ASSESSMENT OF CYTOLOGIC FOLLOW-UP AS THE RECOMMENDED MANAGEMENT FOR PATIENTS WITH ATYPICAL SQUAMOUS CELLS OF UNDETERMINED SIGNIFICANCE OR LOW-GRADE SQUAMOUS INTRAEPITHELIAL LESIONS

BACKGROUND, The optimal management of low grade Papanicolaou (Pap) sme ar abnormalities remains controversial. This center's experience with recommending cytologic follow-up for women with atypical cells of unde termined significance (ASCUS) or low grade squamous intraepithelial le sions (LSIL) was reviewed to determine outcome and patient/physician c ompliance. METHODS, The records were reviewed on women with Pap smears reported as either ASCUS (320) or LSIL (112) who did not have a histo ry of dysplasia. The cytologic and colposcopic follow-up for a 2-year period was obtained from the laboratory data base that includes the co lposcopy and cancer referrals for this region. Repeat Pap smear in 6 m onths was recommended. If patients subsequently demonstrated high grad e SIL (HSIL) or persistent ASCUS or LSIL over three time intervals, co lposcopic evaluation was recommended. RESULTS, The outcome was determi ned by the most significant diagnosis among the follow-up Pap smears o r colposcopic biopsies. 29% of patients were lost to follow-up. Of the remaining patients, 70.5% reverted to normal or benign cellular chang es, 25.3% persisted as ASCUS or LSIL, and 5.2% progressed to HSIL. The majority of patients (68%) were referred for colposcopy for persisten t mildly abnormal Pap smears. The timing of referral ranged from 3-30 months. CONCLUSIONS, These results suggest that cytologic follow-up of women with low grade Pap smear abnormalities will identify a large nu mber whose smears will regress to normal. A small but significant prop ortion of women showed subsequent HSIL. Most HSIL was detected within 1 year of the initial abnormal Pap smear and the majority of interveni ng Pap smears also were abnormal. Approximately one third of patients did not have follow-up within the study system and their outcome was u ncertain. Although the recommendations are standard, patterns of follo w-up and referral to colposcopy varied widely, suggesting that the gui delines need to be reinforced to both patients and physicians. (C) 199 8 American Cancer Society.