Objective: To investigate the clinical significance of atypical squamous cells (ASCUS) and low-grade squamous intraepithelial lesions (LSIL).
Methods: A total of 800 patients cytologically diagnosed with ASCUS and LSIL were referred for colposcopy. The histopathology diagnosis undergoing colposcopic biopsy, endocervical curettage (ECC), cervical loop electrosurgical excision procedure (LEEP) were analyzed. Using pathology as gold criterion, the sensitivity, specificity and positive predictive value of colposcopy to detect cervical lesions and cervical cancer were measured. The follow-up results were recorded.
Results: (1) Among the 405 patients with ASCUS, the percentage with chronic cervicitis was 57.04%, LSIL was 34.81%, HSIL was 3.95%, otherwise 2 cases (0.49%) of microinvasive cervical cancer and 15 cases (3.70%) of vulvar intraepithelial neoplasia (VIN) were found respectively. Among the 395 patients with LSIL, the percentage with chronic cervicitis was 34.18%, LSIL was 50.89%, HSIL was 10.38%, 2 cases (0.51%) of microinvasive cervical cancer, 1 case (0.25%) of vulva squamous cancer and 15 cases (3.80%) of VIN was identified respectively. (2) The impression undergoing colposcopy was consistent with the histologically diagnosis in 637 of 800 cases (79.63%). The sensitivity, specificity and positive predictive value was 96.17%, 58.41% and 73.34% respectively. (3) All patients with HSIL or above regressed to normal after 1 year of follow-up. 501 of 738 patients with chronic cervicitis, LSIL and VIN were followed up more than 1 year.
Conclusion: ASCUS and LSIL does not represent a single biologic entity; it subsumes changes that are unrelated to neoplasia as well as findings that suggest the possible presence of underlying Cervical intraepithelial neoplasia (CIN) and rarely carcinoma. Thorough evaluation using colposcopy will detect early not only the histological cervical HSIL and cervical cancer, but also VIN and vulvar squamous cancer. Colposcopy is a viable option in management patients with ASCUS/LSIL.