Clinicopathologic Significance And Treatment Of ASC-US In Cervical Cytology

In China,Cervical cancer is one of the most common gynecologic malignancies.Cervical cytology is an essential method for screening cervical cancer and precancerous lesions(CIN),and the most common cervical cytological abnormality in screening results is ASC-US(atypical squamous cells of undetermined significance).Due to the lack of doctors and the difference in the diagnostic level of Chinese cytology doctors,the final pathological results of ASC-US patients are very different from those of foreign countries.Thereby,the clinicians have different opinions on the treatment of ASC-US.In china how to effectively deal with ASC-US cytology has become the focus of scholars.Objective:We aim to analyze the final histopathological results,clinicopathological significance and current rationality of cervical cytology of ASC-US(Atypical squamous cells of undetermined significance)in the gynecological outpatient department of Qilu Hospital of Shandong University in recent years.Methods:All patients with first ASC-US cytological reports who attended our gynecological outpatient clinic in Qilu Hospital of Shandong University during January 2010 to December 2015 were recruited to this study.The data of women with ASC-US cytology diagnosis were derived from clinical records and evaluated retrospectively.The results of age,High-Risk HPV(DNA)testing,colposcopy and pathological outcomes were obtained.Directed biopsy was performed under colposcopy guide if there were any suspicious cervical lesions,while four quadrant biopsy and/or endocervical curettage(ECC)were performed if no suspicious lesions in colposcopies.Results:A total of 1246 patients diagnosed with a first ASC-US reports were involved in the final statistical analysis.Mean age of patients was 41.6 years and the age range between 40-49 years represented 38.52%of all ASC-US women in this study.All patients in our study were evaluated for HPV(DNA).Overall,positive percent for High-Risk HPV was(67.1%)and(32.8%)of the cases were negative tested for High-Risk HPV.According to the final histopathological outcomes after ASC-US cytology,31.5%of the total cases having CIN,included 15.9%low-grade CIN(CIN1),15.56%?CIN2+ and there were 1.1%cases had invasive carcinoma that determined by cervical biopsies.Patients with invasive carcinoma were associated with HPV16+and HPV18+.The detection rate of ? CIN2+among ASC-US/High-Risk HPV+group was(53.9%)with negative-predictive-value(NPV)of 100%.Our findings showed that the final pathological results of?CIN2+were consistent with colposcopy with a coincidence rate of(77%)and colposcopical impression sensitivity and specificity for?CIN2+was(91.1%and 96.1%)respectively.Conclusion:In our study we found that women with cervical cytology ASC-US have a wide range of final pathological results,and high-level CIN accounted for a large proportion.ASC-US can be the initial warning of high-grade CIN or cervical cancer.In China,HPV(DNA)testing triage is a useful shunting measure for ASC-US patients and an immediate colposcopy is a consequential strategy for dealing with ASC-US cytology as increase the detection rate of high-level cervical lesions or invasive cancer.