Successfully conservative treatment of large cervical choriocarcinoma with profuse vaginal bleeding.

Primary choriocarcinoma of the uterine cervix is a rare disease. The accurate diagnosis of such a disease is difficult to achieve because of its rarity. Furthermore, the majority of cases presented with abnormal vaginal bleeding that could be caused by other more common conditions including, threatened abortion, cervical polyp, cervical pregnancy, or cervical cancer. In the present report, the authors present a case of large cervical choriocarcinoma with life-threatening vaginal bleeding, which was initially misdiagnosed as a cervical cancer The active cervical bleeding was successfully controlled with selective uterine arterial embolization. Remission of cervical choriocarcinoma was accomplished with combination chemotherapy without the need of hysterectomy.

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+.

Underlying histopathology of HIV-infected women with squamous cell abnormalities on cervical cytology.

This study was undertaken to evaluate the underlying histopathology of HIV-infected women who had abnormal cervical cytology. HIV-infected women with abnormal cervical cytology undergoing colposcopy at Chiang Mai University Hospital between January 2001 and February 2008 were reviewed. The cohorts were matched and compared with an HIV-negative group. During the study period, 65 HIV-infected women with abnormal cervical cytology were available for review. The abnormal cervical smears were atypical squamous cell (9), low-grade squamous intraepithelial lesion (22), high-grade squamous intraepithelial lesion (27), and squamous cell carcinoma (7). When stratified by severity of abnormal cytology, HIV-infected women had a higher risk of having cervical intraepithelial neoplasia II or higher, whether the cervical smear showed low-grade (P=0.01) or high-grade abnormality (P=0.04) compared with the HIV negative group. After adjustment by age, parity, and menopausal status, HIV-infected women had 2.56 times the risk of having CIN II or higher (69.2% of HIV-infected women compared with 47.7% of HIV negative women; 95% CI=1.21-5.40, P=0.01). In conclusion, HIV-infected women with abnormal Pap smears are a population subset with a higher risk of significant cervical lesions, irrespective of the severity of abnormal cervical smears.

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.

Incidence and predictors of febrile morbidity after radical hysterectomy and pelvic lymphadenectomy for early stage cervical cancer patients.

This study was undertaken to evaluate the incidence and independent predictors for febrile morbidity after radical hysterectomy and pelvic lymphadenectomy. Patients with FIGO stage IB-IIA cervical cancers who had undergone RHPL at Chiang Mai University Hospital between January 2003 and December 2005, were reviewed. The clinical variables including the age at diagnosis, menopausal status, body mass index, previous cervical conization, tumor size, preoperative chemotherapy, preoperative anemia, operative time, and estimated blood loss were analyzed for prediction of postoperative febrile morbidity. During the study period, 357 women were reviewed. The mean age was 44.7 years. Sixty-five (18.2%) women were postmenopausal. The majority of women (77.3%) were in FIGO stage IB1. The most common histology was squamous cell carcinoma (69.2%). Febrile morbidity was noted in 94 women (26.3%, 95% CI= 21.8-31.2) in whom 25 (7.0%) had urinary tract infection (19), abdominal wound infection (4), and vaginal cuff infection (2), respectively. Only massive blood loss (>1,500 ml) was noted as the significantly independent predictor for febrile morbidity (aOR= 2.7, 95% CI=1.1-6.6, P=0.028). In conclusion, approximately one-fourth of the women undergoing RHPL at our institute had postoperative febrile morbidity. Only massive blood loss is a significant predictor for this complication.

Interobserver reproducibility with LiquiPrep liquid-based cervical cytology screening in a developing country.

OBJECTIVE: A modified liquid-based techniques known as the "LiquiPrep (LP) system" requires neither expensive equipment nor complicated specimen preparation. The aim of this study was to assess the applicability of the LP for use in a developing country. METHODS: Cervical cytology specimens were collected from 777 women, using the Cervex-Brush. The brush was first smeared on a glass side for conventional Papanicolaou (CP) stain, and then immersed in preservation fluid for LP preparation. Cytologic interpretations were classified into four categories: 1) no atypical cells, 2) atypical squamous epithelial cells (ASC), 3) definite epithelial cell abnormality, and 4) unsatisfactory specimen. Interobserver variability was tested using weighted kappa statistics. RESULTS: An LP specimen cost $9 per case compared to $3 per case for a conventional Pap smear. The time to learn the technique was only a few days. Forty six (5.92%) specimens by LP were unsatisfactory. The overall agreement between cytopathologists was 96.7% (weight kappa=0.62), with 95.6% (weight kappa=0.44) for the cases enrolled earlier, increasing to 97.9% (weight kappa=0.78) for the cases enrolled later. CONCLUSIONS: In summary, after a short learning curve, interobserver reproducibility of LP smear was near perfect. This feature of the LP, together with the relatively low cost and simple protocol, makes it quite suitable for cervical cytology screening in developing countries. Moreover, with this technique, some of each sample can be reserved for additional studies such as HPV detection and subtyping.

