Improving the cost-effective evaluation and management of atypical squamous cells of undetermined significance and low grade squamous intraepithelial lesions.

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In their article is this issue of Cancer Cytopathology, Alanen et al. evaluated cytologic follow-up for patients presenting with atypical squamous cells of undetermined significance (ASCUS) or low grade squamous intraepithelial lesions (LSIL). With the advent of the Bethesda system and the epidemic spread of human papillomavirus (HPV), the number of ASCUS and low grade Papanicolaou (Pap) smears has increased significantly. Standard management guidelines are needed to improve patient care and decrease medical costs. The management of patients with ASCUS and LSIL varies not only by recommendations of professional groups, but of the individual practitioners’ understanding of the Bethesda system. Increasingly, physicians at Emory University, such as family practitioners, are performing colposcopic evaluation of patients with abnormal Pap smears. A more defined clinical algorithm is required. Colposcopy and LEEP (loop electrosurgical excision procedure) continue to be used by practitioners to treat LSIL. Alanen et al conducted a retrospective review of cytologic diagnoses, colposcopic evaluation, and follow-up of patients evaluated at the London Health Sciences Centre and St. Joseph’s Health Care Centre in London, Ontario, Canada. Six thousand three hundred and nineteen Pap smears obtained between January and June 1994 were reviewed. Four hundred and thirty-two patients had an initial diagnosis of ASCUS (320) or LSIL (112). Seventy-two patients were disqualified from See referenced original article on pages 5–10, this issue. the original cohort of 510 patients, secondary to a previous diagnosis of cervical intraepithelial neoplasia (CIN) or carcinoma. The data base Address for reprints: Ira R. Horowitz, M.D., Dewas reviewed, with a total of 598 follow-up visits that included 557 partment of Gynecology and Obstetrics, Emory Pap smears from 41 colposcopic evaluations. Approximately 70% of University School of Medicine, 1639 Pierce patients with LSIL and 60% of patients with ASCUS had at least 2 Drive, Atlanta, GA 30322. subsequent visits for evaluation of their abnormal Pap smears. Approximately 33% of patients with LSIL (37 patients) and 28% of paReceived November 25, 1997; accepted December 2, 1997. tients with ASCUS (90 patients) were lost to follow-up. For those