June 2022 – Clinical Informatics

A 24-year-old patient just received a result of LSIL HPV 16+. The patient has a history of ASCUS HPV+ non-genotyped the year prior. The patient has no other pertinent medication history and does not wish to have children.

Figure 1: Decision Tree (Click image to Enlarge)

Using the guideline decision tree what should be the patient's follow up?

  • 3-year follow-up
  • 1-year follow-up
  • Colposcopy
  • Cannot be determined

The correct answer is ...

1-year follow-up.

As you follow down the center of the diagram you will see first that the patient has a one-year follow-up for the ASCUS HPV+, then with the LSIL diagnosis has an additional year of follow-up regardless of the HPV status. Having progressive changes to cytology compounded by persistent HPV positivity and HPV 16 diagnosis can be concerning. However, the data shows that patients who are younger have a high chance of clearing HPV infections and cytologic changes.1,2

Additionally, guideline decision trees like the one in this case are immensely powerful tools in medicine. They distill data and knowledge into an easy-to-view format that non-medical patients can follow. They have been used in publications of these guidelines and others for years. They can also be distilled for informaticians, analysts, and engineers into clinical decision support logic for use in an EMR very easily by supplementing the branches into if/else logic functions. Some software has even utilized this format for knowledge, automation, and treatment recommendation (Epic and Trisotec).3,4,5


  1. Perkins, R. B., Guido, R. S., Castle, P. E., Chelmow, D., Einstein, M. H., Garcia, F., ... & Schiffman, M. (2020). 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. Journal of lower genital tract disease, 24(2), 102.
  2. Demarco, M., Egemen, D., Raine-Bennett, T. R., Cheung, L. C., Befano, B., Poitras, N. E., ... & Schiffman, M. (2020). A study of partial human papillomavirus genotyping in support of the 2019 ASCCP risk-based management consensus guidelines. Journal of lower genital tract disease, 24(2), 144.
  3. Greenes, R. A. (Ed.). (2014). Clinical decision support: the road to broad adoption. Academic Press.
  4. Epic. (n.d.). Retrieved April 15, 2022, from https://www.epic.com/about
  5. Trisotech. (2022, April 11). Retrieved April 15, 2022, from https://www.trisotech.com/

Jason Greenwood, M.D., M.S.
Fellow, Clinical Informatics
Mayo Clinic

Justin Juskewitch, M.D., Ph.D.
Senior Associate Consultant, Transfusion Medicine
Mayo Clinic
Assistant Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine and Science

MCL Education (@mmledu)

MCL Education

This post was developed by our Education and Technical Publications Team.