Colposcopy Requirement of Papanicolaou Smear after Atypical Squamous Cells of Undetermined Significance (ASC-US) by Follow-up Protocol in an Urban Gynaecology Clinic, a Retrospective Study in Thailand

Abstract

<b>Background:</b> ASC-US cases are managed according to the current American Society for Colposcopy andCervical Pathology (ASCCP) guideline in which a human papillomavirus (HPV) test and repeat Pap smear areperformed in the next 1 year. Colposcopy in cases of positive high risk HPV and persistent ASC-US or morein subsequent Pap smear is recommended. The HPV test is more expensive and still not currently a routinepractice in Thailand. <br/><b>Objective</b>: To identify the risk factors of persisted abnormal Pap smear and the colposcopicrequirement rate in women with ASC-US. Materials and <br/><b>Methods</b>: During 2008-2013, this study was conductedin Prapokklao Hospital, Chanthaburi, Thailand. Participants were women who attended gynaecology clinicfor cervical cancer screening. Women who had cytological reports with ASC-US were recruited. During thestudy period, 503 cases were enrolled. Colposcopic requirement was defined as those who were detected with anASC-US or more in subsequent Pap smears up to 1 year follow-up. <br/><b>Results</b>: The colposcopic referral rate was23.2 (85/365) percent at 12 months. Prevalence of cervical intraepithelial neoplasia (CIN) 2/3 was 3.3 (12/365)percent. Loss follow-up rate of subsequent Pap smear and colposcopic appointment were 27.4 (138/503) and48.2 (41/85) percent, respectively. There was no invasive cancer. High risk factors for persisted abnormal Papsmears in subsequent test were premenopausal status, HIV infected patients and non-oral contraceptive pills(COC) users. <br/><b>Conclusions</b>: Referral rate for colposcopy in women with ASC-US reports was rather high. Lossto follow-up rate was the major limitation. Immediate colposcopy should be offered for women who had highrisk for silent CIN.