Prognostic value of p53 expression in early stage cervical carcinoma treated by surgery.

OBJECTIVE: To evaluate the prognostic significance of p53 protein expression in patients with early stage cervical carcinoma treated by surgery alone in a well-controlled study. METHODS: A matched case-control study was performed in patients with stage Ib-IIa cervical carcinoma who underwent radical hysterectomy with pelvic lymphadenectomy. Patients had neither lymph node metastasis nor involvement of the parametrium and surgical margins, and did not receive any adjuvant treatment. Cases included 30 patients who had tumor recurrence within 5 years after surgery; controls included 60 patients who were disease-free for at least 5 years after surgery. Cases and controls were within 10 years of age, had the same stage and tumor type, and underwent surgery on as close to the same date as possible. The tumor sizes of cases and controls were within 1 cm of each other. Expression of p53 protein was studied by immunohistochemistry. Expression was considered positive when at least 10% of tumor cells showed nuclear staining. RESULTS: No significant difference of p53 expression was observed between the case group and the control group (33% versus 40%). High histologic grade of tumors and lymphovascular space invasion were significantly associated with tumor recurrence in multivariable analysis (p=0.012 and 0.014, respectively). CONCLUSION: In this study, expression of p53 did not correlate with tumor recurrence. Immunohistochemistry for p53 protein appears to provide no prognostic information in the patients with early stage cervical cancer treated by surgery.

Appropriate interval for repeat excision in women undergoing prior loop electrosurgical excision procedure for cervical neoplasia.

The objective of the present study was to evaluate the impact of intervals on complications and pathological examination in women undergoing a repeat loop electrosurgical excision procedure (LEEP) for cervical neoplasia. During October 2004 and January 2007, 78 women who had undergone repeat LEEP at Chiang Mai University Hospital, were prospectively evaluated. The mean age was 47.5 years (range; 27-69 years). The mean duration of uncomplicated vaginal bleeding was 4.4 days (range; 1-20 days). The occurrence of persistent vaginal bleeding was noted in 9 women. Among 78 women, 2 (2.56%) and 7 (8.97%) experienced intraoperative and postoperative hemorrhage, respectively. Six (7.69%) had postoperative infection. These complications were not significantly different from those observed in women undergoing first LEEP in the same period (P=0.56). There was no significant difference in the incidence of perioperative complications and the incidence of non-evaluable cone margins among women who undergoing repeat LEEP within 4-6 weeks, between 6-8 weeks, and more than 8 weeks after first LEEP. In conclusion, repeat LEEP could be safely performed 4-12 weeks after the first procedure without any impact on pathological specimen examination.

Lymphovascular space invasion as a prognostic determinant in uterine cancer.

The objective of this study was to evaluate the clinical significance of lymphovascular space invasion (LVSI) in patients with uterine cancer in terms of lymph node metastasis, recurrence and survival rate. A total of 190 patients with newly diagnosed uterine cancer who underwent total abdominal hysterectomy (TAH), bilateral salpingo-oophorectomy (BSO), omentectomy, peritoneal washing or ascitic fluid collection, and pelvic/paraaortic lymph node sampling at Chiang Mai University Hospital between January 1999 and December 2004 were evaluated. All medical records and histopathologic slides were retrospectively reviewed to determine the relationship between LVSI and clinicopathological characteristics. LVSI was present in 79 patients (42%) and significantly correlated with lymph node metastasis (p0.001), BMI 25 kg/m2 (p0.001), advanced FIGO stage (p 0.001), poor histologic grade (p0.001), and deep uterine invasion (p0.001). Patients with LVSI, when stratified by FIGO stage, also had a significant lower 5-year survival rate. For those who had disease recurrence, LVSI and histologic grade were found to be independent prognostic factors in a multivariate analysis. LVSI was one of the prognostic determinants for disease recurrence and associated with poor survival in patients with uterine cancer.

How can the overtreatment rate of "see and treat" approach be reduced in women with high-grade squamous intraepithelial lesion on cervical cytology?

