is recommended.  Routine annual screening may be continued if 2 consecutive cervical smears and colposcopies are negative. Biopsy is recommended if high-grade colposcopic lesions are identified at follow-up or if HSIL cytology findings persist for 1 year.  If HSIL persists for 2 years, a diagnostic hysterectomy is recommended. Adolescent and young women may return to routine screening if two consecutive negative cytologic scrapings and no high-grade colposcopic abnormalities are present.