Follow-up
Atypical Squamous Cells of Undetermined Significance
There are several management options for patients whose tests are classified as ASCUS. Some reports have indicated that there is a 10-40% rate of CIN found in patients with this report. Invasive cancer is very rare.
The 1991 Bethesda Conference recommended classifying ASCUS as “favor reactive” or “favor neoplasia.” The validity of this subclassification in predicting CIN by biopsy was subsequently confirmed. For those patients whose ASCUS test results favor a reactive process, the appropriate management is to repeat the Pap test in 4-6 months. If subsequent test results are abnormal, the patient should be scheduled for colposcopy. If there are three consecutive negative results within 2 years, the patient can be returned to routine screening.
A report of ASCUS in postmenopausal women not taking hormone replacement therapy may be due to atrophy, and a course of topical estrogen therapy may result in a normal report. If the Pap test is still equivocal after estrogen therapy, colposcopy should be considered. Colposcopy should be considered as initial evaluation for patients with ASCUS test results who previously have been treated for CIN, have a history of poor compliance to follow-up, or whose ASCUS Pap test result is qualified by a statement indicating that a neoplastic process is favored.
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Ideally the patient with an ASCUS test result would have an intermediate triage test that is less expensive than colposcopy and more reliable than repeat cytology to direct her further care. Human papillomavirus testing has been evaluated in several studies and shows a sensitivity for the detection of high-grade lesions between 74% and 93 %.
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