Background: The aim of this study was to determine the incidence and predictors of overtreatment in "see and treat" approach using loop electrosurgical excision procedure (LEEP) in women with high-grade squamous intraepithelial lesion (HSIL) on cervical cytology. The overtreatment was considered when LEEP specimens contained no cervical pathology. Between January 2001 and April 2006, 446 women with HSIL on Pap smear underwent colposcopy followed by LEEP at Chiang Mai University Hospital. Mean age of these patients was 45.6 years with a range of 25-78 years. One hundred and twenty-one (27.1%) women were menopausal. Unsatisfactory colposcopy was observed in 357 (80.0%) women. Of 446 women, histologically-confirmed HSIL, invasive cancer, low-grade squamous intraepithelial lesions, and adenocarcinoma in situ were detected in 330 (74.0%), 76 (17.0%), 9 (2.0%), and 5 (1.1%), respectively. The overtreatment rate on LEEP specimens was noted in 26 women or 5.8% (95% confidence interval [CI] = 3.8 to 8.4) of 446 women. By multivariate analysis, postmenopausal status was the only significant independent predictor of overtreatment with an adjusted odds ratio of 2.89 (95% CI = 1.30 to 6.43, P = 0.009). When postmenopausal women were excluded from analysis, the overtreatment rate was reduced to only 4.0%. In conclusion, "see and treat" approach appears to be an appropriate strategy in managing women with HSIL cytology. The overtreatment rate could be reduced when such policy is limited for premenopausal women.

Factors affecting residual lesion in women with cervical adenocarcinoma in situ after cone excisional biopsy.

The objective of this study was undertaken to evaluate the factors affecting residual lesion in women with adenocarcinoma in situ (AIS) on cervical conization specimens. The medical records of women with AIS who had no associated invasive carcinoma after cervical conization and underwent subsequent hysterectomy at Chiang Mai University Hospital were reviewed. During March 1998 and March 2006, 45 women were included for analysis. The mean age was 45.2 years (range, 30-66 years). Thirteen (28.9%) women presented with AIS on Pap smear. Thirty (66.7%) underwent loop electrosurgical excision procedure and the remaining 15 (33.3%) underwent cold-knife conization. Twenty (44.4%) women had mixed lesions of AIS and squamous intraepithelial lesion on cervical specimens. Surgical cone margins were clear in 25 (55.6%) women. Eighteen (40%) and two (4.4%) women had involved and non-evaluable cone margins, respectively. Residual lesion was noted in 14 (31.1%) hysterectomy specimens. There was no residual lesion in women with clear cone margins while 72% and 50% of women with involved and non-evaluable cone margins, had residual lesion, respectively. These differences were statistically significant (P<0.001). No significant association between the ECC results and the residual lesion was noted (P=0.29). In conclusion, approximately one-third of women with AIS on cervical conization have residual lesion on subsequent hysterectomy specimens. Only cone margin status is a significant predictor for residual lesion.

Efficacy of cisplatin in early stage cervical cancer with a long waiting period for surgery.

This study was undertaken as a prospective trial to evaluate the efficacy and safety of pre-operative cisplatin for controlling the tumor volume of stage IB-IIA cervical cancer patients whose schedule for radical surgery was longer than 3 weeks. Between June 2004 and July 2005, 42 patients were recruited to enter the study. Seventy-five mg/m(2) of cisplatin was administered for 1-2 courses. Cervical tumor volume was measured 1 day before chemotherapy and 1 day before the operation by using 3-dimensional ultrasound. Reduction of cervical tumor volume was noted in 76.2%of cases. The clinical stage, gross appearance of the tumor, histology and number of chemotherapy courses did not significantly affect chemo-responsiveness. The incidence of lymph node metastases was 16.3%. One patient experienced severe vomiting which could be controlled by ondansetron antiemetic. No severe hematologic or other non-hematologic toxicities were identified. In conclusion cisplatin is effective and safe for administration in a pre-operative setting for early stage cervical cancer patients whose surgical schedule is delayed more than 3 weeks.

Benefit of electrocardiography during front-line combination paclitaxel and carboplatin chemotherapy for epithelial ovarian cancer.

