ASCCP - Consensus Guidelines - About the Consensus Conference

CONSENSUS GUIDELINES: About the Consensus Conference

DEVELOPMENT OF CONSENSUS GUIDELINES FOR THE MANAGEMENT OF CYTOLOGICAL ABNORMALITIES AND CERVICAL INTRAEPITHELIAL NEOPLASIA

Since the publication of the 2001 Consensus Guidelines, new information has become available which includes the key follow-up results from the National Cancer Institute (NCI)-sponsored ASCUS (atypical squamous cells of undetermined significance)/LSIL (low-grade squamous intraepithelial lesion Triage Study (ALTS). Moreover, molecular testing for high-risk types of human papillomavirus (HPV) is being used together with cervical cytology for screening in women 30 years of age and older. Although "interim guidance" for the use of HPV deoxyribonucleic acid (DNA) testing in the screening setting was proposed in 2004 by the American Cancer Society (ACS), NCI, and ASCCP, recommendations for how to manage the combination of test results have not been formally evaluated by a large, multidisciplinary group. Once the guidelines were implemented in a variety of clinical settings and became the standard for management of these clinical problems, it became apparent that there were a number of areas in which changes were needed, particularly in regards to the populations of adolescents and postmenopausal women. Thus in 2005, the American Society for Colposcopy and Cervical Pathology (ASCCP), together with its partner professional societies and Federal and international organizations, began the process of revising the guidelines.

Working Groups composed of representatives of the ASCCP, ACS, NCI, Society of Gynecologic Oncologists (SGO), College of American Pathologists (CAP), American College of Obstetricians and Gynecologists (ACOG), the Centers for Disease Control and Prevention (CDC), and others performed comprehensive literature reviews of various aspects of Papanicolaou test management published after 2000. New Working Groups were also created to evaluate special management algorithms for young women and women with abnormal results of HPV DNA testing.

The Working Groups developed draft guidelines based on a critical evaluation of the published literature. The draft guidelines were made available for two public comment periods in the spring and summer of 2006 through internet-based bulletin boards monitored by the Working Groups and the overall Steering Committee. After each public comment period concluded, the draft guidelines were taken off the internet and revised to reflect the public comments. After the final revision, the guidelines and the comprehensive literature reviews were rated to include an indication of the quality of clinical evidence supporting the specific recommendation and the strength of the recommendation. In additional three separate conference calls of the invited Conference participants to discuss the prospective 'hot topics' were held in the summer of 2006. The invited participants included over 140 selected experts in the fields of gynecological cytology, pathology, and management of cervical disease, all of whom served as appointed delegates of the sponsoring medical organizations and Federal agencies (see below for sponsors' list).

The resulting draft Consensus Guidelines for the management of cervical cytological and histological abnormalities were then presented to the invited participants and formal observers at the ASCCP Consensus Conference, held on September 18-19, 2006, at the Natcher Conference Center on the NIH campus, in Bethesda, Maryland where they were discussed, modified as necessary, and then voted on. Following the Conference, the ASCCP Steering Committee drafted the guidelines and submitted them for publication in the American Journal for Obstetrics and Gynecology and the ASCCP's Journal of Lower Genital Tract Disease.

WORKING COMMITTEES AND DELEGATES
(Full affiliations listed in the Guidelines)

ASC		AGC
Thomas C. Wright, Jr, MD, Chair Warner K. Huh, MD Cornelia L. Trimble, MD Carol L. Brown, MD Hershel Lawson, MD Mark Sherman, MD Thomas J. Herzog, MD Dennis M. O'Connor, MD Monique Bertrand, MD Francisco Garcia, MD, MPH Jason Wright, MD		Charles J. Dunton, MD, Chair Ronald D. Alvarez, MD Walter K. Kinney, MD Raheela Ashfaq, MD Edward L. Trimble, MD J. Thomas Cox, MD Michael A. Gold, MD David Greenspan, MD R. Marshall Austin, MD, PhD Kathleen McIntyre-Seltman, MD Robert A. Burger, MD Benjamin Greer, MD William H. Rodgers PhD, MD Leo B. Twiggs, MD
LSIL		HSIL
Mark Spitzer, MD, Chair Barbara Apgar, MD, MS Burton A. Krumholz, MD Terri Cornelison, MD Marluce Bibbo, MD Alan G. Waxman, MD Edward Partridge, MD Howard W. Jones III, MD Melvin V. Gerbie, MD Kenneth L. Noller, MD Richard S. Guido, MD Mary M. Rubin, RNC, PhD, CRNP		L. Stewart Massad, MD, Chair Edward J. Mayeaux, Jr, MD Diane D. Davey, MD Carmel Cohen, MD Hope K. Haefner, MD Edward R. Kost, MD
HPV		Young Women
Edward J. Wilkinson, MD, Chair Christopher P. Crum, MD, Co-Chair Mark H. Schiffman, MD, MPH Diane Solomon, MD Terence J. Colgan, MD Kenneth D. Hatch, MD Jonathan Berek, MD Julia A. Corrado, MD Gary R. Newkirk, MD Mark Stoler, MD Philip Castle, PhD, MPH		Anna-Barbara Moscicki, MD, Chair Claudia L. Werner, MD Lori A. Boardman, MD, ScM Jeffrey Waldman, MD Neal M. Lonky, MD

ASCCP Staff:
Kathleen Poole Ann Bass Cindy Desirant Lindsay Hicks Amy Mason Debbie McClain
Participants and Observers list

Participating national and international medical organizations and Federal agencies include:

American Academy of Family Physicians (AAFP)
American Cancer Society
American College Health Association
American College of Obstetricians and Gynecologists (ACOG)
American Social Health Association
American Society for Clinical Pathology
American Society for Colposcopy and Cervical Pathology
American Society of Cytopathology
Association of Reproductive Health Professionals (ARHP)
Centers for Disease Control's Human Papillomavirus Laboratory, National Center for Infectious Diseases and Division of Viral and Rickettsial Diseases
Centers for Disease Control and Prevention: Division of Cancer Prevention and Control
Centers for Disease Control and Prevention: Division of Laboratory Systems
Centers for Medicare & Medicaid Services (CMS)
College of American Pathologists
Food and Drug Administration
International Academy of Cytology
International Federation for Cervical Pathology and Colposcopy
International Federation of Gynecology and Obstetrics (FIGO)
International Gynecologic Cancer Society
International Society of Gynecologic Pathologists
National Cancer Institute
Nurse Practitioners in Women's Health
Pan American Health Organization
Papanicolaou Society
Planned Parenthood Federation of America
Society of Canadian Colposcopists
Society of Gynecologic Oncologists
Society of Gynecologic Oncologists of Canada
Society of Obstetricians & Gynaecologists of Canada