Clinical Significance of Atypical Squamous Cells of Undetermined Significance from Cervical Pap Smear

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Bandit Chumworathayi
Wanpen Ungpinitpong
Sanguanchoke Launratanakorn
Pissamai Yuenyao
Pilaiwan Kleebkaew

Abstract

Objective: To estimate the prevalence of human papillomavirus (HPV) infection, cervical intraepithelial neoplasia (CIN) and cervical carcinoma in patients with atypical squamous cells of undetermined significance (V) from cervical Pap smear.

Study design: Descriptive study

Setting: Srinagarind Hospital, Faculty of Medicine, Khon Kaen University.

Subjects: Two hundred and seventy-three women with a new cervical cytology diagnosis of ASCUS, without prior dysphasia or cervical carcinoma between July 1st, 1999 and June 30th, 2001

Method: We reviewed 273 records to collect follow-up Pap smear results, colposcopic results and histological reports

Main out come measures: Prevalence of HPV infection, CIN and cervical carcinoma.

Results: The 273 new reported ASCUS cervical smears represented 0.8% of all cervicovaginal smears diagnosed in our center during the same time period (33,744 smears). Ninety five patients (34/8%) were lost to  follow-up. Of the remaining 178 patients, 27 cases had cytological follow-up; 24 cases (13.5%)  reverted to normal or benign cellular changes, 2 cases (1.1%) persisted as ASCUS and then lost to follow-up, 1 case progressed to high grade squamous intraepithelial lesion, then lost to follow-up; 138 cases underwent colposcopy with or without biopsy as indicated; 5 cases had biopsy without colposcopy; 8 cases had hysterectomy without colposcopy or Pap smear follow-up. The majority of patients (64.5%) underwent histological examination; 72 cases (40.7%) were negative (without HPV and CIN); 16 cases (9.0%) showed HPV infection, 26 cases  showed CIN, of which 6 cases (3.4%) were CIN I, 6 cases (3.4%) were CIN II and 14 cases (7.8%) were CIN III and 1 case (0.6%) was invasive lesion.

Conclusion: This study showed that 24.2% of ASCUS cervical Pap smears finally had HPV, CIN and invasive cervical carcinoma.  Thus, ASCUS should be assessed colposcopically.

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