To treat or not to treat; the clinical dilemma of atypical squamous cells of undetermined significance (ASC‐US)

Abstract

Management of patients diagnosed on cervical smears with twice consecutively atypical squamous cells of undetermined significance (ASC-US) remains a clinical dilemma. We describe a follow-up of aggressive vs. less aggressive colposcopic treatment in order to determine which treatment is preferable. Retrospective cohort study with a follow-up of 10 years. Two hospitals in The Netherlands. Women referred for primary colposcopy with two consecutive ASC-US smears (n=230) to either one of the two hospitals. In one hospital, patients underwent direct loop excision of all colposcopically detected abnormalities, even if not suspected for cervical intraepithelial neoplasia (CIN; aggressive strategy; n=118). In the other hospital, a less aggressive policy was followed when low-grade CIN lesions were suspected at colposcopy (less aggressive strategy; n=112). The number of loop excisions, detection of CIN lesions and cytological follow-up of both groups. Less aggressive management resulted in less loop excisions (p<0.001). At initial colposcopy, the aggressive group showed a 10-fold incidence of histologically detected CIN lesions compared with the less aggressive group (1.8 vs. 19.5%). During 10 years of follow-up, both groups showed the same percentages of CIN lesions (8.1 vs. 8.4%). Aggressive management resulted in faster normalization of cervical smears (p<0.001). However, at final follow-up, there was no statistical difference in the percentage of normalization of cervical smears between both groups. Aggressive and less aggressive colposcopic strategies are equally safe and show good clinical outcomes. Treatment decisions, however, must be adjusted to women's individual demands.