Objectives: To evaluate the prevalence of histological high-grade lesions and cervical cancer in patients with ASCUS cytology. Methods: This is a cross-sectional prospective study involving 703 women with a uterus and atypical squamous cells of undetermined significance (ASCUS). The patients were submitted to a colposcopy and underwent a guided biopsy when changes on the colposcopy were detected. Results: The findings revealed 456 (64.9%) women with a normal colposcopy and 247 (35.1%) with colposcopic abnormalities. The biopsy results were: cervical intraepithelial neoplasia grade 1 (CIN 1) in 51 (20.6%) patients, CIN 2 in 11 (4.5%) patients, CIN 3 in 8 (3.2%) patients, and a negative result in 177 (71.7%) patients; no cases of cancer were detected. Tallying of 456 normal colposcopies and 177 negative biopsies yielded a total of 90.04% negative exams. Furthermore, around 7.2% (51/703) of the patients exhibited CIN 1, a lesion associated with a high potential for regression. The biopsy results were not associated with patient age or menopausal status. Conclusion: We conclude that cytological surveillance of patients with ASCUS is feasible and safe given the low risk of CIN 2/3 or cervical cancer.

Keywords:
Papanicolaou test, Colposcopy, Cervical intraepithelial neoplasia, Human papillomavirus, Uterine neoplasms
1.
GLOBOCAN. GLOBOCAN 2012: estimated cancer incidence, mortality and prevalence worldwide in 2012. http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx (accessed May 15, 2014).
2.
de Sanjose S, Quint WG, Alemany L, Geraets DT, Klaustermeier JE, Lloveras B, et al: Human papilomavirus genotype attribuition in invasice cervical cancer: a retrospective cross-sectional worldwide study. Lancet Oncol 2010;11:1048-1056.
3.
Jaisamrarn U, Castellsagué X, Garland SM, et al: Natural history of progression of HPV infection to cervical lesion or clearance: analysis of the control arm of the large, randomised PATRICIA study. PLoS One 2013;8:e79260.
4.
Lowy DR, Solomon D, Hildesheim A, Schiller JT, Schiffman M: Human papillomavirus infection and the primary and secondary prevention of cervical cancer. Cancer 2008;113:1980-1993.
5.
Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain J, et al: American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA Cancer J Clin 2012;62:147-172.
6.
Dunne EF, Friedman A, Datta SD, Markowitz LE, Workowski KA: Updates on human papillomavirus and genital warts and counseling messages from the 2010 Sexually Transmitted Diseases Treatment Guidelines. Clin Infect Dis 2011;53(suppl 3):S143-S152.
7.
Instituto Nacional de Câncer: Brazilian guidelines for the screening of cervical cancer Rio de Janeiro. 2011. http://www1.inca.gov.br/inca/Arquivos/Diretrizes_rastreamento_cancer_colo_utero.pdf.
8.
Kececioglu M, Seckin B, Baser E, Togrul C, Kececioglu TS, Cicek MN, et al: Cost and effectiveness comparison of immediate colposcopy versus human papillomavirus DNA testing in management of atypical squamous cells of undetermined significance in Turkish women. Asian Pac J Cancer Prev 2013;14:511-514.
9.
Bal MS, Goyal R, Suri AK, Mohi MK: Detection of abnormal cervical cytology in Papanicolaou smears. J Cytol 2012;29:45-47.
10.
Lonky NM, Felix JC, Naidu YM, Wolde-Tsadik G: Triage of atypical squamous cells of undetermined significance with Hybrid Capture II: colposcopy and histologic human papillomavirus correlation. Obstet Gynecol 2003;101:481-489.
11.
Veiga FR, Russomano F, Camargo MJ, Monteiro ACS, Reis A, Tristão MA: Prevalência das lesões intra-epiteliais de alto grau em pacientes com citologia com diagnóstico persistente de ASCUS. Rev Bras Ginecol Obstet 2006;28:75-80.
12.
Bornstein J, Bentley J, Bösze P, Girardi F, Haefner H, Menton M, et al: 2011 colposcopic terminology of the International Federation for Cervical Pathology and Colposcopy. Obstet Gynecol 2012;120:166-172.
13.
Mountzios G, Soultati A, Pectasides D, Pectasides E, Dimopoulos MA, Papadimitriou CA: Developments in the systemic treatment of metastatic cervical cancer. Cancer Treat Rev 2013;39:430-443.
14.
Solomon D, Schiffman M, Tarone R; ALTS study group: Comparison of three management strategies for patients with atypical squamous cells of undetermined significance: baseline results from a randomized trial. J Natl Cancer Inst 2001;93:293-299.
15.
Yarandi F, Izadi Mood N, Mirashrafi F, Eftekhar Z: Colposcopic and histologic findings in women with a cytologic diagnosis of atypical squamous cells of undetermined significance. Aust NZ J Obstet Gynaecol 2004;44:514-516.
16.
Jones HJ: Clinical treatment of women with atipycal squamous cells of undetermined significance or atipycal glandular cells of undetermined significance cytology. Clin Obstet Gynecol 2000;43:381-393.
17.
Wright TC, Sun XW, Koulos J: Comparison of management algorithms for the evaluation of women with low-grade cytologic abnormalities. Obst Gynecol 1995;85:202-210.
18.
Gupta N, Srinivasan R, Nijhawan R, Rajwanshi A, Dey P, Suri V, Dhaliwal L: Atypical squamous cells and low-grade squamous intraepithelial lesion in cervical cytology: cytohistological correlation and implication for management in a low-resource setting. Cytopathology 2011;22:189-194.
19.
Vanni T, Legood R, Franco EL, Villa LL, Luz PM, Schwartsmann G: Economic evaluation of strategies for managing women with equivocal cytological results in Brazil. Int J Cancer 2011;129:671-679.
20.
Yarandi F, Shojaei H, Eftekhar Z, Izadi-Mood N: Comparison of three management strategies for patients with atypical squamous cells of undetermined significance, after six months delay: a three-year experience in an Iranian university hospital. Aust NZ J Obstet Gynaecol 2009;49:207-210.
21.
López-Alegría F, Poblete OQ, Lorenzi DS, Oyanedel JC: Clinical management of the first ASCUS report in Chile: prospective single-cohort study. Sao Paulo Med J 2015;133:480-487.
© 2016 S. Karger AG, Basel
2016
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.