"Suggestions/recommendations" on Pap reports

[levels x3]

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What do you and/or your partners do for routine cases? The type of suggestions I'm talking about are recommended follow-up based on the Pap interpretation. For example, adult woman with LGSIL; would you add a suggestion like "consider colposcopy".

Personally, I don't do this for most cases. I assume that the clinician knows what to do and I don't really want to tell them what to do. I will suggest HPV testing when appropriate, because I sense that some guidance is still needed out there. Some of my partners, however, will suggest a follow-up course for every case.

One area where I am considering making suggestions though, is adolescent women with ASC-US and LGSIL. I see too many follow-up biopsies when the guidlines (ASCCP at least) suggest follow-up with another Pap at 12 months.

 

[KCShaw]

I don't remember adding such in my resident days. Personally, the treatment & follow-up guidelines seem to change from time to time, so I always had some reservations about ever including treatment &/or follow-up suggestions on a permanent diagnostic report unless the requisition asked something that I didn't think the test performed answered as well as an alternative might (so, generally limited to suggesting alternative tests or summarizing why the reported test was suboptimal to answer the question at hand, etc.). I would be more inclined to have a few discussions with clinicians and hopefully clarify things once than to put a suggestion in every single report. Of course, I also don't practice typical surgical/cytopathology either.

 

[2121115]

Like you, I don't feel this is necessary. Putting additional information in the medical record like that just increases the chances for there to be a disagreement/discrepancy.

 

[Ruination]

One of the attendings at my institution exclusively does cytology and cited an algorithm put out by ACOG that GYNs use to manage their patients. I think this is the most current one I could find:

http://www.acog.org/publications/patient_education/bp161.cfm

Anyway, we don't usually provide case by case recommendations on our paps.