Prevalence of High-Grade Intraepithelial Neoplasia in Patients with Cytology Presenting Atypical Squamous Cells of Undetermined Significance

Abstract

Objectives: To evaluate the prevalence of histological high-grade lesions and cervical cancer in patients with ASCUS cytology. Methods: This is a cross-sectional prospective study involving 703 women with a uterus and atypical squamous cells of undetermined significance (ASCUS). The patients were submitted to a colposcopy and underwent a guided biopsy when changes on the colposcopy were detected. Results: The findings revealed 456 (64.9%) women with a normal colposcopy and 247 (35.1%) with colposcopic abnormalities. The biopsy results were: cervical intraepithelial neoplasia grade 1 (CIN 1) in 51 (20.6%) patients, CIN 2 in 11 (4.5%) patients, CIN 3 in 8 (3.2%) patients, and a negative result in 177 (71.7%) patients; no cases of cancer were detected. Tallying of 456 normal colposcopies and 177 negative biopsies yielded a total of 90.04% negative exams. Furthermore, around 7.2% (51/703) of the patients exhibited CIN 1, a lesion associated with a high potential for regression. The biopsy results were not associated with patient age or menopausal status. Conclusion: We conclude that cytological surveillance of patients with ASCUS is feasible and safe given the low risk of CIN 2/3 or cervical cancer.

Abnormal Pap-smear frequency and comparison of repeat cytological follow-up with colposcopy during patient management; The importance of pathologist's guidance in the management

“…The third method of management after abnormal index pathology, involving HPV testing, was not used in the management because it was not widely compassable in our country at that time. Despite that it has been used later in Turkey, it is still not available in a wide number of developing countries [8]. In addition, HPV testing was found to be more costly than direct colposcopy in such countries in contrast to developed countries like USA [8].…”

“…Despite that it has been used later in Turkey, it is still not available in a wide number of developing countries [8]. In addition, HPV testing was found to be more costly than direct colposcopy in such countries in contrast to developed countries like USA [8].…”

“…The American Society for Colposcopy and Cervical Pathology, offers three possible ways for management of ASCUS: (1) Follow-up with cytology, (2) HPV testing, or (3) colposcopy. Different countries choose distinct pathways depending on their resources, social factors, and health-care system features [8]. Furthermore, at the time these guidelines were reported, HPV testing was not frequently used in Turkey or many other countries, and most patients were managed by either cytological follow-up or colposcopy.…”