Background:
The optimal management of low grade papanicolaou (pap) smear abnormalities remains controversial. this center's experience with recommending cytologic follow-up for women with atypical cells of undetermined significance (ascus) or low grade squamous intraepithelial lesions (lsil) was reviewed to determine outcome and patient/physician compliance.
Methods:
The records were reviewed on women with pap smears reported as either ascus (320) or lsil (112) who did not have a history of dysplasia. the cytologic and colposcopic follow-up for a 2-year period was obtained from the laboratory data base that includes the colposcopy and cancer referrals for this region. repeat pap smear in 6 months was recommended. if patients subsequently demonstrated high grade sil (hsil) or persistent ascus or lsil over three time intervals, colposcopic evaluation was recommended.
Results:
The outcome was determined by the most significant diagnosis among the follow-up pap smears or colposcopic biopsies. 29% of patients were lost to follow-up. of the remaining patients, 70.5% reverted to normal or benign cellular changes, 25.3% persisted as ascus or lsil, and 5.2% progressed to hsil. the majority of patients (68%) were referred for colposcopy for persistent 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 number whose smears will regress to normal. a small but significant proportion of women showed subsequent hsil. most hsil was detected within 1 year of the initial abnormal pap smear and the majority of intervening pap smears also were abnormal. approximately one third of patients did not have follow-up within the study system and their outcome was uncertain. although the recommendations are standard, patterns of follow-up and referral to colposcopy varied widely, suggesting that the guidelines need to be reinforced to both patients and physicians. [see editorial on pages 1-4, this issue.]