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KMID : 0388420020120010093
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Konkuk Journal of Medical Sciences
2002 Volume.12 No. 1 p.93 ~ p.105
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Triage of Women with Abnormal Pap Smear (ASCUS, LSIL)
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Gu Hee-Ju
Kim Soo-Nyung
Sohn In-Sook
Lee Ji-Young
Yun Byoung-Il
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Abstract
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The considerable false-negativerates associated with Pap smear and increasing number of minor cytological abnormalities have prompted gynecologists to look for an adjuvant test. either to improve primary screening or to act as a triage for minor abnormalities. This study was conducted to determine the follow-up and triage method for ASCUS(atypical squamous cells of undetermined significance) and LSIL(low-grade squamous intraepithelial lesion) smears.
´A total of 2591 asymptomatic women who presented to the outpatient department of Obstetrics and Gynecology in KonKuk University Hospital between April 1, 1996 and March 30, 1999 were screened for CIN(cervical intraepithelial neoplasia) and invasive cervical cancer by Pap smear.
Women whose cytologic screening showing ASCUS or LSIL were evaluated with HPV-DNA testing, cervicography, and colposcopy in 6 months interval. Initial Pap smear was normal in 2395(92.4%), ASCUS in 93(3.9%), and LSIL in 77(3.2%) women.
HPV-DNA test was positive in 9(20.9%) of 43 women with Pap smears showing ASCUS, and in 13(40.6%) of 32 women with Pap smears showing LSIL. The positive rate of HPV-DNA test was higher in LSIL group than in ASCUS group, but there was no statistical significance.
Women with ASCUS on Pap smear, their cervicographic finding was positive in 26 patients (28.0%), and colposcopic finding was CIN in 12 patients (12.9%). Clinicopathologic diagnosis was CIN in 12 patients(12.9%) and invasive cancer in 2 patients(2.2%).
Women with LSIL on Pap smear, their cervicographic finding was positive in 65 patients (84.4%), colposcopic finding was CIN in 59 patients (76.6%), and their pathologic finding was dysplasia in 63 patients (81.8%). The positive rate of cervicography was higher than colposcopy in both ASCUS and LSIL group, but there was no statistically significant difference between two study.
We followed up 122 of 170 patients with ASCUS and LSIL in initial Pap smear every 6 months with cytology, cervicography and colposcopy.
In ASCUS group, 42(56.7%) were negative and 33(43.1%) were positive in 4 second Pap smear, 59(78.7%) were negative and 16(21.3%) were positive in cervicography, 6(8.0%) were CIN in colposcopy.
In LSIL group, 8(17.0%) were negative, 39(83.0%) were positive in second Pap smear, 10(21.3%) were negative and 37(78.7%) were positive in cervicography N and 23(49.0%) were CIN in colposcopy. Among patients with ASCUS and LSIL in Pap smear, the positive rate of cervicography was higher than of colposcopy, but there was no statistically significant difference between two study. Cervicography and colposcopy can be used as an important intermediate triage technique for the evaluation of patients with Pap smears showing ASCUS or LSIL and follow-up every 6 months in patients vAose Pap smear revealed ASCUS and LSIL may improve the diagnosis rate of CIN and prevent invasive cancer.
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KEYWORD
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ASCUS, LSIL, triage, CIN
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