The evaluation of women with low-grade cytologic abnormalities including atypical cells of undetermined significance(ASCUS) and low-grade squamous intraepithelial lesion (LSIL) is a topic of considerable controversy. Some women with low-grade
cytologic
abnormalities will have high-grade intraepithelial neoplasia(CIN ⅡorⅢ) or even invasive cancer. Now, it is almost universally accepted that the majority of invasive cervical cancer and high-grade intraepithelial neoplasia are associated with
Human
papillomavirus(HPV). Because of this, there has been increasing tendancy on using another triaging methods for evaluating women with a low grade abnormal Papanicolaou smear. Traditionally colposcopy was used and recently HPV DNA test and
cervicography
was widely used as a triaging methods.
This study used the data gained from 151 evaluable women with ASCUS and LSIL in the Department of Obstetrics & Gynecology, Catholic University Medical College, Kangnam St. Mary's Hospital from march 1995 to April 1996.
11,401 women had done cytology during this period and result was like this ; 10,501 patients had normal cytology(92.1%), 244 patients had ASCUS(2.14%), 35 had AGCUS(atypical glandular cells of undetermined significance : 0.31%), 191 had
LSIL(1.68%), 170
had HSIL(1.49%), and 160 had cervical cancers(1.41%).
Patients with ASCUS were showed that CIN I was 5.6%(4/72), CIN Ⅱ4.2%(3/72) and CINⅢ15.3%(11/72). Patients with LSIL were showed that CIN I was 5.1%(4/79), CIN Ⅱ7.6%(6/79), CINⅢ15.2%(12/79) and invasive cancer 7.6%(6/79).
We adopted three management algorithms for evaluating women with ASCUS and LSIL. Three methods were like this ; Colpscopy only or HPV DNA testing using hybrid capture which were used with DNAs extracted from the cervcal swabs and tested with two
pooled
probes(probes containing HPV types of low oncogenic risk ; 6, 11, 42, 43 and 44 or HPV types of high oncogenic risk ; 16, 18, 31, 33, 35, 45, 51, 52 and 56) for HPV detection or both. We adopted only positive result with high risk HPV-probes in
this
article. At ASCUS group, sensitivity and specificity were 90.0% and 32.5% in 62 women with colposcopy and 71.4%, 75%% in 28 women with Hybrid Capture System. 27 Women with colposcopy and Hybrid Capture System showed that sensitivity was 100%, and
specificity was 26.3%. At LSIL group, sensitivity and specificity were 92.6% and 22.7% in 71 women with colposcopy and 69.2%, 65.4% in 39 women with Hybrid Capture System. 37 women with colposcopy and Hybrid Capture System showed that sensitivity
was
91.7%, and specificity was 12%.
Our result indicate that patients with smears showing some of ASCUS and LSIL are evaluated as CIN I, Ⅱ,Ⅲand even invasive cancer. Therefore as a triage methods, the combination with colposcopy and HPV DNA test in Women referred for low-grade
abnormal
cytology would be used as a sensitive methods for the detection of CINs. However, low-specificity of this combination approach was also considered as problem. This approach provides another information to differentiating ASCUS and LSIL into high
of
low-risk group of progression.
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