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Guideline
. 2023 Jun 13;30(6):5738-5768.
doi: 10.3390/curroncol30060431.

2023 Canadian Colposcopy Guideline: A Risk-Based Approach to Management and Surveillance of Cervical Dysplasia

Karla Willows  1 , Amanda Selk  2   3 , Marie-Hélène Auclair  4 , Brent Jim  5 , Naana Jumah  3   6 , Jill Nation  7 , Lily Proctor  8 , Melissa Iazzi  9 , James Bentley  1
Affiliations
Guideline

2023 Canadian Colposcopy Guideline: A Risk-Based Approach to Management and Surveillance of Cervical Dysplasia

Karla Willows et al. Curr Oncol. .

Abstract

This guideline provides evidence-based guidance on the risk-based management of cervical dysplasia in the colposcopy setting in the context of primary HPV-based screening and HPV testing in colposcopy. Colposcopy management of special populations is also discussed. The guideline was developed by a working group in collaboration with the Gynecologic Oncology Society of Canada (GOC), Society of Colposcopists of Canada (SCC) and the Canadian Partnership Against Cancer (CPAC). The literature informing these guidelines was obtained through a systematic review of the relevant literature via a multi-step search process led by information specialists. The literature was reviewed up to June 2021 with manual searches of relevant national guidelines and more recent publications. Quality of the evidence and strength of recommendations was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. The intended users of this guideline include gynecologists, colposcopists, screening programs and healthcare facilities. Implementation of the recommendations is intended to promote equitable and standardized care for all people undergoing colposcopy in Canada. The risk-based approach aims to improve personalized care and reduce over-/under-treatment in colposcopy.

Keywords: HPV; cervical cancer; colposcopy; guideline; human papillomavirus.

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Conflict of interest statement

A.S. is the current president of the Society of Canadian Colposcopists. K.W. is the president-elect of the Society of Canadian Colposcopists. K.W. has received speaker honoraria from Merck Canada. M.-H.A. has received consultation fees from GSK and Merck Canada. J.B. has received honoraria from GSK and Merck Canada and research support from the Canadian Cancer Society. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 2
Figure 2
Low-grade referral pathway (HPV-positive ASCUS or LSIL). The low-grade referral pathway addresses persons referred to colposcopy with HPV-positive ASCUS and LSIL cytology.
Figure 3
Figure 3
High-grade referral pathway (HPV-positive ASC-H or HSIL). The high-grade referral pathway addresses persons referred to colposcopy with HPV-positive ASC-H and HSIL cytology.
Figure 4
Figure 4
Conservative management of CIN2 in persons under the age of 30. This pathway addresses persons under the age of 30 referred to colposcopy with HPV-positive ASC-H and HSIL cytology, where wishes for childbearing outweigh risk of invasive cancer.
Figure 5
Figure 5
Post-treatment pathway (no invasive cancer identified). The post-treatment pathway addresses all persons undergoing excisional procedure in colposcopy where no invasive cancer was found.
Figure 6
Figure 6
Glandular referral pathway (HPV-positive AGC and AIS cytology). The glandular pathway addresses persons referred to colposcopy with HPV-positive AGC or AIS cytology. Initial workup should include endocervical curettage and endometrial biopsy where indicated. Further management is based on referral cytology.
Figure 7
Figure 7
Post-discharge follow-up for patients with SIL not treated in colposcopy *. The post-discharge pathway addresses patients discharged from colposcopy who do not undergo an excisional procedure.
Figure 1
Figure 1
Transformation zones [16].
See this image and copyright information in PMC

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