Construction and Validation of a Model for Predicting Cervical Intraepithelial Neoplasia Grade II+: A Cross-Sectional Population Study via Machine Learning

Cervical cancer screening primarily uses the human papillomavirus (HPV) test with partial genotyping (HPV 16/18) and liquid-based cytology using ThinPrep cytology test (TCT) to triage women with a positive HPV test. Although quantitative DNA ploidy analysis has shown reliability, its integration into screening guidelines as a triage test, compared to partial genotyping and TCT, has not been fully established. The objective of the study is to evaluate the clinical utility of DNA ploidy analysis as a triage test for women with a positive HPV test in primary screening, comparing it to HPV 16/18 genotyping and TCT. We retrospectively analyzed data from 335 women aged ≥18 years who participated in a cervical cancer screening program at Shanghai Ruijin Hospital and underwent triage using HPV 16/18, TCT, and DNA ploidy testing. The sensitivities and specificities of these methods, both individually and combined, were evaluated. The test showed sensitivities and specificities of 35.4% and 76.1% for HPV 16/18, 29.2% and 88.2% for TCT, and 93.8% and 92.7% for DNA ploidy, respectively. Combining these tests improved outcomes, with DNA ploidy plus HPV 16/18 genotyping showing enhanced sensitivity and high specificity. Notably, DNA ploidy alone identified high-grade squamous intraepithelial lesions (HSIL) and cervical cancer with a higher detection rate and lower positivity rate in triage than HPV 16/18 and TCT. DNA ploidy analysis demonstrated superior specificity and sensitivity in the triage of women with positive HPV test results, offering a more effective alternative for detecting high-grade lesions and cervical cancer. These findings support the potential of integrating DNA ploidy into current cervical cancer screening protocols to enhance triage effectiveness and reduce unnecessary colposcopy referrals.

Objective To explore the therapeutic effects of human papilloma virus (HPV) test combined with thinprep cytologic test (TCT) on evaluating loop electrosurgical excision procedure (LEEP) and the follow-up of high-grade cervical intraepithelial neoplasia(CIN). Methods From March 2005 to December 2006, 115 patients who subjected to loop electrosurgical excision procedure(LEEP) due to histologically confirmed cervical intraepithelial neoplasia(CIN) Ⅱ/Ⅲ were selected. They were classified into two groups according to the diagnosis, one of which was consisted of patients with cervical intraepithelial neoplasia Ⅱ(CINⅡ group, n=68, 59.13%), the other with cervical intraepithelial neoplasiaⅢ(including carcinoma in situ, CIN Ⅲ group, n=47, 40.87%). The study was according to the ethical standards enacted by the ethics committee and confirmed by the committee. Informed consent was obtained from all participates. All 115 cases who underwent loop excision procedure were followed-up until January 2008. Follow–up visits were consisted of cervical thinprep cytologic test during the following 4~6 months after the operation and hybrid capture Ⅱ (HC2) during the following 6~8 months. A retrospective analysis was performed to study effects and prognosis after loop electrosurgical excision procedure. Results The positive human papilloma virus rate was 95.74% in CIN Ⅲ group which was significantly higher than that in CIN Ⅱ group (73.53%) before loop electrosurgical excision(P 0.05). The sensitivity, specificity, positive predictive value(PPV), negative predictive value of hybrid capture Ⅱ were 66.67%, 98.12%, 57.14%, 98.15%. While the sensitivity, specificity, positive predictive value, negative predictive value of the thinprep cytologic test were 83.33%, 76.15%, 16.13%, 98.81%. Four cases whose hybrid capture Ⅱ and thinprep cytologic test both were positive showed residual or recurrent. Specificity and positive predictive value were significantly higher when two tests were combined. Conclusion Loop electrosurgical excision procedure is an effective way for treating high–grade cervical intraepithelial neoplasia. High risk human papilloma virus may play an important role in the occurrence of high grade cervical intraepithelial neoplasia. Pre–treatment of high risk human papilloma virus testing seems to have no predictive value for the prognosis of patients who undergo loop electrosurgical excision procedure for high–grade cervical intraepithelial neoplasia. High risk human papilloma virus combined with thinprep cytologic test during the post–treatment may be of great importance after loop electrosurgical excision procedure. Key words: cervical intraepithelial neoplasia (CIN); loop electrosurgical excision procedure (LEEP); human papilloma virus (HPV); thinprep cytologic test (TCT)

