CYTOLOGIC ATYPIA - CLINICAL-SIGNIFICANCE AND FOLLOW-UP RECOMMENDATIONS

OBJECTIVE: To assess the evolution of cytologic atypia on cervical cyt ologic smears as an attempt to better understand the natural history o f these lesions and to establish a follow-up protocol. STUDY DESIGN: T he study group consisted of 76 patients with a of cytologic atypia on cervical cytologic smears performed at the Gynecology Outpatient Clini c, Hospital del Mar, between December 1989 and June 1993. Patients wit h inflammatory atypia, a reparative process or findings consistent wit h human papillomavirus infection had been excluded. Follow-up smears w ere reviewed. Compliance with follow-tip recommendations was also eval uated. RESULTS: Thirty-nine patients returned to the clinic for follow -up after a diagnosis of atypia (51.3%). Progression from atypia to dy splasia was found in 38.5% of patients with at least a follow-up smear . Changes consistent with intraepithelial neoplasia were found in 17 p atients: low grade dysplasia was found in 10 patients (mild dysplasia in 8 and atypia in 2) and high grade dysplasia in 7 (moderate in 4 and severe in 3). This progression was most commonly found at the first f ollow-up visit and within the first year. CONCLUSION: Patients with cy tologic atypia were at higher risk of developing dysplasia than those with reparative atypia. Our results support the theory of progression from atypia to dysplasia in a considerable percentage of patients. Fol low-up compliance in our patient population was low. One should emphas ize the importance of this diagnosis and encourage close cytologic fol low-up, especially within the first year after the diagnosis of atypia .