Management of ASCUS , AGUS and LSIL / 대한산부인과학회잡지

ABSTRACT

The diagnoses of ASCUS, AGUS and LSIL were introduced in 1988 by The Bethesda System(TBS) for reporting cervical/vaginal cytologies. However the outcomes and the appropriate managements of patients with these diagnoses are not well established. We reviewed all Papnicolaou smears which totaled 10,630 cases performed in the department of Obstetrics and Gynecology, University of Ulsan, Asan Medical Center from January 1995 through December 1995. The results were as follows. 1. Of the 10,630 specimens accessed during one-year period, 611(5.7%) were diagnosed as SCUS, 13(0.12%) as AGUS and 117(1.1%) as LSIL. 2. Of these, 92 cases with ASCUS and 66 with LSIL and subsequent cervical biopsies. The biopsy cases with ASCUS showed 49(53.3%) cervicitis, 13(14.1%) condyloma, 7(7.6%) CIN I, 3(3.3%) CIN II, 10(10.9%) CIN III and 3(3.3%) invasive carcinoma. Those with LSIL showed 21(31.8%) cervicitis, 5(7.6%) condyloma, 18(27.3%) CIN I, 6(9.1%) CIN II, 11(16.7%) CIN III and 3(4.5%) invasive carcinoma. 3. The repeated cytologic examination of 415 cases with ASCUS after 3~6 months revealed WNL(within normal limit) in 277(66.7%), BCC( benign cellular change) in 13(3.1 %) ASCUS again in 97(23.4%), AGUS in 2(0.1%), LSIL in 21(5.1%) and HSIL in 7(1.7 %). 4. The presence of high-risk or intermediate-risk HPV DNA was confirmed with Hybrid capture system(HCS) in 31.6%(6/19) of patients without evidence of CIN, 50%(4/8) of those with CIN I, 100%(5/5) of those with CIN II, 81.5%(22/27) of those with CIN III and 100%(6/6) of those with invasive squamous cell carcinoma. According to our result and thorough review of the recent articles, the management of ASCUS, AGUS and LSIL is reevaluated and the management guideline of our own is presented.