What criteria should I use to determine whether to refer a patient with CIN for colposcopy?

Criteria for referral of a patient with cervical intraepithelial neoplasia (CIN) for colposcopy include:

• Referral is indicated for people who test positive for high-risk human papillomavirus (hrHPV) with abnormal cytology results, as these findings suggest the presence of CIN2+ lesions that require further assessment by colposcopy.
• People who are hrHPV positive but have negative cytology should have repeat HPV testing at 12 and 24 months; persistent hrHPV positivity at 24 months warrants referral to colposcopy.
• Individuals with inadequate cytology results or unavailable hrHPV test results on two consecutive occasions should be referred for colposcopy.
• People with cytology showing high-grade dyskaryosis or severe abnormalities should be referred promptly for colposcopy.
• Following treatment for CIN, a test of cure (repeat cervical sample) is performed 6 months after treatment; if hrHPV is positive but cytology is negative, referral to colposcopy is recommended.
• Pregnant individuals with abnormal screening results may undergo colposcopy in the late first or early second trimester unless contraindicated; low-grade changes may be deferred until after delivery.

These criteria ensure timely identification and management of pre-cancerous cervical lesions to prevent progression to cervical cancer.

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