Great catch! I don’t see any tagged QID. Support
Should we add this part to extra field?
Repeat cytology every year for two years; if repeat cytology is normal for two consecutive years, resume age-appropriate screening
Yeah good idea
Added it 
Haven’t had a chance to dig into this yet but this would seemingly conflict with the image in extra as it tells us women under 25 with ASCUS get reflex HPV testing (which, if negative, allows continuing routine screening)
I couldn’t find any place in Amboss that confirms what the image says. I think the image in the Extra is based off the image in Additional Resources, which is not from UWorld or Amboss. I couldn’t confirm the authenticity of the image.
Also, the image conflicts with what is in Amboss: “In a woman < 25 years of age with a low-grade lesions (LSIL or ASC-US), cytology alone should be repeated every year for two years. If repeat cytology is normal for two consecutive years, resume age-appropriate screening.”
The image in the additional resources is from the American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines, specifically their 2013 update. the 2020 update (also used in uptodate) has the same info. both the card and the algorithm in the extra section are correct according to ASCCP guidelines and uptodate since they use the same algorithm
but it’s worth mentioning there’s some inconsistency in the deck on which guideline they follow (USPSTF, ACS, ASCAP)
there’s a step 3 Uworld question that indirectly refers to a patient with ASCUS at age 24 who did HPV testing and then continued with routine screening after a negative test (according to ASCCP guidelines i assume, but the q was asking about sth else). Amboss, in their references, says they use ASCCP guidelines but only mention the left part of the algorithm in their article
@beejumm suggestion is always correct if it had LSIL instead of ASCUS in the text so the original card and algorithm in the extra are pretty specific to ASCUS (as mentioned in the algorithm). i guess that’s why Amboss only mentions the left part of the algorithm since it’s more applicable and correct for all low-grade histology findings (LSIL and ASCUS)
so both @beejumm and the original card are correct, but since the card mentions ASCUS, the patient can either repeat the cytology after 1 year or do HPV testing and continue with routine screening if HPV is negative
Overall, the card seems correct to me, but there are three issues
- there’s inconsistency in the cards regarding which guideline to follow
- the topic feels low yield to me, and i don’t remember seeing questions that go into much detail
- A good option in my opinion would be to go with @beejumm suggestion but mention in the extra that the patient can go for HPV testing and then routine screening if negative
@AnKing-Maintainers Okay instead of starting this conversation over I wanted to continue it here (and then we can address with a new suggestion)
THIS card conflicts with a dupe in the deck so it needs addressed ASAP IMO.
DUPE: nid:1547916146828
@mohannadkh10 Shared some insight above on the most likely reason for confusion. There are technically two options. “Repeat Pap in 1 year” Labeled by ASCCP as the preferred option, and “Reflex HPV testing” labeled by ASCCP as “acceptable” option.
I believe the other card (nid:1547916146828) is written accurately as the true “recommendation” and this card could use an update to the wording:
What is the alternative management for a 21-year-old woman with atypical squamous cells of undetermined significance (ASCUS) discovered on Pap testing and negative HPV testing?
{{c1::Reflex HPV testing (routine screening if negative)}}
This would help test when reflex HPV testing is used (not currently tested in the deck) and remove duplicate content that is presently contradicting itself.
@Jwill think this is a great solution!