Clinical Characteristics of Atypical Squamous Cell of Undetermined Significance (ASCUS) and Low Grade Squamous Cell Intraepithelial Lesion (LSIL) Which Predispose Women to High Grade Squamous Cell Intraepithelial Lesion (HSIL) at Maharat Nakhon Ratchasima
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Abstract
Background: Cervical cancer is still the leading cancer in female Thai population. Pap smear is widely used as the screening test but managements of abnormal report such as atypical squamous cell of undetermined significance (ASCUS) and low grade squamous cell intraepithelial lesion (LSIL), are still varied and inaccurate. Some patients had been over or under treatment. Although HPV DNA testing has been widely used in developed countries to help in the management but its cost is inappropriate for most Thai people. Thus, the author would present the clinical data of the patients in both ASCUS and LSIL and compare variables that may help to predict high grade squamous cell intraepithelial lesion (HSIL). Objective: To identity clinical parameters of ASCUS and LSIL that might predict histologic HSIL. Patients & Methods: Historical cohort study was conducted at Department of Obstetrics and Gynecology, Maharat Nakhon Ratchasima Hospital. Two hundred and ninety-eight cases of either ASCUS or LSIL from March 2001 to December 2005 who underwent colposcopy and biopsies were included into the study. Treatment was depended on histologic finding and 2-year follow up with Pap smear was performed. Data were collected from medical records, reanalyzed and input into the computer software. Statistic analysis was done by standard software. Statistics were odds ratio, and Chi-square test. Results: One hundred and twenty cases of ASCUS were found to have > HSIL in 16 cases (13.3%). These were confirmed through pathologic reports. Their ages ranged from 29 to 66 years old. The variables were age, number of parity, the age of first intercourse, and the duration of having sexual intercourse. There was no statistic significant for all variables in this group. Of 178 cases of LSIL, 22 cases were proved to be HSIL through pathologic reports. The youngest age in this group was 22 years old. The only variable that was statistically significant was more than one partner (OR = 4.30 , 95% CI 1.54-12.1, P < 0.001). When combine number of sexual partner with other risk factors by logistic regression we found no statistically significant. However the study found that those patients who had single partner with fewer than 3 children did not experience any HSIL. Conclusion: The groups of ASCUS and LSIL were proved to be HSIL by pathologic examination in 13.3% and 12.4%, respectively. The youngest age of the former group was 29 years old and the latter group was 22 years old. In ASCUS group, there was no clinical characteristic that help to predict HSIL significantly. But having more than one partner increased the risk of HSIL in LSIL group with statistically significant (OR=4.30, 95% CI 1.54-12.1, P >0.001).
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