OBJECTIVE: To evaluate the patterns of electrocardiography (ECG), cardiac risk factors and its clinical consequence in women with epithelial ovarian cancer (EOC) who received paclitaxel and carboplatin (PC) as front line chemotherapy. MATERIAL AND METHOD: The medical records and electrocardiographic data of women with EOC who received paclitaxel (175 mg/min2) and carboplatin (AUC=5) every 3 weeks at Chiang Mai University Hospital between January 2000 and December 2004 were reviewed for cardiac risk factors and clinical consequence. RESULTS: Among 79 women receiving PC for EOC, 43 (54.4%) had cardiac risk factors. Seventy (88.6%) women had normal ECG, the remaining nine had sinus tachycardia (5), bundle branch block (2), mild T inversion (1), and Wolff-Parkinson-White syndrome (1) before the first course of chemotherapy. Among 70 women with normal initial ECG 8 (11.4%) had sinus tachycardia, one (1.4%) had early depolarization, two (2.9%) had sinus bradycardia and three (4.3%) had sinus arrhythmia in subsequent ECG All these cardiac disturbances were asymptomatic and needed no intervention, indicating grade I toxicity. The odds ratio of developing abnormal ECG in women with cardiac risk factor was 1.24 (95% CI = 0.33 to 4.64, p = 0.77). Among nine patients with abnormal ECG before the first course of PC, six (66.7%) had subsequent abnormal ECG but all were asymptomatic and no worsening of abnormal ECG pattern was noted. CONCLUSION: Although paclitaxel and carboplatin chemotherapy could induce abnormal ECG in women with either normal or abnormal prior ECG, its consequence was of no clinical significance. Therefore, the benefit of ECG before each treatment course was theoretically limited.

Can adenocarcinoma in situ of the uterine cervix be predicted before cervical conization?

This study was undertaken to determine the effectiveness of the Papanicolaou (Pap) smear, colposcopically-directed biopsy (CDB), and endocervical curettage (ECC) in preconization detection of adenocarcinoma in situ (AIS) of the uterine cervix. Women, whose cervical conization specimens contained adenocarcinoma in situ without any associated invasive lesion at Chiang Mai University Hospital between March 1998 and March 2006, were reviewed. During the study period, fifty-one women who matched the study inclusion were identified. Glandular abnormality was detected by Pap smears in 22 women (43.1%). Among 29 women with squamous lesions on Pap smears, 9 additional glandular abnormalities were detected on CDB and/or ECC. In total, glandular abnormality was suspected in 31 women (60.8%) preoperatively. According to the histological type of AIS, glandular abnormality suspected from preoperative evaluation was noted in 20 women (70.4%) who had pure AIS. Among women with mixed AIS/HSIL, only 12 women (50.0%) had preoperative evaluation suggesting glandular abnormality. These data demonstrate that the sensitivity of combining Pap smear, CDB and/or ECC in detecting glandular lesions before conization containing AIS appears to be suboptimal. Further study concerning the improvement of detecting AIS before conization is warranted to select the most appropriate diagnostic conization method for such lesions.

Clinicopathological features and prognosis of Thai women with endometrioisis-associated ovarian carcinoma.

This study was undertaken to evaluate the clinical features and survival outcomes of ovarian cancer patients who had associated pelvic endometrioisis. The medical records of 1076 patients with ovarian cancer treated at Chiang Mai University Hospital between 1995 and 2005 were reviewed. Among of these patients, 37 (3.4%) had associated pelvic endometriosis. The mean age of the patients was 44 years (25-62 years). The most common presenting sign and symptom was an abdominal mass (12), followed by abdominal pain (10), abdominal distension (7), abnormal uterine bleeding (2). Twenty-one (56.8%) patients were nulliparous and 14 (37.8%) were single. The stage distribution was stage I (24), stage II (4), stage III (4), and stage IV (1). Four patients had 2 primary carcinomas. The most common histology of the 37 patients was clear cell carcinoma (17) followed by endometrioid carcinoma (11). The estimated 5-year disease - free survival was 55.4%. In conclusion, most patients associated with endometriosis- associated ovarian carcinoma present with abdominal masses and pain. Clear cell CA is the most common histology in ovarian cancer patients who have associated endometriosis. Three fourths of the patients are in stage I and have favorable prognosis.

Limited value of vaginal cytology in detecting recurrent disease after radical hysterectomy for early stage cervical carcinoma.

The objective of this study was to evaluate the value of vaginal cytology in routine surveillance for recurrent cervical cancer after surgery. We reviewed the medical records of 565 patients with stage IB-IIA cervical cancer who were treated with radical hysterectomy and pelvic lymphadenectomy (RHPL) and attended follow- up at Chiang Mai University Hospital between January 2000 and May 2006. With the median follow-up of 35 months (range 1-76 months), 23 (4%) patients developed recurrence. The interval from surgery to detection of recurrence ranged from 5-61 months with a median of 23 months. Of the total 4,376 vaginal smears, 5 (0.1%) showed abnormal cytology but only 1 had malignant cells and tumor recurrence. The sensitivity and specificity of vaginal cytology for detection of recurrence were 4.3% and 99.3%, respectively. In conclusion, vaginal cytology has limited value in detection of recurrence after RHPL for early-stage cervical cancer.

Clinical outcomes and prognostic factors of node-negative cervical cancer patients with deep stromal invasion or lymphovascular space involvement following radical hysterectomy.

