The Outcome Comparison Of Pre-and Postmenopausal Women With A Cytologic Result Of ASCUS

Objects: Through this comparative retrospective analysis to find out thecharacteristics and outcomes of women who had a diagnosis of atypicalsquamous cells of undetermined significance (ASCUS) with the status ofmenopausal, meanwhile compare the results with premenopausal women whohad the same diagnosis.In order to give a better guideline to treatpostmenopausal with a cervical TCT (thinprep cytologic test) result ofASCUS more reasonably and more appropriatly.Materials and methods: This retrospective chart review study wascarried out at the second hospital of hebei medical university.59469womenwho came to clinic service and health examination center of the secondhospital of hebei medical university between March,2006to March,2010accepted TCT. with the evacuating of5unsatisfied smears cases,59464women were evaluated.Between August1,2009and December31,2009, the data of8544postmenopausal women who came to gynecology clinic of the SecondHospital of Hebei Medical University and had TCT results of ASCUS wereevaluated. Chose277women with a TCT result of ASCUS who came to theclinic service and health examination center of the second hospital of hebeimedical university during August2009to Decembei2009as the researchobjects. With the evacuated of8cases with a history of HRT or cervicalhigh-leveal lesion,the total number of research objects was269,includingpremenopausal women231cases and postmenopausal women38cases.Forwomen who accepted cytology follow-up per3~6months last for12months.For accepted colposcopy women,if the result is positive, biopsy by theguidance of colposcopy was assessed,and if the result is negative,cytologyfollow-up per3~6months and last for12months was assessed.during the period of cytology follow-up,if TCT test showed a result of ASCUS or morehigh-grade cytology abnormal, cervical biopsy under colposcopic guidancewas underwent.women who had accepted hormone replacement therapy (HRT)and had any history of high-level cervical lesions (≥CIN2) were excluded.Results:59469Women who came to clinic service and healthexamination center of the Second Hospital of Hebei Medical Universitybetween March,2006to March,2010accepted TCT. With the evacuating of5unsatisfied smears cases,59464women were evaluated.There were8544women accepted thin layer of liquid-based TCT duringthe five months from August2009to December2009in gynecology clinic andhealth examination center of the Second Hospital of Hebei MedicalUniversity.Among those women7109were premonopause with a percentage of84.21%and1435were at menopausal status with a percentage of16.79%.Total number of women with results of ASCUS was277,8of whomwere excluded because of hysterectomy and cervical high-level lesion(≥CIN2)history. The269women left for the study were devided into two groups:231women premenopausal group with a mean age of38.35years old,median age39years old and38women in postmenopausal group with a mean age of56.71years old,median age of57years old.In premenopausal group,there were160cases accepted cytologyfollow-up per3~6months till12months,among whom149cases hadn’tshown ASCUS or any abnormal TCT results higher than ASCUS,and11casesshowd higher abnormal results and underwent colposcopy. In addition to71women directly accepted colposcopy there were82cases undergoingColposcopy.30of them showed negative results,52of them received biopsyby the guidance of colposcopy.The histopathological results came out to be42cases of benign lesion(including Inflammatory, Atrophic change,polyps,and CIN1),and10cases of cervical hign-level lesion(≥CIN2). The rateis4.33%. Among the cervical high-level lesion cases,there were8cases ofCIN2~3,2of whom had HPV test showed high-risk HPV of type16 infection,8cases of squamous cell carcinoma,2of whom had HPV DNA teatand showed high-risk HPV of type16,52,58infection.In postmenopausal group,there were19cases accepted cytologyfollow-up per3~6months till12months,among whom16cases hadn’t shownASCUS or any abnormal TCT results higher than ASCUS,and3cases showdhigher abnormal results and underwent colposcopy. In addition to womendirectly accepted Colposcopy there were22cases undergoing Colposcopy,and12of them showed negative results,7of them received biopsy by the guidanceof colposcopy.The histopathological results came out to be5cases of benignlesion(including Inflammatory, Atrophic change, polyps,and CIN1),and2cases of cervical hign-level lesion(≥CIN2). The rate is5.26%. among thecervical high-level lesion cases,there was1case of cervical intraepithelialneoplasia who haven’t had the HPV DNA test,and1case of cervicaladenosquamous carcinoma who had high-risk HPV of type16and31infection.Conclusion:1.The rate of abnormal TCT results in postmenopausal women is higherthan that in premenosaul women. In those abnormal results,the diagnosis rateof reactive change and results higher than ASCUS and cervical carcinoma inpostmenopausal women is higher than that in premenosaul women;meanwhilethe rate of ASCUS in postmenopausal women is lower than that inpremenopausal women.So cervical disease screening of postmenopausalwomen is very important;2.The checking out rate of cervical high level lesion between pre-andpostmenopausal women who had a TCTresult of ASCUS has no significantdifferences,and the checking out rate of cervical carcinoma in women with acomeout of cervical high level lesion in postmenopausal women group ishigher than that in premenopausal women group.Thus those postmenopausalwomen who have a TCT result of ASCUS should be treat as the same aspremenopausal women;3.As to women with a TCT result of ASCUS,HPV DNA test should be the diffluence. If positive result is achieved,biopsy by the guidance ofcolposcopy should be assessed,and if negative result is achieved,cytologyfollow-up per3~6months and last for12months should be assessed.