Recently, practice guideline for the early detection of cervical cancer in Korea has been released in this journal [1].It was developed based on preexisting guidelines generated by the American Society for Colposcopy and Cervical Pathology (ASCCP) [2], the National Comprehensive Cancer Network [3], the United States Preventive Services Task Force [4], and the Institute for Clinical Systems Improvement [5].Coincidentally, updated versions of ASCCP guideline [6] and American Cancer Society (ACS) guideline [7] have been issued around the same time.Therefore, the updated contents of the abovementioned guidelines are not reflected in ours.The essential changes of the 2012 ASCCP guidelines from prior 2006 version are as follows [6]: 1) cytology reported as negative but lacking endocervical cells can be managed without any repeat, 2) cytology reported as unsatisfactory requires repeat even if human papillomavirus (HPV) is negative, 3) For atypical squamous cells of undetermined significance (ASC-US) cytology, immediate colposcopy is not an option.The serial cytology option for ASC-US incorporates cytology at 12 months, and then if negative, cytology every 3 years, 4) ASC-US and HPVnegative results should be followed with co-testing at 3 years rather than 5 years, 5) ASC-US and HPV-negative results are insufficient to allow exit from screening at age 65 years, 6) women aged 21-24 years are managed conservatively.Recently reported rates of cytology results reported as negative but lacking endocervical cells have ranged from 10% to 20% [8].Prior guidelines recommended early repeat cytology [9].A recent meta-analysis found that negative cytology had favorable specificity and negative predictive value despite absent endocervical cell component [10].Given that most cytology is performed using liquid-based media, unsatisfactory cytology results arise mainly from insufficient squamous cells [11].The 2012 ASCCP guidelines recommended repeat cytology in 2 to 4 months for women with an unsatisfactory cytology result.Those two issues regarding specimen adequacy were not included in our guidelines.The management of women with ASC-US has also been

PurposeTo evaluate the diagnostic performance of the current three-step cervical cancer screening strategy in Chinese women and explore the optimized value of integrating human papillomavirus (HPV) testing, ThinPrep cytology test (TCT), and colposcopic visual inspection with acetic acid/Lugol’s iodine (VIA/VILI) for improving cervical disease detection.Patients and MethodsA retrospective study was conducted on 11,405 outpatients of Shenzhen People’s Hospital (2018–2023). Inclusion criteria were a history of sexual activity plus at least one of the following: high-risk HPV (HR-HPV) positivity, abnormal TCT results, or highly suspicious symptoms. Exclusions included prior hysterectomy, cervical cancer (CC) treatment history, pregnancy, or incomplete medical records. The diagnostic performance of HR-HPV testing, TCT, and colposcopic VIA/VILI results was evaluated using pathologically confirmed high-grade squamous intraepithelial lesion (HSIL) and CC as the reference standard. The calculated metrics comprised sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC).ResultsAmong the cohort, the positive rates were 71.56% for HR-HPV, 32.57% for abnormal cytology, and 9.34% for colposcopic VIA/VILI. For detecting HSIL/CC, the NPVs of HPV testing, TCT, and colposcopic VIA/VILI were 0.976, 0.955, and 0.965, respectively. Combined use of the three modalities achieved an NPV of 0.999 for HSIL/CC. Integrating colposcopic VIA/VILI into primary screening also reduced both false-positive and false-negative results compared with single-modality strategies.ConclusionIn this large real-world retrospective cohort, combining HPV testing, TCT, and colposcopic VIA/VILI improves the diagnostic accuracy of high-grade cervical disease (HSIL and CC), with practical feasibility for clinical application. However, this integrated approach needs prospective multi-center validation before widespread promotion in cervical cancer screening among community populations.

