CLINICAL-SIGNIFICANCE OF A CERVICAL CYTOLOGIC DIAGNOSIS OF ATYPICAL SQUAMOUS CELLS OF UNDETERMINED SIGNIFICANCE - FAVORING A REACTIVE PROCESS OR LOW-GRADE SQUAMOUS INTRAEPITHELIAL LESION

OBJECTIVE: To define the clinical significance of qualifying the cytol ogic diagnosis of atypical squamous cells of undetermined significance (ASCUS) as favoring either a reactive process or a low grade squamous intraepithelial lesion (LSIL) in an effort to provide management guid elines. STUDY DESIGN: A total of 118 consecutive nonpregnant women wit h a cytologic diagnosis of ASCUS favoring either a reactive process or LSIL were evaluated in our colposcopy clinic by repeat cervical cytol ogic smear, colposcopy and colposcopically directed biopsies and/or en docervical curettage, as indicated. RESULTS: Of the 58 patients evalua ted for a smear of ASCUS, favoring a reactive process, 5 (8.6%) had ce rvical intraepithelial neoplasia (GIN) CIN 1 documented by biopsy. Non e had a high grade lesion. Twenty-six (45%) of the 58 patients who had a cytologic diagnosis of ASCUS favoring a reactive process had a repe at smear that was normal. None was found to have GIN. Of the 60 patien ts who had a cervical cytologic diagnosis of ASCUS favoring LSIL, 9 (1 5%) had CIN 1 or 2. Nineteen (32%) of the 60 patients who had a cytolo gic diagnosis of ASCUS favoring LSIL had a repent smear that was norma l. One of these patients had CIN 1 oil biopsy. The sensitivity of a re peat smear, in this limited series, after an initial smear of ASCUS fa voring a reactive process is 100%, while it was 66% after an initial s mear of ASCUS favoring LSIL. CONCLUSION: This study showed that in our laboratory a cytologic diagnosis of ASCUS favoring either a reactive process or LSIL is associated with with a very low risk that the patie nt is harboring CIN. In the patient whose initial smear shows ASCUS fa voring a reactive process, a repeat smear that is normal is reassuring . The patient whose smear shows ASCUS favoring LSIL probably requires further evaluation even in the presence of a normal repeat smear.