1. Management of Women with Abnormal Pap Test

4. Comparison of Terminology Bethesda System CIN system Dysplasia ASCUS Cellular Atypia Unspecified Cellular changes LSIL CIN I Mild Dysplasia HSIL CIN II Moderate dysplasia CIN III Severe Dysplasia/ CIS

6. Abnormal Pap test ASCUS LSIL HSIL HPV –ve HPV +ve Rpt Pap Negative Colposcopy LEEP ECC +ve -ve Treat & Follow up Diagnostic cone Treat & Follow up

7. ATYPICAL SQUAMOUS CELLS

11. Rpt Cytology @ 6 & 12 Months HPV –ve HPV +ve Rpt Cytology @ 12 months Colposcopy ECC if no lesions or unsatisfactory colpo No CIN CIN Repeat Cytology @ 6, 12 months Or HPV DNA test @12 months Treat & follow up ASCUS

14. ASC-H Colposcopy ECC if no lesions or unsatisfactory colpo CIN 2,3 > ASC or HPV+ Treat & Follow up Rpt Cytology @ 6, 12 months OR HPV DNA Test @ 12 mths No CIN 2,3 Colposcopy Negative Routine screening

15. Low Grade SIL

18. LSIL Colposcopy Negative Unsatisfactory colpo No lesion Satisfactory Colpo Lesion in TZ ECC No CIN CIN 2,3 Cytology @ 6, 12 mths OR HPV testing Treat & Follow up

20. HIGH GRADE SIL HSIL

22. HSIL Colposcopy ECC Unsatisfactory colpo Satisfactory Colpo No CIN 2,3 Diagnostic Excisional procedure Observe with Cytology / Colposcopy Treat & Follow up LEEP CIN 2,3

28. ATYPICAL Glandular Cells

32. AIS Hysterectomy preferred Margins involved ECC +ve Reexcision recommended Long term Follow up Diagnostic excisional procedure If future fertility desired Conservative Management Margins negative