OBJECTIVE: To evaluate the clinical outcomes and prognostic factors of node-negative cervical cancer patients who had deep stromal invasion (DSI) and/or lymphovascular space invasion (LVSI) following radical hysterectomy and pelvic lymphadenectomy (RHPL). MATERIAL AND METHOD: The medical records of 150 node-negative stage IA2-IIA cervical cancer patients who had DSI and/or LVSI after RHPL from 1999 to 2004 were reviewed. RESULTS: Eighty-eight (58.4%) patients were treated with RHPL alone. Twenty-eight (18.7%), 23 (15.4%), eight (5.3%), and three (2%) patients received postoperative chemotherapy, chemoradiation, radiotherapy, and brachytherapy, respectively. Overall, 11 (7.3%) patients developed recurrence. The estimated 5-year disease-free survival of the patients was 90.9%. By multivariate analysis, two factors, age of less than 35 years old and a non squamous histology, were significantly independent prognostic. Eight (5.3%) patients experienced treatment-related complications. CONCLUSION: Node-negative cervical cancer patients with DSI and/or LVSI had excellent clinical outcomes. Young age and non-squamous histology are significant independent prognostic factors.

High-grade squamous intraepithelial lesion with endocervical cone margin involvement after cervical loop electrosurgical excision: what should a clinician do?

This study was undertaken to evaluate the incidence and severity of residual lesions in women featuring high-grade squamous intraepithelial lesion (HSIL) histology with endocervical cone margin involvement after the loop electrosurgical excision procedure (LEEP). The medical records of women undergoing LEEP at Chiang Mai University Hospital between October 2004 and February 2006 were retrospectively reviewed and 74 cases were identified. Nineteen women were excluded because of loss to follow-up. The remaining 4 were referred to other hospitals and 2 declined re-excision, leaving a study population of 55 women for analysis. Mean age+/-SD of the patients was 48.5+/-8.9 years. Residual lesions were noted in 26 (47.3%, 95%CI=33.7 to 61.2). Four (7.3%) had unrecognized invasive cervical carcinoma in subsequent specimens. In conclusion, approximately half of women with positive endocervical cone margins after LEEP for HSIL histology have residual disease. Repeat diagnostic excision is recommended for evaluation of lesions and severity.

Histopathological outcomes of women with squamous cell carcinoma on cervical cytology.

The aim of this study was to determine the final histopathological outcome for women with a squamous cell carcinoma (SCCA) diagnosed by cervical cytology. The medical records and computerized colposcopic database of patients with SCCA on cytology who underwent colposcopy at Chiang Mai University Hospital between February 2003 and December 2005 were reviewed and 48 women with SCCA cytology were identified (mean age 50 years, range 31-73). Nineteen (39.6%) women were postmenopausal. Unsatisfactory colposcopy was noted in 42 (87.5%). Thirty one (64.6%) of the patients had a final pathological diagnosis of high-grade squamous intraepithelial lesions (HGSIL), whereas only 16 (33.3%) had invasive cancer. The remaining one patient had a low-grade squamous intraepithelial lesion. Sensitivity and specificity of colposcopic examination for predicting invasive cancer was 50% and 78%, respectively. In conclusion, most women with a SCCA on cervical cytology have high-grade cervical lesions on final pathology, with only one third demonstrating invasive cancer. The loop electrosurgical excision procedure (LEEP) remains an important measure for combined treatment and diagnosis.

Northern Thai women with high grade squamous intraepithelial lesion on cervical cytology have high prevalence of underlying invasive carcinoma.

The aim of this study was to determine the underlying pathology of women with high grade squamous intraepithelial lesion (HSIL) on cervical cytology. A total of 681 women with HSIL cytology undergoing colposcopic examination at Chiang Mai University Hospital (CMUH) between January 2000 and December 2005 were evaluated for the underlying cervical pathology. The final pathology was diagnosed from the most severe lesions obtained by punch biopsy, loop electrosurgical procedure, cold knife conization or hysterectomy. Underlying high grade cervical lesions including cervical intraepithelial neoplasia grade 2, 3 and adenocarcinoma in situ were noted in 502 (73.7%) women. Invasive cervical carcinoma was identified in 141 (20.7%). The remaining 38 (5.6%) had either low grade or no intraepithelial lesions. No significant difference in the prevalence of underlying high grade and invasive lesions was noted between women with cytologic diagnosis of HSIL from CMUH and other hospitals. In conclusion, northern Thai women with HSIL cytology are at significant risk of having underlying severe cervical lesions, and especially invasive carcinoma which is detected in approximately one-fifth of the cases.