Results Of A Colposcopic Evaluation After A Repeated Papanicolaou Smear Demonstrating Atypical Squamous Cells Of Undetermined Significance (ascus)

Abstract

Abstract Objective: The management of patients who present atypical squamous cells of undetermined significance (ASCUS) on Pap smear remains controversial. Should a colposcopic evaluation be carried out immediately or should the Pap smear be repeated ? We chose to repeat the Pap smear after four to six months. If ASCUS were revealed by this second test, the patient was advised to undergo a colposcopic examination. The objective of this study was to determine the clinical significance and the prediction of neoplasia among these patients through a colposcopic examination. Patients and Method: Between January 1996 and December 1997, a total of 29'827 patients underwent a Pap smear. ASCUS was diagnosed in 1'387 of them (5 %). A second Pap smear was proposed to these patients; 225/1'387 patients showed repeated ASCUS (16%). A colposcopy was performed on 186 /225 patients. Thirty-nine patients could not be included, because they refused the examination. All cytologic and histologic examinations were screened by the same laboratory. Results: Colposcopy was normal in 91/186 patients (49%) and confirmed with a new Pap smear. Colposcopic examination was abnormal in 95/186 patients (51%), corresponding to 40 ASCUS (21%), 38 low-grade squamous intraepithelial lesions (L-SIL) (21%) and 17 high-grade squamous intraepithelial lesions (H-SIL) (9%). Among these latter 17 H-SIL, 3 carcinoma in situ (CIS) were found. Conclusion: A colposcopic evaluation after a repeated Pap smear with ASCUS is an appropriate cost-effective management. Finding 30% of L-SIL or H-SIL justifies this additional investigation.Objective: The management of patients who present atypical squamous cells of undetermined significance (ASCUS) on Pap smear remains controversial. Should a colposcopic evaluation be carried out immediately or should the Pap smear be repeated ? We chose to repeat the Pap smear after four to six months. If ASCUS were revealed by this second test, the patient was advised to undergo a colposcopic examination. The objective of this study was to determine the clinical significance and the prediction of neoplasia among these patients through a colposcopic examination. Patients and Method: Between January 1996 and December 1997, a total of 29'827 patients underwent a Pap smear. ASCUS was diagnosed in 1'387 of them (5 %). A second Pap smear was proposed to these patients; 225/1'387 patients showed repeated ASCUS (16%). A colposcopy was performed on 186 /225 patients. Thirty-nine patients could not be included, because they refused the examination. All cytologic and histologic examinations were screened by the same laboratory. Results: Colposcopy was normal in 91/186 patients (49%) and confirmed with a new Pap smear. Colposcopic examination was abnormal in 95/186 patients (51%), corresponding to 40 ASCUS (21%), 38 low-grade squamous intraepithelial lesions (L-SIL) (21%) and 17 high-grade squamous intraepithelial lesions (H-SIL) (9%). Among these latter 17 H-SIL, 3 carcinoma in situ (CIS) were found. Conclusion: A colposcopic evaluation after a repeated Pap smear with ASCUS is an appropriate cost-effective management. Finding 30% of L-SIL or H-SIL justifies this additional investigation.