Cost-effectiveness of Alternative Triage Strategies for Atypical Squamous Cells of Undetermined Significance

Abstract

In the United States, cytological screening has reduced the incidence of invasive cervical cancer, but as a result of screening, many women are diagnosed as having equivocal cytological abnormalities (eg, atypical squamous cells, herein referred to as ASC).¹ The management of an ASC result is controversial, and clinical practice patterns range from performing immediate colposcopy to repeating cervical cytology at specified intervals.² Clinicians who prefer immediate colposcopy argue that some women with ASC have cervical intraepithelial neoplasia grade 2-3 (CIN 2-3) or invasive cancer, and in fact, a substantial proportion of all biopsy-confirmed CIN 2-3 is identified in women with an ASC result.³ Clinicians who prefer to use repeat cytology argue that most women have either no lesion or CIN grade 1, which is likely to regress in the absence of any treatment. A third option is DNA testing for high-risk types of human papillomavirus (HPV) and performing colposcopy only in women with positive test results. This strategy is increasingly adopted in the United States because HPV DNA testing appears to be more sensitive than a single repeat cervical cytology for identifying women with ASC who have CIN 2-3.^4-8