For patients with abnormal cervical cytology results from cervical screening, referral to colposcopy is typically indicated NICE CKS.
Abnormal cytology results that may lead to referral include borderline changes in squamous or endocervical cells, low-grade dyskaryosis, high-grade dyskaryosis (moderate or severe), invasive squamous cell carcinoma, or glandular neoplasia NICE CKS.
Specifically, if a patient tests positive for high-risk human papillomavirus (hrHPV) and their cytology is reported as abnormal, they must be referred to colposcopy NICE CKS. This applies to initial abnormal cytology after a positive hrHPV test, as well as abnormal cytology at 12 or 24 months in the follow-up pathway NICE CKS.
Referral to colposcopy is also required for certain inadequate cytology results NICE CKS. This includes people who have inadequate cytology at the 24-month repeat test NICE CKS. Additionally, people who have two consecutive unavailable hrHPV results or inadequate cytology results, in any combination, are referred to colposcopy NICE CKS.
Separately, if a physical examination identifies an appearance of the cervix consistent with cervical cancer, a suspected cancer pathway referral should be considered NICE NG12.