Human papillomavirus (HPV) DNA testing for high-risk types after Papanicolaou (Pap) smear interpretations of atypical squamous cells of undetermined significance (ASCUS) is a sensitive method for identifying women who harbor underlying high-grade squamous intraepithelial lesions (HSIL). To the authors' knowledge, the application of HPV testing to ASCUS smears in routine practice with comparison of probabilistic and interpretive models of cytologic reporting has not been reported. HPV DNA testing was performed reflexively on 216 liquid-based Pap smears that initially were interpreted as ASCUS. According to the interpretive model, ASCUS interpretations were modified and reported as either low-grade squamous intraepithelial lesions (LSIL) or squamous intraepithelial lesions (SIL) when HPV positive and as reactive when HPV negative. Using the probabilistic model, ASCUS interpretations were maintained and simply reported with the HPV test result. Histologic follow-up data were obtained. Of the 216 women with ASCUS cytology, 142 (65.7%) were positive for high-risk HPV types. Of the 142 HPV-positive ASCUS smears, 101 (71.1%) were modified to an interpretation of LSIL (96 cases) or SIL (5 cases). Histologic follow-up of 55 of the 101 HPV-positive smears in the interpretive group and 26 of the 41 HPV-positive smears in the probabilistic group yielded similar percentages of lesions (18 lesions [32.7%] and 9 lesions [34.6%], respectively). However, there was a preponderance of low-grade lesions in the interpretive group (89%) but a nearly equal distribution of low-grade and high-grade lesions in the probabilistic group (56% and 44%, respectively); overall, 22% of the lesions were high-grade. Of the 74 HPV-negative ASCUS smears, 71 (96%) were modified to reactive and all 5 with histologic follow-up were judged as negative. Colposcopy with tissue studies was virtually restricted to HPV-positive cases, regardless of the reporting model used, suggesting that clinicians are basing colposcopy triage on the HPV test result rather than the definitiveness of the cytologic interpretation. This observation, the similar yield of lesions in both groups, and the significant risk of high-grade lesions argue against application of the interpretive model to HPV-tested ASCUS cases.

To preliminarily evaluate the clinical significance of different methods in diagnosis of cervical glandular intraepithelial neo- plasia (CGIN). Clinical manifestations, ThinPrep cytologic test (TCT), cervical biopsy, and pathological features of 106 patients with CGIN admitted to Beijing Obstetrics and Gynecology Hospital between 2008 and 2011 were retrospectively analyzed. Among 146 cases diagnosed with CGIN, 87 (59.6%) had L-CGIN and 59 (40.4%) H-CGIN. Thirty-seven patients (25.6%) were found to have simple CGIN and 109 (74.6%) had CGIN complicated with cervical intraepithelial neoplasia (CIN). TCT revealed atypical glandular cells (AGC) in 20 patients (13.7%), six of whom had L-CGIN (6.9%) and 14 (23.7%) had H-CGIN with statistical significance between two groups (p < 0.05). TCT detected AGC in 13 cases (35.1%) with simple CGIN and seven with mixed CGIN (6.4%) (P<0.05). Endocervical curettage (ECC) revealed AGC abnormality in ten cases (25.6%). Cervical biopsy under colposcope revealed 32 patients (22.9%) had CGIN, including 15 L-CGIN (18.3%), and 17 H-CGIN (29.3%) with no statistical significance (p > 0.05). Among those diagnosed with CGIN by colposcope-assisted cervical biopsy, 19 (51.4%) had simple CGIN and 13 (11.9%) mixed CGIN (p < 0.05). Preoperative diagnostic rate of simple CGIN was higher than CGIN complicated with CIN.

