Abstract
Objective: To evaluate adherence to the 2012 ASCCP guidelines by
physicians referring patients to a large academic center for a
colposcopy and to understand the factors associated with incorrect
referrals. Design: A retrospective observational study
Setting: A large tertiary referral hospital
Population: Woman referred to Virginia Commonwealth University
for colposcopy or loop electrosurgical excision procedure from January
2015 to December 2016.
Methods : Data on patient demographics, cervical cytology, human
papillomavirus status, and the recommended interventions were gathered.
Main Outcome Measures: Concordance with ASCCP guidelines
Results: Referral requests for 430 women were reviewed. Of the
referrals, 17.4% were discordant with the ASCCP guidelines. The most
common discordant colposcopy referrals were for low-grade squamous
intraepithelial (LSIL) lesion (48%) and atypical squamous cell of
undetermined significance (29%). The likelihood of incorrect referral
was decreased for high grade lesions (OR 0.03), increased in women age
< 25 (OR 31.6) and those referred by family medicine (OR 3.6)
or internal medicine (OR 4.4). Ten patients were referred for cervical
cytology collected on vaginal cuffs despite hysterectomies performed for
benign reasons.
Conclusions: Patients referred outside of the guidelines were
most often women age < 25 with low-grade lesions. Referrals
outside of evidence-based guidelines may lead to unnecessary procedures
and added healthcare expense. Our results help identify areas for
provider education and potential areas for concern in the implementation
of the 2019 ASCCP updates.
Keywords: ASCCP Guidelines, colposcopy, pap test, LEEP,
cervical cancer, cervical dysplasia, CIN
Tweetable Abstract: 17.4% of colposcopy referrals to a large
academic center were discordant with the ASCCP guidelines.