Clinical relevance of atypical squamous cells of undetermined significance by the 2001 bethesda system: experience from a cervical cancer high incidence region.

The aim of this study was to evaluate the underlying lesions and factors predicting cervical intraepithelial neoplasia (CIN) 2+ in women who had 'atypical squamous cells of undetermined significance' (ASC-US) on cervical cytology in the region with a high incidence of cervical cancer. This study was prospectively conducted at Chiang Mai University Hospital, Chiang Mai, Thailand. All women with ASC-US cytology undergoing colposcopic evaluation between October 2004 and August 2008 were recruited. During the study period, 208 women were enrolled. Mean age was 44.4 years. The histopathologic results at the initial evaluation were as follows: CIN 2-3, 21 (10.1%); adenocarcinoma in situ, 3 (1.4%); cancer, 5 (2.4%); CIN 1, 26 (12.5%); and no lesions, 153 (73.6%). Multivariate analysis revealed that nulliparity (adjusted odds ratio [aOR] =4.09; 95% confidence interval [CI] = 1.04-16.10) and current oral contraceptive use (aOR=2.85; 95%CI= 1.14-7.15) were independent predictors for having CIN 2+ at the initial colposcopy. At the median follow-up time of 6.7 months, CIN 2-3 lesions were additionally detected in 2 women. In conclusion, ASC-US cytology in our population has a relatively high prevalence of underlying invasive carcinoma. Nulliparity and current oral contraceptive use are independent predictors for harboring CIN 2+.

Factors predicting occult invasive carcinoma in women undergoing a 'see and treat' approach.

This study was undertaken to evaluate the incidence and independent predictors of unexpected invasive cancer of cervix in women with high-grade squamous intraepithelial lesions (HSIL) on Pap smear who had undergone a 'see and treat' approach. Women with HSIL on cervical cytology undergoing colposcopy, followed by loop electrosurgical excision procedure (LEEP) at Chiang Mai University Hospital between January 2001 and April 2006 were analyzed. During the study period, 446 women were identified. Mean age was 45.6 years (range, 25-75 years). One hundred and twenty-one (27.1%) women were postmenopausal. Unsatisfactory colposcopy was observed in 357 (80.0%) women. Of the 446 women, 76 (17.04%, 95% CI=13.67 to 20.86) had invasive lesions on LEEP specimens. Multivariate analysis revealed that unsatisfactory colposcopy and premenopausal status were statistically significant independent predictors for invasive lesions in a 'see and treat' LEEP with an adjusted odds ratio of 4.68 (95%CI=1.82 to 12.03, P<0.01) and 2.10 (95%CI=1.12 to 3.94, P=0.02), respectively. In conclusion, occult invasive lesion of the cervix was noted in 17% of women with HSIL Pap smear who underwent a 'see and treat' approach at our institute. Unsatisfactory colposcopy and premenopausal status were significant independent predictors of having such lesion.

Cytomorphologic comparison between rehydrated air-dried and conventional wet-fixed pap smears.

OBJECTIVE: To compare the cytomorphologic quality of the cervical (Pap) smears between two fixation techniques, rehydration of air-dried smears (AD) versus wet fixation (WF). MATERIAL AND METHOD: Paired-cervical smears (AD and WF) from 172 women who underwent cervical cytology screening at Chiang Mai University Hospital between August 2004 and September 2004 were prospectively evaluated for the cytologic parameters and the staining qualities. RESULTS: The mean age of the 172 women was 41.7 years +/-2 SD 18.1), 27 women (15.7%) were postmenopausal. Absence ofred blood cells in the smear background was significantly more frequent in AD smears than in WF specimens (p = 0.0006). Air-drying artifact was more frequent in AD smears compared to those of WF (p = 0.036) but was of only mild degree in all cases. There was no significant difference between AD and WF smears in the cytoplasmic quality including distinctness of cell border (p = 0.30) and satisfactory staining (p = 0.054). For the nuclear morphology, there was no significant difference between both fixation techniques in the distinctness of nuclear border (p = 0.26) and chromatin crispness (p = 0.23) of the endocervical nuclei. In squamous nuclei, AD smears had higher frequency of indistinct nuclear border and hazy chromatin compared to WF smears (p = 0.003 each). However, these were observed in only mild degree and did not affect the cytologic interpretation. CONCLUSION: The quality of AD smears was slightly inferior to WF smears but was still satisfactory for cervical cytology. AD technique may be acceptable as an alternative to wet fixation in cytologic cervical cancer screening.