The aim of the study was to investigate the positivity of human papillomavirus (HPV) and the possible related risk factors for HPV infection in certain district government in Daqing city, Heilongjiang province. A total of 2015 female staffs who participated cervical cancer screening were selected as subjects, in certain district government in Daqing city, Heilongjiang province, from June to October, 2010. First of all, a standardized questionnaire was used for collection of subject's demographic information and possible risk factors. Afterwards, cervical cytological and HPV DNA testing were applied to all participants. Subjects with suspected cervical intraepithelial neoplasia (CIN) or cervical cancer were recalled for taking biopsy under colposcopy for further histopathological diagnosis. Standardized HPV positivity by Segi's world population and compared the difference of HPV positivity of different types. The positivity of HPV between women with and without cervical abnormalities were compared by unconditional logistic regression. And the possible risk factors for HPV infection were also investigated. A total of 1759 out of 2015 subjects had gynecological examination, among which 152 subjects were HPV positive. The positivity of HPV was 8.64% (95%CI: 7.37% - 10.05%), and it was 8.47% (95%CI: 7.93% - 9.03%) after age standardization. Finally, 57 (3.24%) and 1702 (96.76%) subjects had abnormal (≥ CIN1 or low-grade squamous intraepithelial lesion (LSIL)) and normal cervix, respectively. The HPV positivity between women with and without cervical abnormalities were 73.68% (42/57) and 6.46% (110/1702), respectively. There was a significant difference (χ(2) = 307.23, P < 0.05) in HPV positivity between women with and without cervical abnormalities. The risk of cervical abnormalities for women with HPV positivity was 40.52 times (95%CI: 21.79 - 75.36) higher than that for women with HPV negativity. Among women with cervical abnormalities, the most three common HPV types, in descending order, were HPV16 (28.07% (16/57)), HPV52 (14.04% (8/57)) and HPV58 (12.28% (7/57)). While among women with normal cervix, the most three common HPV types were HPV52 (1.23% (21/1702)), HPV16 (1.00% (17/1702)) and HPV58 (0.71% (12/1702)). The positivity of HPV clade A9 among women with and without cervical abnormalities were 59.65% (34/57) and 3.23% (55/1702), which were higher than that of other clades. Analysis for risk factors of HPV infection showed that smoking (OR = 2.71, 95%CI: 1.00 - 7.33), late age (≥ 15 years old) of menarche (OR = 1.44, 95%CI: 1.00 - 2.05), early age (≤ 20 years old) of marriage (OR = 3.09, 95%CI: 1.30 - 7.35), multiple (≥ 2) sexual partners (OR = 2.69, 95%CI: 1.46 - 4.95), husband's extramarital sexual behaviors (OR = 2.77, 95%CI: 1.25 - 6.12) and multiple (≥ 2 times) parity (OR = 1.77, 95%CI: 1.03 - 3.03) would increase the risk of HPV positivity. HPV positivity among women with cervical abnormalities was significantly higher than that among women with normal cervix. HPV16, 52, 58 were the major genotypes among the study population. Smoking, late age of menarche, early age of marriage, multiple sexual partners, husband extramarital sexual behaviors and multiple parity increase the risk of HPV infection.

Objective To explore the value of cervical lesions screened with white acetate solution. Methods Four hundred and eighty- five patients who were suspected with cervical lesion during Janurary to March 2016 were enrolled in this study. The patients were asked about the medical history, filled the registration form, and performed routine gynecological examinations with white acetate solution, thinprep cytology test (TCT) and vaginal endoscopic biopsy. The value of white acetate solution in clinic was assessed. Results In 485 patients, 450 patients (92.78%) were pathologically diagnosed of inflammation (92.78%), 24 patients (4.95%) were diagnosed of low-grade squamous intraepithelial lesion(LSIL), 10 patients (2.06%)were diagnosed of high- grade squamous intraepithelial lesion (HSIL), and one patient (0.21%) was diagnosed of cervical cancer. The detection rate of white acetate solution and TCT were gradually increased with the increase of the degree of cervical lesions. The detection rate of white acetate solution in the inflammation was 1.33%, in LSIL was 91.67%, in HSIL was 9/10, and in cervical cancer was 1/1. The detection rate of TCT in the inflammation was 8.44%, in LSIL was 66.67%, in HSIL was 6/10, and in cervical cancer was 1/1. The sensitivity, specificity and coincidence rate of the diagnostic results with white acetate solution were 84.21%, 99.33%, 98.14%, and with TCT were 62.30%, 93.63%, 89.69%. There were significant differences (P <0.05). Conclusions Cervical lesions screened with white acetate solution is good in sensitivity and specificity, which is an effective way for screening cervical cancer. Key words: Uterine cervical diseases; Diagnostic self evaluation; Pathology, clinical; White acetate solution; Thinprep cytology test

Objective To explore the role of thinprep cytology test(TCT)and HPV-DNA hybrid capture detection played in the screening of cervical lesions.Methods Do TCT examination on 9260 outpatients and do HPVDNA hybrid capture detection on 840 cases therein,836 positive cases continued to have biopsy by colposcope,conformed to the gold standard of histopathology and contrast with cytology in the meantime.Results 8374 cases were negative in the TCT examination;836 cases were cytological abnormal.Cytology-positive rate was 9.03％,ASC-US 398 were 4.29％,LSIL 239 were 2.58％,HSIL 179 are 1.93％,SGUS 9 are 0.097％,SCC 11 are 0.12％.The group of 30 ～40 ranked the highest in cytological positive,it's 43.66％,the second highest was the group of 40 to 50,it's 27.39％.The results of other groups were as follow:＜ 30 is 2.85％,50 ～ 60 is 5.14％,＞ 61 is 0.96％ The difference of them was significant ( P ＜ 0.01 ).HPV infection rate was 27.98％ (235/840).In ASC-US,the detectable rate of CIN in the HPV-positive group was 81.58％ (31/38),the HPV-negative group was 8.98％ ( 15/167),there was significant differene between the two methods(P ＜ 0.01 ).In LSIL,the detectable rate of CIN in the HPV-positive group was 95.45％ (21/22).In HSIL,the detectable rate of CIN in the HPV-positive group was 100％ (16/16).The infection rate in different age group is different,the difference was significant ( x2 =25.2 P ＜ 0.01 ) ; 836positive cases had biopsy by colposcope,507 cases were diagnosed to be CIN,the detectable rate was 60.65％ (507/836).To organize pathology as control,the diagnose accordance rate of cytology and pathology of LSIL and HSIL and SCC were 50.46％,82.12％,100％ (P ＜0.01 ).Took their accordance rate into comparison,the differene was significant.Conclusion Cervical lesion was collected in sex activity period,the peak was 31-40 years.TCT is propitious to screen cervical cancer and precancerous lesion,combined with HPV-DNA hybrid capture detection,colposcopy and pathology,can improve the diagnostic accuracy and the detective rate of CIN and cervical cancer. Key words: Thinprep cytology test ( TCT ) ; Cervical lesions; Human papillomavirus (HPV)

