INCIDENCE AND PREDICTORS OF CERVICAL DYSPLASIA IN PATIENTS WITH MINIMALLY ABNORMAL PAPANICOLAOU SMEARS

Objective: To estimate the incidence of dysplasia in patients with Pap anicolaou smears showing atypical squamous cells of undetermined signi ficance (ASCUS) and low-grade squamous intraepithelial lesions (SIL) a nd to identify clinical predictors of dysplasia in these patients. Met hods: Patients referred for ASCUS and low-grade SIL were reviewed retr ospectively. All patients were evaluated with immediate colposcopy. A multivariate logistic regression analysis was performed to identify cl inical predictors of histologic SIL and histologic high-grade SIL. Res ults: One hundred thirty-seven (34%) of 406 consecutive patients had h istologic SIL. Regression analysis identified age (under 35 versus 35 years or above) and initial smear (low-grade SIL versus ASCUS) as stat istically significant predictors of histologic SIL and high-grade SIL (P < .001). When patient outcomes were analyzed by age and initial Pap anicolaou smear results, the subgroup of patients 35 years or older wi th ASCUS had low incidences of histologic SIL (14%) and high-grade SIL (1%). The other subgroups (under 35 years with ASCUS, under 35 years with low-grade SIL, and 35 years or older with low-grade SIL) had inci dences of histologic SIL and histologic high-grade SIL of at least 28% and 14%, respectively. Conclusion: The high incidence of dysplasia in patients with minimally abnormal Papanicolaou smears suggests that im mediate colposcopy might be appropriate for many of these patients. Ag e and initial Papanicolaou smear are predictive of dysplasia and might be used to select patients who have low incidence of dysplasia and mi ght not require immediate colposcopy. (Obstet Gynecol 1998;92:356-9. ( C) 1998 by The American College of Obstetricians and Gynecologists.).