ASCCP Practice Guidelines Management Guidelines for the Follow-up of Atypical Squamous Cells of Undetermined Significance (ASCUS)

: Editor's Note: This guideline was first published in The Colposcopist in January 1996 and reflected the peer-reviewed literature available on the management of ASCUS at that time. The decision to republish this guideline in The Journal of Lower Genital Tract Disease, to accompany guidelines on the management of low-grade squamous intraepithelial lesion (LGSIL) and benign cellular changes (BCC) was made to complete the set of guidelines in the Journal pertaining to management of the cytology screening system. (See also previous guidelines on Management Issues Related to the Quality of the Smear, Management of Atypical Glandular Cells of Undetermined Significance (AGUS), and the Abnormal Pap Follow-up System.) Our original intention was to update the ASCUS guideline for this publication in the expectation that the data from the enrollment phase of the National Cancer Institute's ASCUS LGSIL Triage Study (ALTS) would be available to provide relevant evidence-based recommendations. The unavailability of this data at this time has ensured a later update of the ASCUS guideline. However, an accumulating body of new literature, particularly on the clinical utility of HPV testing with Hybrid Capture II (Digene Corp., Gaithersburg, MD), will be incorporated within the next year with the enrollment ALTS data in a new ASCUS guideline. Until that time, the guideline presented here remains the recommendation of the ASCCP, based on the review of the literature at that time, and on the collective experience and knowledge of the ASCCP Practice Committee and the Board of Directors.The cost analysis in this guideline is based upon a set of cost assumptions which will vary from setting to setting. This analysis is intended to serve as a reference for average costs in a fee-for-service setting. The individual practitioner will need to analyze cost differentials for his/her own setting.This guideline reflects emerging clinical and scientific advances as of February 1996, and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed.

Initial evaluation of the use of the potassium-titanyl-phosphate (KTP/532) laser in gynecologic laparoscopy

A new surgical laser, the potassium-titanyl-phosphate 532 nm laser (Laserscope, Santa Clara, CA) has recently become available for investigative procedures in gynecology. This article reports initial investigation of this laser energy at laparoscopy with the use of a flexible fiberoptic delivery system in rabbits and patients with endometriosis. Tissue effects on peritoneal structures of rabbits with laparoscopic firing of this new laser demonstrated the ability to accomplish surface vaporization without bowel perforation or penetration greater than 2 mm. In ten patients with pelvic endometriosis and pain, effective laparoscopic vaporization of implants has been safely accomplished with ease. Early follow-up revealed symptomatic improvement in all patients. This new laser is easy to use laparoscopically, appears safe in early investigations, and effectively reduces early postoperative pain associated with pelvic endometriosis.