Objective To investigate the value of TCT and HPV detect in CIN patients. Method 135 patients diagnosed as CIN by pathologic method were involved. Their clinical and pathological data were reviewed and were given a 3-times follow-up in 2007,2008 and 2009. The follow-up studies include TCT and HPV detect. Results (1) in 73 HR-HPV positive patients, 15 of them were diagnosed as ASCUS, 3 were ASCUS-H ,28 were LSIL and 27 were HSIL by ThinPrep Cytology Test(TCT). In those 73 patients, 17 of them were CIN Ⅰ,24 were CIN Ⅱ,30 were CIN Ⅲ and 2 were possibly-invasive cervical cancer. (2) in the 3-times follow-up, non of the patients recurred. Conclusion TCT and HPV detect are effective in diagnose and follow-up of CIN patient. Key words: Cytology; Papillomavirus,human; Cervical intraepithelial neoplasia

BackgroundA predictive nomogram model was established for the prognosis of cervical intraepithelial neoplasia 2 (CIN2).MethodsThis study was based on the research data of CIN2 obtained from the Shanxi CIN cohort study from 2019 to 2022. We conducted a cross-sectional analysis of 512 female patients with CIN2. Subsequently, the least absolute shrinkage and selection operator (LASSO) regression, along with univariate and multivariate regression analyses, were conducted to identify five risk factors associated with CIN2 prognosis. These factors include age at first sexual activity, ThinPrep cytologic test (TCT) results, Human papillomavirus (HPV) infection type, lesion area detected by colposcopy, and acetowhitening thickness. A predictive model was constructed employing R software. Receiver operating characteristic (ROC) curve and resampling methods were employed to evaluate the predictive model in terms of accuracy and calibration. Decision curve analysis (DCA) was performed to assess its clinical application value.ResultsWomen with CIN2 (n = 512) aged 19–65 were included in the study; after 6 months of follow-up, 185 showed lesion regression, and 336 showed lesion persistence or progression. The factors for the predictive model included age of sexual activity (P = 0.005), multiple sexual partners (P = 0.076), TCT results (P < 0.0001), HPV infection (P = 0.0025), lesion area (P < 0.0001), and the thickness of acetic acid stain (P < 0.0001). Subsequent ROC curve analysis showed the respective sensitivity and specificity of the predictive model to be 0.827 and 0.708. Finally, DCA, used to assess the predictive value of the 5-factor CIN2 regression predictive model, was higher than the combined predictive model of HPV and TCT.ConclusionThe study could successfully establish a model for predicting the pathological regression status of CIN2 patients.

