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Assessment of cytologic follow‐up as the recommended management for patients with atypical squamous cells of undetermined significance or low grade squamous intraepithelial lesions
Author(s) -
Alanen Ken W.,
Elit Laurie M.,
Molinaro Patricia A.,
McLachlin Catherine M.
Publication year - 1998
Publication title -
cancer cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/(sici)1097-0142(19980225)84:1<5::aid-cncr2>3.0.co;2-q
Subject(s) - ascus (bryozoa) , medicine , colposcopy , papanicolaou stain , cytology , squamous intraepithelial lesion , gynecology , dysplasia , bethesda system , obstetrics , cytopathology , referral , cervical intraepithelial neoplasia , cancer , cervical cancer , pathology , family medicine , botany , ascospore , spore , biology
BACKGROUND The optimal management of low grade Papanicolaou (Pap) smear abnormalities remains controversial. This center's experience with recommending cytologic follow‐up for women with atypical cells of undetermined significance (ASCUS) or low grade squamous intraepithelial lesions (LSIL) was reviewed to determine outcome and patient/physician compliance. METHODS The records were reviewed on women with Pap smears reported as either ASCUS (320) or LSIL (112) who did not have a history of dysplasia. The cytologic and colposcopic follow‐up for a 2‐year period was obtained from the laboratory data base that includes the colposcopy and cancer referrals for this region. Repeat Pap smear in 6 months was recommended. If patients subsequently demonstrated high grade SIL (HSIL) or persistent ASCUS or LSIL over three time intervals, colposcopic evaluation was recommended. RESULTS The outcome was determined by the most significant diagnosis among the follow‐up Pap smears or colposcopic biopsies. 29% of patients were lost to follow‐up. Of the remaining patients, 70.5% reverted to normal or benign cellular changes, 25.3% persisted as ASCUS or LSIL, and 5.2% progressed to HSIL. The majority of patients (68%) were referred for colposcopy for persistent mildly abnormal Pap smears. The timing of referral ranged from 3‐30 months. CONCLUSIONS These results suggest that cytologic follow‐up of women with low grade Pap smear abnormalities will identify a large number whose smears will regress to normal. A small but significant proportion of women showed subsequent HSIL. Most HSIL was detected within 1 year of the initial abnormal Pap smear and the majority of intervening Pap smears also were abnormal. Approximately one third of patients did not have follow‐up within the study system and their outcome was uncertain. Although the recommendations are standard, patterns of follow‐up and referral to colposcopy varied widely, suggesting that the guidelines need to be reinforced to both patients and physicians. [See editorial on pages 1‐4, this issue.] Cancer (Cancer Cytopathol) 1998;84:5‐10. © 1998 American Cancer Society.