Prävention des Zervixkarzinoms. Leitlinie der DGGG und DKG (S3-Level, AWMF-Register-Nummer 015/027OL, Dezember 2017) – Teil 2 mit Abklärung, Therapie und Nachbetreuung

Zusammenfassung

Ziele Seit 1971 erfolgt in Deutschland die jährliche, opportunistische Früherkennungsuntersuchung des Zervixkarzinoms. Durch die Etablierung dieser S3-Leitlinie wird zum einen eine wichtige Forderung des Nationalen Krebsplans zum Zervixkarzinom-Screening erfüllt. Zum anderen kann die S3-Leitlinie wesentliche Informationen und Hilfestellungen für das geplante organisierte Zervixkarzinomscreening in Deutschland geben.

Methoden Mit finanzieller Unterstützung durch die Deutsche Krebshilfe wurden durch 21 Fachgesellschaften evidenzbasierte Statements und Empfehlungen (GRADE-System) zu Screening, Management und Behandlung von Zervixkarzinom-Vorstufen erarbeitet. Zwei unabhängige wissenschaftliche Institute haben systematische Reviews für diese Leitlinie erarbeitet.

Empfehlungen Der zweite Teil dieser Kurzzusammenfassung behandelt u. a. Abklärung, Therapie und Nachbetreuung zervikaler Dysplasien. Im Hinblick auf Nichtteilnehmerinnen am Screening empfiehlt die Leitliniengruppe erneute Einladungsschreiben oder eine HPV-Selbstabnahme. Ab einer Zytologie von Pap II-p in Kombination mit einem positiven HPV-Befund sollte eine Kolposkopie zur weiteren Abklärung durchgeführt werden, ebenso bei einem positiven HPV 16 oder HPV 18 Screening Test. Ein alleiniger auffälliger Pap-Abstrich sollte eine Triage mittels HPV-Test oder p16/Ki67 Dual-stain zur Folge haben.

Schlüsselwörter

Zervixkarzinom - zervikale intraepitheliale Neoplasie (CIN) - zervikale Präkanzerosen - HPV

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