ObjectivesThis study aimed to analyze chromosomal arm-level copy number variations (CNVs) in benign diseases, cervical intraepithelial neoplasia (CIN), and cervical cancer (CC) using low-coverage whole genome sequencing (LC-WGS) and evaluate the efficacy of the ultrasensitive chromosomal aneuploidy detector (UCAD) model in distinguishing CC from CIN and benign diseases.MethodsCervical exfoliated cell specimens from 50 patients were collected for high-risk human papillomavirus(hr-HPV) testing, ThinPrep Cytologic Test (TCT), and CNV detection via LC-WGS. UCAD was employed to analyze chromosomal changes, with validation using WGS data from the National Center for Biotechnology Information(NCBI) database.ResultsAmong 50 patients, 8 had benign disease, 3 CIN1, 15 CIN2, 6 CIN2-3, 13 CIN3, and 5 CC. Chromosomal instability was detected in 9 patients (18%): all 5 CC cases, 3 CIN3 cases, and 1 CIN1 case. Gains in 3q were observed in all CC and CIN3 cases with CNVs. UCAD achieved 100% sensitivity and 91.11% specificity in differentiating CC from CIN and benign diseases, outperforming hr-HPV and TCT. The UCAD model was also applied to 5 CC and 1 high-grade squamous intraepithelial lesion (HSIL) cases obtained from the NCBI database, and the findings validated its ability to detect chromosomal aberrations in all cases.ConclusionsCNV analysis of cervical exfoliated cells shows promise for CC detection, with UCAD demonstrating high accuracy. Further validation in larger cohorts is needed to confirm its clinical utility.

Cervical cancer is a commonly-encountered malignant tumor in women. Cervical screening is particularly important due to early symptoms being deficient in specificity. The main purpose of the study is to assess the application value of cervical thinprep cytologic test (TCT) and human papillomavirus (HPV) detection in screening for cervical cancer and precancerous lesions. In the study, cervical TCT and HPV detection were simultaneously performed on 12,500 patients selected in a gynecological clinic. Three hundred patients with positive results demonstrated by cervical TCT and/or HPV detection underwent cervical tissue biopsy under colposcopy, and pathological results were considered as the gold standard. The results revealed that 200 out of 12,500 patients were abnormal by TCT, in which 30 cases pertained to equivocal atypical squamous cells (ASCUS), 80 cases to low squamous intraepithelial lesion (LSIL), 70 cases to high squamous intraepithelial lesion (HSIL) and 20 cases to squamous cell carcinoma (SCC). With increasing pathological grade of cervical biopsy, however, TCT positive rates did not rise. Two hundred and eighty out of 12,500 patients were detected as positive for HPV infection, in which 50 cases were chronic cervicitis and squamous metaplasia, 70 cases cervical intraepithelial neoplasia (CIN) I, 60 cases CIN II, 70 cases CIN III and 30 cases invasive cervical carcinoma. Two hundred and thirty patients with high-risk HPV infection were detected. With increase in pathological grade, the positive rate of high-risk HPV also rose. The detection rates of HPV detection to CIN III and invasive cervical carcinoma as well as the total detection rate of lesions were significantly higher than that of TCT. Hence, HPV detection is a better method for screening of cervical cancer at present.

Relevance of human papillomavirus screening in management of cervical intraepithelial neoplasia

The Enduring Consensus Cervical Cancer Screening and Management Guidelines Committee developed recommendations for the use of extended genotyping results in cervical cancer prevention programs. Risks of cervical intraepithelial neoplasia grade 3 or worse were calculated using data obtained with the Onclarity HPV Assay from large cohorts. Management recommendations were based on clinical action thresholds developed for the 2019 American Society for Colposcopy and Cervical Pathology Risk-Based Management Consensus Guidelines. Risk estimates were reviewed in relation to clinical action thresholds and used as the basis for draft recommendations. After an open comment period, recommendations were finalized and ratified through a vote by the Consensus Stakeholder Group. Colposcopy is recommended after positive tests for human papillomavirus (HPV) types 16 and 18. For those positive for HPV 45, 33/58, 31, 52, 35/39/68, or 51 but negative for 16 or 18, triage with cytology or dual stain testing is recommended. When screening with primary HPV testing, for patients who test positive for HPV types 56/59/66 and no other carcinogenic types, repeat HPV testing in 1 year is recommended. When screening with cotesting, for those who test positive for HPV types 56/59/66 and no other carcinogenic types, 1-year return is recommended for negative for intraepithelial lesion or malignancy, atypical squamous cells of undetermined significance, and low-grade squamous intraepithelial lesion, and colposcopy is recommended for atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H), atypical glandular cells, high-grade squamous intraepithelial lesion, or carcinoma. When patients without prior high-grade cytology (atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion, atypical glandular cells, high-grade squamous intraepithelial lesion, or carcinoma) or histology (cervical intraepithelial neoplasia [CIN]2, CIN3, or adenocarcinoma in situ) are being followed, use of extended genotyping results is acceptable. When high-grade cytology or histology results are present, or when patients are being followed after treatment of CIN2+, management using the 2019 guidelines is recommended. Human papillomavirus extended genotyping can guide clinical management in the setting of a positive HPV test result.