DEGREE OF DYSPLASIA FOLLOWING DIAGNOSIS OF ATYPICAL SQUAMOUS CELLS OFUNDETERMINED SIGNIFICANCE IS INFLUENCED BY PATIENT HISTORY AND TYPE OF FOLLOW-UP

Previous studies have shown that atypical squamous cells of undetermin ed significance (ASCUS) are a predictor of higher grade lesions when p atients are followed up by biopsy. The purpose of this study was to ex amine follow-up on all patients with ASCUS to determine if the predict ion of higher grade lesions seen in association with ASCUS is a functi on of bias in selection of patients for biopsy. The diagnosis of ASCUS , based on Bethesda System criteria, was made on 235 cases between Jun e 1993 and December 1994 (2% of the total cases at Yale-New Haven clin ics), Of these cases, 36 were biopsied and 94 were followed by cervica l/vaginal smears (CVS). As has been seen in other retrospective studie s, we found that 55% (20 of 36) biopsied after ASCUS on CVS showed con dyloma or dysplasia. In cases with CVS follow-up instead of biopsy onl y 26% (25 of 94) had significant lesions. We find that if ASCUS is eva luated by biopsy the prediction for higher grade lesions is roughly tw ice that predicted by follow-up CVS. We propose that nonstandardized m anagement by gynecologists results, in many instances, in selection of patients with significant past history for biopsy. Consequently, the current literature finding of ASCUS as predictor of higher grade lesio ns should be reanalyzed, taking into account other parameters (past hi story, age, etc.) in the process of defining the clinical and biologic al implications of the ASCUS diagnosis. (C) 1997 Wiley-Liss, Inc.