Colposcopy During the Pandemic

Recommendations for diagnosis and treatment 

1. Diagnostic testing for low-grade cervical cancer on screening can be deferred 6-12 months.
2. • LSIL, ASC-US, high-risk HPV with normal cytology 
   • Low-grade intraepithelial lesion on biopsy (cervical/vaginal/vulvar)
3. Diagnostic testing for high-grade cervical cancer on screening should be done within 3 months. 
4. Procedures for high-grade cervical disease should be done within 3 months.
   1. HSIL, ASC-H, AGS-NOC
   2. High-grade intraepithelial lesion with no suspected invasive disease on biopsy (cervical/vaginal/vulvar) 
5. Assessment for suspected invasive disease should be done within 2-4 weeks. 
   1. SCC, AGC-FN, endocervical adenocarcinoma in situ, adenocarcinoma
   2. Possibility of invasive disease on biopsy (cervical/vaginal) requiring excision for diagnosis
   3. Follow up for invasive disease diagnosis after an excision 
   4. Abrupt symptoms of cancerous lesions
6. Case-by-case review is recommended. 

HPV Vaccination

1. HPV vaccination doses can be deferred; all doses must be administered in the span of 1 year.

Precautions for Lower Genital Tract Outpatient Surgery

1. Risks of aerosolization of the viral particles arise from surgical smoke in LEEP or CO2 procedures; electrosurgical devices should be set to minimal power. 
2. Preoperative testing for COVID-19 and surgical masks for patients are advised.
3. Disposable instruments and colposcope protectors are recommended. 
4. A high-efficiency filter smoke evacuation system must be connected to the electrosurgical devices or to the speculum to clear surgical smoke. 
5. Regulated PPE is essential. 
6. The OR should be disinfected as per regulated protocols. 

This information comes from two sources. The American Society for Colposcopy and Cervical Pathology (ASCCP) released adapted recommendations for diagnosis and treatment in this setting based on organized screening. Ciavattini et al. wrote an expert consensus article with recommendations for the management of colposcopy evaluations in Italy based on organized screening tests, cervical cytology results or histopathological diagnosis, as well as precautions for outpatient surgery. 

Sources:

1. The American Society for Colposcopy and Cervical Pathology. (March 19, 2020). ASCCP Interim Guidance for Timing of Diagnostic and Treatment Procedures for Patients with Abnormal Cervical Screening Tests. Retrieved from: https://www.asccp.org/covid-19
2. Ciavattini A., Carpini G.D,. Giannella L. et al. (April 8, 2020). Expert consensus from the Italian Society for Colposcopy and Cervico-Vaginal Pathology (SICPCV) for colposcopy and outpatient surgery of the lower genital tract during the COVID-19 pandemic. https://doi.org/10.1002/ijgo.13158