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

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 studySetting: 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, 2001Method: We reviewed 273 records to collect follow-up Pap smear results, colposcopic results and histological reportsMain 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.