Clinicopathological significance and treatment of ASCUS in PAP smear test
Cervical cancer is the most common gynecologic malignancies. Best screening method is cervical cytology , means PAP smear. This is cheap, easy , and quick method that can be done in office.
The most common result is ASCUS ( atypical squamous cells of undetermined significance). This is low risk abnormality but % 5-10 of women with this diagnosis have an underlying high level cervical lesion CIN2 -CIN 3). % 30 of women with ASCUS cytology diagnosis have a low grade cervical lesion , but up to % 40 of these cases will progress to a high grade cervical lesion.
Three feasible courses of action for ASCUS cytology can be done .1) Immediate colposcopic exam 2) Repeat PAP smear test in 3-4 months later if second exam is abnormal do colposcopy 3) Use HPV test and if positive , do colposcopic exam. An important issue is for not to delay in the diagnosis of high grade CIN or cervical cancer quick action has been preferred.
A colposcopic exam with a guided biopsy remains the gold standart diagnostic procedure among women with ASCUS for deciding which patients need treatment. The reason is that the final pathological outcomes revealed cervical squamous cell carcinoma 0-1 %,CIN 3 in %3 and CIN 2 in % 1-5 respectively in cases of women with PAP test ASCUS