What is the first step in managing atypical squamous cells of undetermined significance?

The first step in managing atypical squamous cells of undetermined significance (ASC-US) is to test for HPV infection. This is because ASC-US is a category of abnormal Pap test results that indicates that there may be some atypical changes in the cervical cells, but it does not confirm the presence of precancerous changes.

When ASC-US is detected, the next logical step involves determining whether the changes are associated with high-risk HPV types. Testing for high-risk HPV can help stratify the risk of cervical cancer and decide on the appropriate management pathway. If the HPV test is positive for high-risk types, further evaluation, such as colposcopy, is typically warranted. Conversely, if the HPV test is negative, the recommendation is often to return to routine screening.

This approach is based on the understanding that not all cases of ASC-US will progress to malignancy, and the presence of high-risk HPV is a crucial factor in determining the need for more invasive diagnostic procedures like colposcopy or biopsy. Therefore, testing for HPV infection is an essential step in effectively managing cases of ASC-US and ensuring patient safety without unnecessary invasive interventions.